급성망막괴사에서 망막박리 발생의 위험인자

박성후,신민규,변익수,박현준,이지은,엄부섭,Sung Who Park,Min Kyu Shin,Ik Soo Byon,Huyn Jun Park,Ji Eun Lee,Boo Sup Oum 대한안과학회 2013 대한안과학회지 Vol.54 No.11

Purpose: Retinal detachment (RD) complicated in acute retinal necrosis (ARN) is difficult to be treated and a main cause of blindness. The factors associated with RD in ARN were investigated. Methods: Patients with ARN who were diagnosed and treated from Jan, 2008 to Dec, 2012 were reviewed retrospectively. The eyes were classified into the group I without RD, and the group II with RD. Early vitrectomy, history of ARN in the other eye, extent of necrosis, symptom duration and intravitreal injection of anti-viral drug were evaluated. Results: Of 22 eyes of 20 patients, 11 eyes were included in each group. Symptom duration of 8.0 days in the group I was shorter than 15.8 days in the group II (p = 0.005). There were no macular involvement at initial exam in the group I and 5 eyes (45%) in the group II (p = 0.017). Five eyes (45%) in the group I and 0 eye (0%) in the group II had history of ARN in the other eye (p = 0.017). Six eyes (55%) in the group I and 1 eye (9%) in the group II underwent early vitrectomy (p = 0.031). Age, baseline visual acuity, and intravitreal injection of antiviral agent were not related to RD (p = 0.294-0.699). Conclusions: Broader necrosis and longer symptoms duration were related to occurrence of RD. Correlation of Lower risk of RD with ARN history in the other eye would result from earlier diagnosis and treatment. Early vitrectomy seems to be effective to prevent RD in ARN. Korean Ophthalmol Soc 2013;54(11):1694-1699

눈물길우회술에 사용된 후 제거된 죤스관 배양검사 결과

박성후,박준모,이지은,이종수,Sung Who Park,Jun Mo Park,Ji-Eun Lee,Jong Soo Lee 대한안과학회 2006 대한안과학회지 Vol.47 No.5

Purpose: We evaluated cultured specimens from removed Jones tubes and their antibiotic sensitivities. Methods: In 16 patients who had received lacrimal bypass surgery to resolve nasolacrimal duct obstruction, the Jones tubes were removed due to either recurred symptoms, signs of chronic dacryocystitis, the tubes being obstructed, or migration of the tubes. Jones tubes were cultured to identify bacteria and tested for their antibiotic sensitivity. Results: The average duration from intubation to removal was 11.5 months. Nine cases showed the tube obstruction and six cases showed recurrent inflammation as the respective causes of tube removal. The species of cultured bacteria were Staphylococcus aureus in 9 cases, Pseudomonas in 4 cases, Streptococcus in 2 cases and coagulase negative Staphylococcus in 2 cases. In 1 case, both Staphylococcus aureus and Pseudomonas were cultured. In antibiotics sensitivity tests, 8 of 9 cases of Staphylococcus aureus were resistant to penicillin. The symptoms and signs of nasolacrimal duct obstruction were improved after the tube removal. Conclusions: When treating an obstruction of the lacrimal apparatus due to chronic dacryocystitis using lacrimal bypass surgery with Jones tubes, Staphylococcus aureus and Pseudomonas aeruginosa should be suspected as the main cause of inflammation of the nasolacrimal system or nasal cavity.

잠복외망막병증의 형태로 나타난 안매독

박성후,박종호,변익수,이지은,Sung Who Park,Jong Ho Park,Ik Soo Byon,Ji Eun Lee 대한안과학회 2014 대한안과학회지 Vol.55 No.5

Purpose: To report a case of ocular syphilis presenting as occult outer retinopathy. Case summary: A 42-year-old female presented with decreased visual acuity for one month in duration in the left eye. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and 20/250 in the left eye. There was no sign of inflammation in the anterior segment. Fundus examination showed no distinct abnormal findings including vitreous cell or haziness except mild diabetic retinopathy and subtle opacity of the macula. Spectral domain optical coherence tomography (OCT) showed a marked distortion of the inner segment-outer segment (IS-OS) junction in the photoreceptor layer without macular edema. Fluorescent angiography revealed diffuse subtle hyperfluorescence with microvasculitis in late phase. Full-field electroretinography (ERG) and multifocal ERG showed decreased amplitude; thus, acute zonal occult outer retinopathy (AZOOR) was considered as the diagnosis. Laboratory work-ups before steroid therapy revealed positive serology for active syphilis. One month after treatment with penicillin G (6 million international units per day for 14 days), best-corrected VA improved to 20/30, and restoration of the IS-OS junction was observed on OCT. Conclusions: Ocular syphilis may present as occult outer retinopathy resembling AZOOR, and serologic work-up is required to avoid misdiagnosis. In the present case, anatomical and functional recovery were obtained after antibiotic therapy. J Korean Ophthalmol Soc 2014;55(5):785-788

미숙아망막병증 검사시의 벨 현상과 결막손상의 상관관계

박성후,이지은,최희영,엄부섭.Sung Who Park. M.D.. Ji Eun Lee. M.D.. Hee Young Choi. M.D.. Boo Sup Oum. M.D. 대한안과학회 2007 대한안과학회지 Vol.48 No.12

Purpose: Bell`s phenomenon (BP) was known not to be common in premature babies. If manifested, it may be detected on screening examinations for retinopathy of prematurity (ROP), indicating that conjunctival injury may have occurred. We studied correlations with BP and conjunctival injuries. Methods: Ninety-two eyes of 46 premature babies, ranging from 36 to 38 weeks of gestational age, underwent screening examination for ROP. Rotation of the eyeball was evaluated with an inserted speculum. After observing temporal and nasal ora serrata with indentation, conjunctiva was examined for any possible damage. Results: BP was observed in 50 of 92 subjects (54%). Notable conjunctival hemorrhage was found in 7 of 50 eyes (14%) with BP and in 2 of 42 eyes (5%) without BP. Stronger BP is correlated with severe injury to the conjunctiva (p<0.001). Conclusions: Bell`s phenomenon (BP) may manifest in screening examinations for ROP. Manifestations of BP are related to conjunctival injury.

익상편 수술 후 발생한 메티실린 저항 황색 포도상구균

박성후,이민호,이지은,이종수,Sung Who Park,M,D,Min Ho Lee,M,D,Ji Eun Lee,M,D,Jong Soo Lee,M,D 대한안과학회 2007 대한안과학회지 Vol.48 No.1

Purpose: To report a case, which developed after pterygium excision, of methicillin-resistant Staphylococcus aureus (MRSA) scleritis, for which the patient was treated with antibiotics, debridement, and a scleral graft. Methods: During the application of topical and systemic steroid, because of necrotizing scleritis after pterygium excision, infectious signs were noted. Although the empirical antibiotic treatment with amikacin and ceftazidime was used topically and systemically, no improvement was observed. MRSA was identified by scleral culture, and topical and systemic vancomycin were applied. Results: By one week after beginning vancomycin therapy, the lesion had improved. Over the next seven days, scleral inflammation diminished, and infectious signs regressed. Surgery adding a scleral patch graft and sliding conjunctival flap was performed, and no complications or recurrences were found until eight months postoperatively. Conclusions: In cases of necrotizing scleritis treated with steroid, it should be carefully observed whether there is combined infectious scleritis. If infectious scleritis is resistant to empirical antibiotics, then it should be considered that MRSA can be etiological agent.

접촉 맥락막박리와 장액망막박리를 동반한 감염공막염

김성준(Sung Joon Kim),김소희(So Hee Kim),최윤아(Youna Choi),최승권(Seung Kwon Choi),박성후(Sung Who Park),변익수(Ik Soo Byon),이재정(Jae Jung Lee) 대한안과학회 2021 대한안과학회지 Vol.62 No.3

목적: 접촉 맥락막박리와 장액망막박리를 동반한 감염공막염을 경험하였기에 이를 보고하고자 한다. 증례요약: 65세 여자가 1주 전부터 발생한 우안 충혈과 통증으로 내원하였다. 전방염증이 관찰되었고, 이전 익상편수술로 인한 공막얇아짐 및 괴사 주위 결막 소실이 관찰되었다. 괴사성 공막염과 앞포도막염 진단하에 스테로이드 점안 및 복용을 시작하였다. 1주 후 공막부종, 충혈 증가와 맥락막박리가 관찰되었고, 감염공막염 의심하에 익상편수술 부위 배양검사 및 점안 항생제 치료를 시작하였으나 맥락막박리 진행과 장액망막박리가 악화되는 소견이 보였다. 배양검사에서 녹농균이 동정되어 piperacillin/tazobactam 점안항생제 및 cefepime 2 g을 정맥주사하였으나, 악화 양상을 보여 점안 항생제 침투를 높이기 위해 괴사조직제거술을 시행하였다. 이틀 후 감염이 조절되는 것으로 판단되어 전신 스테로이드를 추가하였고, 이후 호전 경과를 보였다. 결론: 심한 맥락막박리와 장액망막박리를 동반한 감염공막염에서 적절한 항생제 치료에 불응하는 경우 괴사조직제거 병합이 도움이 될 수 있으며, 감염 조절 후 전신 스테로이드 치료가 좋은 결과를 보였다. Purpose: We report a case of infectious scleritis featuring kissing choroidal detachment and serous retinal detachment. Case summary: A 65-year-old female presented with ocular pain and hyperemia of the right eye 1 week in duration. Anterior chamber inflammation was evident. After pterygium excision, a thinned sclera and loss of conjunctiva around a necrotic lesion were observed. Necrotizing scleritis with anterior uveitis was diagnosed and topical and systemic steroids commenced. After 1 week, the scleral thickness increased, but conjunctival injection and choroidal detachment were newly noticed. Infectious scleritis was suspected and the pterygium excision site cultured. Although empirical antibiotics (fortified ceftazidime and tobramycin) were prescribed, the choroidal and serous retinal detachments became aggravated. Pseudomonas aeruginosa was identified on scleral culture, and topical piperacillin/tazobactam and systemic cefepime (2 g) commenced. Although the antibiotics were appropriate, the choroidal and serous retinal detachments became further aggravated. Necrotic tissue was subjected to surgical debridement. Two days later, the infectious signs had diminished and a systemic steroid was added. Over the next few weeks, all of the choroidal and serous retinal detachments, and the infectious signs, improved. Conclusions: Patients with infectious scleritis featuring severe choroidal detachment and serous retinal detachment resistant to appropriate antibiotics may require surgical debridement of necrotic tissue. After controlling the infectious signs, systemic steroids should be considered to ensure a good prognosis.

고도근시안의 황반원공 망막박리에서 내경계막판술 후 잔존한 망막하액 1예

김성준(Sung Joon Kim),이재정(Jae Jung Lee),변익수(Ik Soo Byon),이지은(Ji Eun Lee),박성후(Sung Who Park) 대한안과학회 2021 대한안과학회지 Vol.62 No.12

목적: 고도근시안의 황반원공 망막박리에서 내경계막판술 후 장기간 망막하액이 잔존하면서 불량한 시력 결과를 보이는 증례를 보고하고자 한다. 증례요약: 55세 남자가 한 달 전부터 발생한 우안 중심부 시야장애를 주소로 내원하였다. 우안 최대교정시력 0.32, 안축장 32.57 mm 였다. 안저검사에서 황반원공과 함께 후극부에 국한된 망막박리를 확인하였다. 유리체절제술, 망막앞막제거술, 내경계막제거술 및 뒤집힌 내경계막판술을 시행하고 유리체강을 실리콘기름으로 충전하였다. 수술 1일째 황반원공은 폐쇄되었으나 망막하액은 이후 14개월간 지속되었다. 수술 3개월째 시력은 0.16이었고, 실리콘기름을 제거하였다. 첫 수술 14개월 후 망막하액이 흡수되었고, 황반부에표범무늬변성이 뚜렷해지고, 타원체구역의 소실이 관찰되었고, 시력은 0.1로 감소하였다. 결론: 고도근시안의 황반원공 망막박리에서 뒤집힌 내경계막판술은 원공폐쇄율을 높이나 망막하액의 배출을 방해할 수 있다. 오래지속된 망막하액은 불량한 시력예후를 야기하는 망막의 영구적 손상과 연관되어 있을 수 있음을 고려하여 수술 방법을 결정하여야한다. Purpose: To report a case of poor visual prognosis complicated by residual subretinal fluid after use of the internal limiting membrane flap technique to treat macular hole retinal detachment in a patient with high myopia. Case summary: A 55-year-old male stated that he had experienced a transparent circle in the central visual field of the right eye for 1 month. His best-corrected visual acuity (BCVA) was 0.32 and the axial length of the right eye was 32.57 mm. Fundus examination revealed a macular hole with retinal detachment localized to the posterior pole. We performed vitrectomy, membrane peeling, internal limiting membrane peeling with inverted internal limiting membrane flap, and silicone oil injection. On day 1 after surgery, the macular hole was closed, but subretinal fluid was noticed in the macula. At 3 months after surgery, the BCVA was 0.16 and the silicone oil was removed. At 14 months after the first surgery, the subretinal fluid was completely absorbed, but leopard-pattern pigment degeneration became prominent and the macula exhibited ellipsoid zone disruption. The BCVA decreased to 0.1. Conclusions: In patients exhibiting macular hole retinal detachment in the context of high myopia, an inverted internal limiting membrane flap may increase the macular hole closure rate but disturb subretinal fluid drainage. As persistent subretinal fluid may cause permanent retinal damage with a poor visual prognosis, the surgical method must be carefully chosen.

급격히 진행된 비전형 급성 대상외망막염

김성준(Sung Joon Kim),전혜신(Hyeshin Jeon),변익수(Ik Soo Byon),이지은(Ji Eun Lee),박성후(Sung Who Park) 대한안과학회 2021 대한안과학회지 Vol.62 No.8

목적: 건강한 젊은 여성에서 나타난 급격한 진행을 보이는 단안 비전형 급성 대상외망막염을 보고하고자 한다. 증례요약: 특이 병력이 없는 32세 여자가 일주일 전 시작된 좌안의 시력저하로 내원하였다. 좌안 시력은 0.4였고 뇌자기공명영상, 혈액검사에서 특이 소견은 없었다. 안저검사에서 좌안 시신경유두 주변으로 고리 형태의 망막혼탁이 관찰되고, 빛간섭단층촬영에서 해당 부위의 외망막층의 손상, 시야검사에서 해당 부위의 시야 소실이 관찰되었다. 형광안저혈관조영 및 인도사이아닌그린 혈관조영을 시행한 후 소실다발흰점증후군으로 추정하고 프레드니솔론 복용을 시작하였다. 10일 후 시력이 안전 수동으로 감소하였고 고리 형태의 망막혼탁이 주변부로 확장된 소견이 관찰되었다. 3일간 고용량 스테로이드 정맥주사를 시행하였으나 호전이 없었고, 전방수를 이용한 중합효소연쇄반응에서 바이러스는 검출되지 않았고 항바이러스제에도 반응하지 않았다. 결론: 시신경유두 주변에서 시작된 외망막염이 빠른 속도로 진행하였고 시력이 소실되었다. 후극부에서 시작된 외망막염이 주변부 망막까지 급격히 진행하였다는 점에서 기존 보고들과 차이가 있다. 비전형 급성 대상외망막염으로 진단하고 이를 보고하고자 한다. Purpose: To report a case of unilateral progressive atypical acute zonal outer retinitis in a healthy young female. Case summary: A 32-year-old healthy woman presented with visual disturbance in the left eye for 1 week. Best corrected visual acuity was 0.4 in the left eye. No abnormal findings were detected on brain magnetic resonance imaging and a laboratory work-up. Zonal retinal opacity around the optic nerve disc was noticed in a fundus photo which was consistent with the outer retinal signal defect on optical coherence tomography and a defect in the central visual field from perimetry. Multiple evanescent white dot syndrome was suspected based on fluorescein angiography and indocyanine green angiography. Prednisolone was prescribed. Visual acuity was reduced to hand-motion after 10 days with extended zonal retinal opacity. No virus was detected by multiplex polymerase chain reaction of the aqueous humor. The lesion did not improve despite high-dose intravenous steroid and antiviral treatment. Conclusions: Visual function was lost with the progression of outer retinitis. This case differed from previous cases as the outer retinitis progressed rapidly from the posterior pole to the peripheral retina. It was named fulminant progressive atypical acute zonal outer retinitis.

유리체절제술과 내경계막제거술 후 9개월에 지연 폐쇄된 특발성 황반원공 1예

이종헌,김호윤,박성후,이지은,변익수,Jong Heon Lee,Ho Yun Kim,Sung Who Park,Ji Eun Lee,Ik Soo Byon 대한안과학회 2014 대한안과학회지 Vol.55 No.5

Purpose: To report a case of delayed idiopathic macular hole closure after vitrectomy, internal limiting membrane peeling, and gas tamponade. Case summary: A 69-year-old female complained of visual disturbance in her left eye. At presentation, her visual acuity was 20/100 in the left eye. Fundus examination and optical coherence tomography revealed a full-thickness macular hole 489 μm in diameter as well as posterior vitreous detachment. Hence, vitrectomy, concurrent cataract surgery, internal limiting membrane peeling and gas tamponade were performed. One month postoperatively, the hole remained unclosed, although decreased in size to 378 μm. At 2 months, cystoid macular edema developed and postoperatively the hole diameter decreased gradually to 311 μm, 252 μm and 156 μm at 2, 3, and 5 months, respectively. Finally, the hole was closed upon the resolution of macular edema at 9 months. However, the visual acuity of 20/100 remained unchanged. Conclusions: Delayed closure of holes which may be related to cystoid macular edema, can develop after macular hole surgery. J Korean Ophthalmol Soc 2014;55(5):775-779

녹내장 여과수술에서의 마이토마이신 결막하 주사 시기에 따른 여과포 형성의 실험적 연구

정원선,제승연,박성후,김진영,이상협,Weon Seon Jung,Seung Youn Jea,Sung Who Park,Jin Young Kim,Sang Hyup Lee 대한안과학회 2006 대한안과학회지 Vol.47 No.5

Purpose: To investigate the effects of varying the time of Mitomycin-C (MMC) subconjunctival injection before, during and after operation. Method: We divided rabbits into 3 groups according to injection time. Subconjunctival injections of 0.01% MMC 0.05 ml were given to the preoperative group at 6, 12 and 24 hours before operation, and to the postoperative group at 6, 12 and 24 hours after operation. The control group was given the injections during operation. Bleb formation and histologic analyses were studied for 4 weeks after operation. Results: For gross findings, the blebs of the preoperative and control groups were seen on the fourth day and completely formed at one week after operation, and were larger than those of the postoperative group. On the other hand, the blebs of the postoperative group were seen to have poor formation, displaying hypervascularity on the fourth day and disappearing one week after operation. For histologic findings, the proliferation of collagen fibers and the undifferentiation of fibroblasts observed in the preoperative and control groups were almost identical. But, the proliferation of collagen fibers and well-differentiated fibroblasts were seen to increase in the postoperative group, so aqueous flow was obstructed at week 3. Conclusions: Subconjunctival injections within 24 hours before or during glaucoma filtration surgery were better for bleb formation and preservation than those administerd after surgery.