헤르페스 각막염 치료 중 발생한 홍채 후면 칸디다 진균구

방슬기(Seul Ki Bang),강민석(Min Seok Kang),김태기(Tae Gi Kim),진경현(Kyung Hyun Jin) 대한검안학회 2018 Annals of optometry and contact lens Vol.17 No.2

Purpose: To report a case of fungal infection in posterior iris during medical and surgical management of herpetic keratitis. Case summary: A 44-year-old women diagnosed with a dilated cardiomyopathy was presented with decreased visual acuity in the left eye. Best corrected visual acuity was 0.05 in the left eye and slit-lamp examination revealed peripheral ulcerative dendritic keratitis with stromal infiltration. The anti-viral agents and steroid eye drops were initiated under impression of herpetic keratitis and corneal endothelitis. The inflammatory reactions in anterior chamber were increased and the thinning of ulcerative lesion was aggravated at 6 months after treatment. The amniotic membrane transplantation (AMT) was done in the left eye. Despite the continuous medical management, ulcerative thinning readily progressed and the hypopyon in anterior chamber with anterior protrusion of iris in inferonasal portion was observed at 3 months after AMT. The corneal perforation occurred during secondary AMT and iris exposure was observed as perforated region enlarged. The primary closure with conjunctival flap was performed and the penetrating keratoplasty (PKP) was done at 3 days later. The whitish abscess pocket with 1 to 2 mm diameter was found in the posterior portion of protruded iris and the fungal keratitis was confirmed following biopsy. The intravitreal amphotericin B injection was done and fortified voriconazole eye drops were maintained for 4 months after PKP. Both anterior and posterior segment showed no inflammatory reaction and recurrence for 20 months follow-up period after PKP. Conclusions: Infective keratitis that do not respond to treatment after long-term use of anti-viral agents and steroids in immune-suppressed patients may also be accompanied by fungal infection and abscess in posterior iris.

양안 시력 저하를 보인 가역적 후두부 뇌병증 증후군 1예

강민석(Min Seok Kang),방슬기(Seul Ki Bang),김태기(Tae Gi Kim),진경현(Kyung Hyun Jin) 대한안과학회 2016 대한안과학회지 Vol.57 No.9

목적: 양안에서 발생한 피질 시각 장애가 경과 관찰 후 완전히 회복된 가역적 후두부 뇌병증 증후군의 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 46세 여자 환자가 당일 시작된 갑작스런 양안 시력 저하를 주소로 내원하였다. 환자는 10일 전 월경과다 및 자궁 탈출증으로 인한 빈혈로 보존적 치료를 받았고, 2일 전 자궁근종 절제술 시행 후 과다 출혈 및 빈혈 소견이 보여 수혈을 다시 받은 후에 갑자기 뿌옇게 보이는 증상을 호소하였다. 내원 당시 양안 최대교정시력은 모두 안전수동 10 cm였고, 양안 모두 동공의 대광반사는 정상이었으며 안저 검사상 좌안 이측에 일부 미세한 점출혈 소견 외에는 특이소견은 관찰되지 않았다. 빛간섭단층촬영 검사에서도 양안 모두 이상 소견은 없었다. 그러나 섬광 시유발전위 검사상 양안 모두 P100 진폭의 명백한 감소를 보였다. 뇌 자기공명영상 검사에서 양측 두정-후두엽에 고신호 병변이 관찰되어 가역적 후두부 뇌병증 증후군으로 진단하고, 별다른 치료 없이 경과를 관찰하였다. 양안 시력이 점차 호전되는 양상으로 진단 후 16주째 경과 관찰 시 양안 모두 최대교정시력 1.0으로 회복되었고 시유발전위 검사에서도 양안 모두 P100 진폭이 회복된 결과를 나타내었다. 결론: 만성 빈혈 및 수혈 이후 다른 신경학적 증상 없이 양안 시력 저하 증상만을 주소로 내원한 환자에서 가역적 후두부 뇌병증의 빠른 진단하에 불필요한 치료 없이 경과 관찰만으로 시력은 완전히 회복되었다. Purpose: To report a case of recovery of bilateral cortical blindness in a patient with posterior reversible encephalopathy syndrome. Case summary: A 46-year-old female visited the ophthalmology department due to abrupt visual acuity decrease. Ten days earlier, she had received conservative management due to anemia caused by menorrhagia and uterine prolapse. She underwent a gynecological operation to remove a uterine myoma two days previously, and was given a blood transfusion postoperatively because of excessive bleeding. After the transfusion, she complained of acute blurred vision. Her best corrected visual acuity (BCVA) was hand motion 10 cm in both eyes. There were no abnormal specific findings except retinal dot hemorrhage at the temporal side in the left eye on fundus examination. Her pupillary light reflex was normal and optical coherence tomography examination was unremarkable in both eyes. However, flash visual evoked potential findings showed reduced P100 amplitude in both eyes and she was diagnosed with posterior reversible encephalopathy syndrome based on brain magnetic resonance imaging. After close observation without any treatment, the symptoms gradually improved. Finally, her BCVA recovered to 1.0 and P1 and P100 amplitudes were restored to normal range in both eyes at 16 weeks from the first diagnosis. Conclusions: A patient complained of bilateral visual loss without other neurological symptoms after chronic blood loss and blood transfusion. She recovered visual acuity completely with prompt diagnosis of posterior reversible encephalopathy syndrome and close observation only.

안저검사상 망막이 관찰되지 않는 진행 백내장의 시력예후와 술 후 만족도

유종인(Jong In You),방슬기(Seul Ki Bang),강민석(Min Seok Kang),진경현(Kyung Hyun Jin) 대한안과학회 2020 대한안과학회지 Vol.61 No.3

목적: 망막이 관찰되지 않는 진행 백내장환자의 수술 예후와 만족도에 대해 조사하였다. 대상과 방법: 2015년부터 2017년까지 백내장수술을 받은 480명 748안을 후향적으로 분석하였다. 술 전 요인과 백내장의 진행 정도, 수술 방법, 수술 1개월 및 6개월 후 최대교정시력에 대해 조사하였다. 이 중 망막이 관찰되지 않는 진행 백내장환자 78명 91안의 술 후 만족도를 조사하였다. 결과: 고혈압은 수술 6개월 후 시력과 양의 상관관계를 보였다(p=0.004). 낮은 각막 내피세포 수, 원발개방각녹내장, 섬유주절제술, 각막이상증 혹은 각막혼탁, 안저검사상 망막이 관찰되지 않는 진행 백내장, 과숙백내장, 백내장 낭외적출술 및 낭내적출술, 수술 1개월 후 시력이 0.5 미만인 경우는 수술 6개월 후 시력과 음의 상관관계를 보였다(각각 p=0.019, p=0.002, p=0.037, p=0.001, p=0.004, p=0.012, p=0.00, p=0.00). 망막이 관찰되지 않는 진행 백내장은 수술 후 6개월 후 시력 0.5 미만의 위험도가 3.18배(p=0.003) 높았다. 망막이 관찰되지 않는 진행 백내장환자 중, 예후가 좋지 않을 것으로 기대되어 수술을 미룬 환자 10명 10안 중 6안(60%)의 최종시력은 0.5 미만이었다. 하지만, 6명(60%)이 수술 후 만족한다고 답하였으며 수술 후 만족도가 상대적으로 높았다. 결론: 망막이 관찰되지 않는 진행 백내장환자의 수술 후 최종 시력은 낮다. 그러나 진행 백내장환자 중 좋지 않은 예후가 기대되었던 환자의 술 후 만족도는 시력예후에 비해 높다. Purpose: We evaluated the surgical prognoses of patients with advanced cataract who were unable to be evaluated by fundus imaging and their satisfaction with daily life. Methods: We retrospectively reviewed 748 eyes of 480 patients who underwent cataract surgery from January 2015 to December 2017. Preoperative factors, surgical technique, degree of cataract, and the best-corrected visual acuity for 1 and 6 months after surgery were analyzed. Among 91 eyes of 78 patients with advanced cataract who were unable to be evaluated by fundus imaging, the degree of discomfort before surgery and postoperative satisfaction were evaluated. Results: Hypertension was positively correlated with visual acuity after cataract surgery (p = 0.004). Low corneal endothelial cell count, primary open-angle glaucoma, a history of trabeculectomy due to glaucoma, corneal dystrophy or corneal opacity, advanced cataract unable to be evaluated by fundus imaging, hypermature cataract, extracapsular cataract extraction, and intracapsular cataract extraction and visual acuity <0.5 after 1 month showed negative correlations with the visual outcomes after 6 months (p = 0.019, p = 0.002, p = 0.037, p = 0.001, p = 0.004, p = 0.012, p = 0.00, and p = 0.00, respectively). The risk of a final visual acuity <0.5 after cataract surgery was 3.18-fold higher in cases of advanced cataract, unable to be evaluated by fundus imaging (p = 0.003). Ten patients with 10 eyes postponed surgery due to poor prognoses, which was expected, and six patients (60%) had a best-corrected visual acuity <0.5 after 6 months. Six patients (60%), expected to have a poor prognosis were satisfied after surgery and the postoperative satisfaction was high when compared with a poor visual outcome. Conclusions: Poor surgical prognoses were expected in advanced cataract patients unable to be evaluated by fundus imaging. However, advanced cataract patients, who postponed surgery due to an unfavorable visual prognosis, showed a higher subjective satisfaction when compared with the postoperative visual acuity.