변성근시에 동반된 맥락막혈관신생에 대한 유리체강내 베바시주맙 주입술의 단기효과

류정완,조현경,이원기 대한안과학회 2009 대한안과학회지 Vol.50 No.9

목적: 변성근시에 동반된 맥락막혈관신생에서 유리체강내 bevacizumab 주입술의 단기결과를 알아보았다. 대상과 방법: 15명, 15안을 대상으로 bevacizumab 주사를 1회 또는 연속된 2회를 시행하였다. 치료 전, 후 한 달 간격으로 교정시력과 안저검사를 시행했고, 형광안저혈관조영은 치료 전과 치료 후 1개월, 3개월째 시행하였다. 1차 주사 후 1개월째 형광누출이 지속된 경우 2차 주사를 시행했다. 결과: 평균 경과관찰은 9.7개월이었고, logMAR 교정시력은 치료 전 0.81±0.44, 3개월째 0.64±0.41 (p=0.005), 최종 경과관찰 시 0.60±0.41 (p=0.001)이었다. 5안은 1회, 10안은 2회의 연속된 주사를 시행하였다. 1차 주사 후 3개월째 14안(93.3%)에서 형광누출이 소실되었고, 1안(6.7%)은 누출이 감소하였다. 치료 후 3개월과 최종 경과관찰에서 각각 1.7줄과 2.1줄의 시력호전을 보였고, 경과관찰 중 시력이 감소한 경우는 없었다. 결론: 1회 또는 연속된 2회의 유리체강내 bevacizumab 주사는 혈관신생과 연관된 변성근시에서 단기적인 시력의 안정화와 맥락막혈관신생의 퇴행에 효과적이다. Purpose: To investigate the short-term effect of intravitreal bevacizumab injection for choroidal neovascularization associated with degenerative myopia. Methods: In 15 eyes of 15 patients, one or two consecutive intravitreal bevacizumab injections were given. The best-corrected visual acuity (BCVA) and fundus examination were evaluated at baseline and monthly thereafter. Fluorescence angiography (FA) was performed at baseline, 1 month and 3 months after treatment. When the angiographic leakage persisted 1 month after the first injection, a second injection was administered. Results: The mean follow-up period was 9.7 months. The mean logarithm of the minimum angle of resolution (LogMAR) BCVA was 0.81±0.44 at baseline, 0.64±0.41 at 3 months (p=0.005), and 0.60±0.41 (p=0.001) at the final examination. Five eyes received a single injection, while the other ten eyes had two consecutive injections. Three months after the first injection, 14 eyes (93.3%) had no angiographic leakage, and 1 eye (6.7%) showed a decrease in leakage. The mean lines of visual improvement at 3 months and at the final examination were 1.7 and 2.1 lines, respectively. No case of vision loss was observed throughout the follow-up period. Conclusions: One or two consecutive intravitreal bevacizumab injections had favorable short-term effects on visual acuity stabilization and the regression of choroidal neovascularization associated with neovascular degenerative myopia.

큰 망막색소상피 박리를 동반한 맥락막혈관신생에서의 복합치료

류정완,정재훈,이원기 대한안과학회 2009 대한안과학회지 Vol.50 No.6

Purpose: To evaluate the efficacy of the combination therapy of intravitreal bevacizumab injection and photodynamic therapy in neovascular age-related macular degeneration associated with large retinal pigment epithelial detachment. Methods: A total of 13 eyes were reviewed, with 9 eyes diagnosed with definite choroidal neovascularization (CNV) and 4 eyes diagnosed with CNV or polypoidal choroidal vasculopathy (PCV) becausethe exact type could not be determined. Photodynamic therapy was performed within 1 week after bevacizumab injection according to indocyanine green angiography (ICGA). Additional bevacizumab injections were performed within a 4 to 6 week interval. Additional photodynamic therapy was performed within 4 months. Results: The visual acuity on final examination had improved in 3 eyes (23.1%), was maintained in 7 eyes (53.8%), and decreased in 3 eyes (23.1%). The change of the PED before and after treatment showed regression in 5 eyes (38.5%), recurrence after regression in 2 eyes (15.4%), persistence in 4 eyes (30.8%), and retinal pigment epithelial tear in 2 eyes (15.4%). The maintained or improved visual acuity rate was 66.7% (6/9) and 100% (4/4) in the CNV and CNV or PCV group, respectively. Conclusions: The combination therapy in neovascular age-related macular degenerationassociated with large retinal pigment epithelial detachment is a viable alternative treatment in the stabilization and improvement of vision. However, further studies with long-term follow up and controlled studies with anti-vascular endothelial growth factor antibody monotherapy are required. 목적: 큰 망막색소상피박리(PED)를 동반한 신생혈관 나이관련황반변성에서 유리체강내 bevacizumab 주사와 광역학요법(PDT)의 복 합치료 효과를 알아보았다. 대상과 방법: 맥락막혈관신생으로 진단된 9안, 맥락막혈관신생과 결절맥락막혈관병증 사이에 진단이 모호한 4안, 총 13안을 대상으로 하였다. Bevacizumab 주사 후 1주일 이내에 인도시아닌형광안저혈관조영에 따른 PDT를 시행하였다. 추가적인 주사는 4~6주, 추가적인 PDT는 늦어도 4개월 간격으로 시행하였다. 결과: 최종 검사 때 시력변화는 호전 3안(23.1%), 유지 7안(53.8%), 악화 3안(23.1%)이었다. PED의 변화는 소실 5안(38.5%), 소실 후 재발 2안(15.4%), 지속 4안(30.8%), 망막색소상피 파열이 2안(15.4%)이었다. 맥락막혈관신생 군은 66.7%(6/9), 진단이 모호한 군은 100% (4/4)에서 시력이 유지되거나 향상되었다. 결론: 큰 망막색소상피박리를 동반한 신생혈관 나이관련황반변성에서 복합치료는 시력유지 및 호전을 기대할 수 있는 선택적인 치료 방법이다. 추후 장기간의 관찰과 항 혈관내피성장인자 항체의 단일치료와 대조연구가 필요하다.

망막하신생혈관이 동반된 양측 후천성 중심와부근 모세혈관 확장증에서의 복합치료 1예

류정완,이원기,김재련 대한안과학회 2009 대한안과학회지 Vol.50 No.9

Purpose: To evaluate the clinical results of a case of subretinal neovascularization (SRN) in bilateral acquired parafoveal telangiectasis, performed combination therapy of intravitreal bevacizumab (1.25 mg/0.05ml) and photodynamic therapy (PDT). Case summary: A 46-year-old female presented with a decrease invisual acuity. Her best-corrected visual acuity (BCVA) was 1.0 in the right eye and 0.1 in the left eye. On ophthalmic examination, she was diagnosed with bilateral acquired parafoveal telangiectasis combined with SRN in the left eye. Intravitreal bevacizumab was injected, and then photodynamic therapy was performed 4 days later. Three months after the combination therapy, her BCVA improved to 0.5, a regression of SRN was observed and vascular leakage was markedly decreased. However, her BCVA decreased to 0.1 and SRN recurred 9 months later. Conclusions: The combined treatment of intravitreal bevacizumab and photodynamic therapy may be used as a selective alternative treatment modality for SRN in bilateral acquired parafoveal telangiectasis, although its effect is short-term. 목적: 망막하신생혈관을 동반한 양측 후천성 중심와부근 모세혈관 확장증에서 유리체강 내 bevacizumab (1.25 mg/0.05 ml)과 광역학 요법(PDT)의 복합치료를 시행한 1예의 임상결과를 알아보았다. 증례요약: 46세 여자가 좌안의 시력감소를 주소로 내원하였다. 교정시력은 우안 1.0, 좌안 0.1이었다. 안과검사상 좌안에 망막하신생혈 관을 동반한 양측 후천성 중심와부근 모세혈관 확장증으로 진단되었고, 유리체강내 bevacizumab 주사 후 4일째 PDT를 시행하였다. 복합치료 후 3개월째 시력이 0.5로 향상되었고, 망막하신생혈관의 퇴행 및 형광누출의 현저한 감소가 관찰되었다. 그러나 9개월째 시력이 0.1로 감소하였고 망막하신생혈관이 재발되었다. 결론: 유리체강내 bevacizumab과 PDT의 복합치료는 망막하신생혈관이 동반된 양측 후천성 중심와부근 모세혈관확장증의 치료에 단기 적이지만 하나의 선택적인 치료방법으로 이용될 수 있다.

비특이성안와염 환자에서 적외선 체열 촬영 검사의 결과

류정완,백지선,황호식,양석우,Jeong Wan Ryu,Ji Sun Paik,Ho Sik Hwang,Suk Woo Yang 대한안과학회 2012 대한안과학회지 Vol.53 No.12

Purpose: The present study assessed the diagnostic significance of digital infrared thermal imaging (DITI) in determining the inflammatory state of patients with nonspecific orbital inflammation. Methods: The present study included 11 patients diagnosed with nonspecific orbital inflammation between December 2009 and March 2011 and who were followed-up for more than 6 months. All patients were all diagnosed based on computed tomography (CT), magnetic resonance image (MRI) and tissue biopsy. The grade of eyelid swelling was classified as 5 and severe compared with the temperature of location. The temperature of the upper eyelid, caruncle, medial conjunctiva, lateral conjunctiva, lower eyelid, cornea and lateral orbit were measured with DITI. Results: When comparing the normal eye with the diseased eye in patients with nonspecific orbital inflammation, the temperature of the upper eyelid and cornea were statistically significant (p = 0.003, p = 0.038, respectively, Mann-Whitney test). The correlation between the grade of eyelid swelling and the temperature of location was most highly related in the temperature of the upper eyelid (Spearman’s correlation coefficient, r = 0.55, p = 0.008) and cornea (Spearman’s correlation coefficient, r = 0.45, p = 0.037). Conclusions: DITI may aid in evaluating the inflammatory state of nonspecific orbital inflammation. In particular, the temperature of the upper eyelid and cornea can be very useful indicator. Future studies, including larger study population are necessary in order to confirm DITI as a diagnostic tool which can assess the results of medical treatment by comparing temperature before and after treatment.

레이저각막상피절삭가공성형술 후 발생한 내사시 1예

류정완,이영춘,이세엽,Jung-Wan Ryu,Young-Chun Lee,Se-Youp Lee 대한안과학회 2005 대한안과학회지 Vol.46 No.8

Purpose: To report a 38-year-old woman who showed esotropia and diplopia after LASEK surgery. Methods: A 38-year-old mildly myopic woman, who didn`t ordinarily need glasses or contact lenses, visited our clinic complaining of sudden onset of esotropia and diplopia following LASEK. Although she had had rarely intermittent esotropia in the past, her orthophoria had been maintained usually. The refractive error, -2.00 Dsph=-0.75 Dcyl×172 A in the right eye and -2.50 Dsph=-0.75 Dcyl×27 A in the left eye before LASEK. was improved to -0.50 Dsph -0.25 Dcyl×48 A in the right eye and -0.25 Dsph in the left eye after LASEK. However, she showed acute esotropia of 40 prism diopters (PD) at near and 30 PD at distance and diplopia. The Worth 4 dot test and Bagolini striated lens test indicated left suppression. In the Titmus stereo test, she exhibited loss of stereoacuity. Results: Her esotropia persisted for two months after first visiting our clinic, so we performed surgery of unilateral lateral rectus muscle resection and medial rectus muscle recession. After strabismus surgery, she showed orthophoria and the diplopia disappeared, while fusion and stereoacuity were regained. Conclusions: The clinical course of this patient suggested that recovery of accommodative need convert esophoria to esotropia. Therefore we recommend meticulous preoperative evaluation of strabismus in all candidates for refractive surgery.

25 프리즘디옵터 미만의 외편위 환자에서 한눈 외직근후전술 후 수술량에 따른 결과분석

류정완,이세엽,이영춘,Jung Wan Ryu,Se Youp Lee,Young Chun Lee 대한안과학회 2006 대한안과학회지 Vol.47 No.4

황반부 장액성망막박리가 동반된 시신경유두소와의 수술적 치료 1예

류정완,나호,이원기,Jung-Wan Ryu,Ho Ra,Won-Ki Lee 대한안과학회 2010 대한안과학회지 Vol.51 No.1

Purpose: To report the clinical results of a planned vitrectomy, laser photocoagulation and gas tamponade for the treatment of serous macular detachment associated with optic disc pit. However, laser photocoagulation was performed on a postoperative outpatient basis for subretinal fluid. Case summary: A 13-year-old women presented with central visual disturbance in the left eye. Her best-corrected visual acuity (BCVA) was 0.16. On ophthalmic examination, the patient was diagnosed with optic disc pit combined with serous macular detachment. After 3 months, the serous macular detachment increased and visual acuity decreased to 0.1. Pars plana vitrectomy combined with complete posterior vitreous detachment was performed. After intravitreal injection of perfluorodecalin, internal drainage of the subretinal fluid using the back flush needle around the optic disc pit was performed, but the fluid was not drained. The planned intraoperative photocoagulation was not performed due to a large serous macular detachment. Gas tamponade was performed and a facedown position was maintained for 1 week followed by laser photocoagulation. The subretinal fluid was completely absorbed and visual acuity was improved. In addition, recurrence was not observed throughout the follow-up period. J Korean Ophthalmol Soc 2010;51(1):155-158

전신마취하 사시수술 후 안구위치 변화

류정완,이세엽,이영춘 대한안과학회 2006 대한안과학회지 Vol.47 No.11

Purpose: We studied change of eye position according to surgical amount with strabismus surgery under general anesthesia. Methods: The 101 horizontal strabismus patients were classified into 5 groups and analyzed according to strabismus type, surgical method, and surgical amount. Group I had less than 7 mm recession in exotropia;, group II, was more than 7 mm recession in exotropia;, group III, was recession and resection in exotropia;, group IV, was less than 5.5 mm recession in esotropia;, group V, was more than 5.5 mm recession in esotropia. We measured eye position, corneal reflex and medial limbus by photographic measurement taken at a distance of 40 cm form the patient in the supine position. Results: The mean amount of convergence in exotropia group I was 8.93±2.21PD, exotropia group II was 9.64±3.50PD, exotropia group III was 10.77±4.11PD. The mean amount of divergence of esotropia group IV was 6.62±2.10PD, esotropia group V was 7.88±2.90PD. The exotropia and esotropia groups were not statistically different from each other (P>0.05). The correlation coefficient according to surgical amount was 0.18 in exotropia groups, 0.01 in esotropia groups. Conclusions: The change of eye position according to surgical amount showed a weak positive correlation in exotropia groups, but showed no correlation in esotropia groups. Postoperative mean change in eye position was distributed from 9.26PD to 10.90PD in the exotropia group, from 6.10PD to 7.83PD in the esotropia group with 95% confidence interval and was difficult to expect overcorrection and undercorrection after awaking from anesthesia.

당뇨환자에서 백내장 수술 후 각막지각과 눈물의 안정성 변화

류정완,이영춘,김현승 대한안과학회 2006 대한안과학회지 Vol.47 No.11

Purpose: To evaluate the change of corneal sensitivity and tear film stability before and after cataract surgery using a temporal clear corneal incision in diabetic patients. Methods: This study included 16 eyes of 16 patients in the diabetic group and 20 eyes of 20 patients in the control group. All patients had phacoemulsification with 3 mm temporal clear corneal incision. All patients were examined for the corneal sensitivity, Schirmer test, tear break-up time, fluorescein staining for ocular surface, and ocular irritation symptom. All values were compared before and after surgery (1, 7, 30, 60, and 90 days). Results: Before surgery, the Schirmer test and tear break-up time were lower in the diabetic group than the normal group, but the difference was not statistically significant. The values of the Schirmer test tended to temporarily increase after surgery and then decrease. The tear break-up time decreased more in the diabetic group than the normal group until postoperative day 7 (P

역기하렌즈 착용 후 시력, 굴절이상 그리고 각막 난시의 상관성 분석

최정훈,류정완,이영춘,김현승,Jeong Hoon Choi,Jeong Wan Ryu,M,D,Young Chun Lee,M,D,Hyun Seung Kim,M,D 대한안과학회 2006 대한안과학회지 Vol.47 No.8

Purpose: To evaluate correlations with refractive error, astigmatism and uncorrected visual acuity after Ortho-K LKTM lens wear. Methods: Sixty-one eyes of 32 patients who had been wearing reverse geometry lenses for over 5 weeks were recruited. Uncorrected visual acuity, subjective refraction on retinoscopy, objective refraction measured by an autorefractometer, and corneal astigmatism were measured by corneal topography before, at 2 days, and 1, 3, and 5 weeks after lenses fitting. Results: Uncorrected visual acuity improved from 0.12±0.10 to 0.95±0.15 after 5 weeks. Subjective refraction on retinoscopy and objective refraction measures with the autorefractometer were -3.52±1.65D and -4.06±1.73D, respectively before wearing the lenses. These decreased to -0.08±0.40D and -1.98±2.04D, respectively after 5 weeks. The astigmatism detected by corneal topography improved from 0.93±0.49 to 1.20±1.03 after 5 weeks. Uncorrected visual acuity was correlated with the refractive error measured by subjective refraction with retinoscopy rather than that by objective refraction with the autorefractometer. Corneal astigmatism measured by corneal topography correlated with the refraction detected by the autorefractometer. Conclusions: Subjective refraction by retinoscopy rather than refraction found objectively using the autorefractometer, was highly correlated with uncorrected visual acuity (r=0.77~0.87) which seems to be useful in evaluating myopia patients. The astigmatism determined by autorefractometer examination had high correlation with that determined by corneal topography (r=0.51~0.76). This result appears useful in decisions related to the decentering of lenses.