위눈꺼풀성형술, 위눈꺼풀처짐 교정수술 전후 각막굴절력 및 각막 형태의 변화

백지선(Ji Sun Paik),양석우(Suk-Woo Yang) 대한검안학회 2019 Annals of optometry and contact lens Vol.18 No.1

The change of corneal refraction and corneal coverture after upper lid blepharoplasty and blepharoptosis repair surgery is still controversial. Dermatochalasis is redundant and lax eyelid skin and muscle, which commonly occurs in older people. Acquired ptosis involves eyelid drooping caused by a thinning of the levator aponeurosis. Overall, upper eyelid surgery is becoming increasingly popular. Patients who have undergone upper eyelid surgery occasionally complain of blurred vision in the operated eye. Several studies have investigated the effects of eyelid surgery on corneal shape. In this study, we reviewed several studies about the corneal curvature and refraction change after upper eyelid blepharoplasty or ptosis surgery and we want to share with many physicians about the outcomes of studies.

위눈꺼풀뒤당김 환자에서 눈꺼풀올림근 후전술의 치료 효과

이용은,백지선,정수경,손욱현,양석우,Yong Eun Lee,MD,Ji Sun Paik,MD,Su Kyung Jung,MD,Uk Hyun Sonn,MD,Suk Woo Yang,MD 대한안과학회 2012 대한안과학회지 Vol.53 No.10

Purpose: To assess the efficacy of levator recession under local anesthesia to treat upper eyelid retraction. Methods: Records of 12 patients (12 lids) were reviewed retrospectively. Postoperative cosmetic results were assessed as good, fair, or poor based on the upper lid height and symmetry. Preoperative and postoperative marginal reflex distance (MRD1, mm), upper eyelid asymmetry, lid lag, lagophthalmos, and ocular exposure symptoms were compared. The reoperation rate was also evaluated. Results: Causes accounting for upper lid retraction were Graves ophthalmopathy (9 lids, 75.0%), orbital pseudotumor (2 lids, 16.7%), and hypercorrection from previous ptosis operation (1 lid, 8.3%). At a mean ± standard deviation of 27.7 ± 24.0 months follow-up (range, 5-60 months), 11 patients (91.7%) showed significantly better cosmetic results. MRD1 decreased an average of 3.1 ± 1.3 mm from 6.3 ± 1.5 mm preoperatively to 3.2 ± 0.9 mm postoperatively (p < 0.001). Upper lid asymmetry, lagophthalmos, and lid lag were also reduced significantly (p < 0.001). Overcorrection occurred in 3 lids (25%) and required levator advancement. Eleven patients (91.7%) experienced complete resolution of dry eye symptoms following levator recession. Conclusions: Levator recession showed good cosmetic results up to 2 years after surgery for upper eyelid retraction. J Korean Ophthalmol Soc 2012;53(10):1378-1384

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.

비내시경 누낭비강연결술에서 히알루론산나트륨과 카르복시메틸셀룰로오스나트륨 혼합액의 효과

오태훈,백지선,양석우,Tae-Hoon Oh,MD,Ji Sun Paik,MD,Suk-Woo Yang,MD 대한안과학회 2010 대한안과학회지 Vol.51 No.2

Purpose: To evaluate the long-term results of the application of a mixed solution of hyaluronate and sodium carboxymethlycellulose (HACMC, Guardix-sol) intraoperatively in endonasal dacryocystorhinostomy (Endo-DCR). Methods: In this retrospective randomized controlled study, Endo-DCR and silicone tube intubation were performed on 83 eyes of 83 patients who were diagnosed with nasolacrimal duct obstruction. In group A (40 patients, 40 eyes), HACMC was applied to the osteotomy site in the nasal cavity after standard Endo DCR procedure. In group B (43 patients, 43 eyes), a standard Endo-DCR procedure was performed without HACMC. The results for the two groups were evaluated by asking patients about the tearing condition and examining the patency of irrigation, complications, and related treatment. Results: There were no statistically significant differences in age, sex, silicone tube insertion duration, or mean follow-up time between the two groups. The primary success rates of the group A and the group B were 87.5% (35/40) and 81.4% (35/43), respectively. The final success rates after the revisonal surgery were 92.5% (37/40) and 86.0% (37/43), respectively, and there were no statistically significant differences between the two groups (P=0.348, Fisher’s exact test). Conclusions: Applying HACMC to the nasal cavity will be useful in treating patients with poor prognosis, although the higher average primary success rate of patients receiving HACMC, as compared to those who did not, was not statistically significant. J Korean Ophthalmol Soc 2010;51(2):159-163

본태눈꺼풀연축 환자에서 Letibotulinum Toxin A의 유효성과 안전성 평가

김지현(Ji Hyun Kim),정도훈(Doh Hoon Chung),김성은(Sung Eun Kim),백지선(Ji-Sun Paik),김남주(Namju Kim),나태윤(Tae Yoon La),손준혁(Jun Hyuk Son),안희배(Hee Bae Ahn),양재욱(Jae Wook Yang),우경인(Kyung In Woo),유혜린(Helen Lew),윤진숙(Jin S 대한안과학회 2020 대한안과학회지 Vol.61 No.3

목적: 본태눈꺼풀연축 환자를 대상으로 보툴렉스Ⓡ의 유효성 및 안전성을 평가하고자 하였다. 대상과 방법: 총 15개 기관에서 본태눈꺼풀연축 환자 250명이 본 임상시험에 등록되었으며, 이 중 220명의 대상자가 본 시험을 완료하였다. 대상자는 투여 후 4주와 16주 시점에 방문하여 유효성 및 안전성 평가를 시행하였으며, 투여 4주 시점에 일차 유효성 평가가 가능했던 240명이 intention-to-treat (ITT) 분석군에 포함되었다. 유효성 평가는 ITT 분석을 기본으로 하였고, Jankovic Rating Scale(JRS), 기능장애척도, 시험자 반응 평가, 삶의 질 평가를 이용하였으며, 안전성 평가는 이상반응에 대한 분석을 이용하였다. 결과: ITT군에서 일차 유효성 평가변수인 베이스라인 대비 보툴렉스?? 투여 4주 후 JRS 총점의 평균 변화량은 통계적으로 유의한 감소를 나타내었으며(p<0.0001), 유사제제와 비교 시에 비열등함을 확인하였다. 이차 유효성 평가변수 중 베이스라인 대비 투여 16주 후 JRS 총점의 평균 변화량과 베이스라인 대비 투여 4주 및 16주 후 기능장애 평가점수 총합의 평균 변화량이 통계적으로 유의한 감소를 보였다(p<0.0001 for all). 시험약을 투여받은 249명의 대상자 중 44명(17.6%)에서 76건의 이상반응이 발생하였으나, 심각한 이상반응을 보인 대상자는 없었다. 결론: 보툴렉스?榮? 본태눈꺼풀연축 환자에서 효과적이고 안전하게 사용될 수 있는 약제로 사료된다. Purpose: To evaluate the efficacy and safety of BOTULAXⓇ in subjects with essential blepharospasm. Methods: In this study, a total of 250 subjects with essential blepharospasm were enrolled at 15 investigational sites and a total of 220 subjects completed the study. The efficacy and safety were evaluated at weeks 4 and 16 after treatment compared with baseline. In total, 240 subjects were enrolled, treated with the investigational product, and evaluable for the primary efficacy assessment at week 4 after treatment; these subjects were included in the intention-to-treat (ITT) population. With the ITT set as the main efficacy set, efficacy assessment included Jankovic rating scale (JRS), functional disability score, investigator evaluation of global response and quality of life. Safety assessment including the incidence of adverse events was also performed. Results: In terms of the primary efficacy endpoint (i.e., change in JRS total score at week 4 after treatment from baseline [ITT set]), mean change indicated a statistically significant reduction (p < 0.0001) and demonstrated the non-inferiority of the test drug to similar drugs. In terms of the secondary efficacy endpoints, mean change in JRS total score at week 16 after treatment and mean change in functional disability score at weeks 4 and 16 after treatment both exhibited a statistically significant reduction compared with baseline (p < 0.0001 for all). Among the 249 subjects treated with the investigational product in this study, 44(17.67%) experienced 76 treatment emergent adverse events but no serious adverse events were observed. Conclusions: Based on the study results, BOTULAXⓇ is considered to be an effective and safe treatment for essential blepharospasm.

안와 고립성 섬유종

김은경,백지선,양석우,Eun Kyoung Kim,Ji-Sun Paik,Suk-Woo Yang 대한안과학회 2010 대한안과학회지 Vol.51 No.6

Purpose: A Solitary fibrous tumor is a rare orbital neoplasm derived from mesenchymal cells. The neoplasm should be considered in differential diagnosis of any orbital tumor, and immunohistochemial analysis is important for correct diagnosis. The authors herein describe a case of a solitary fibrous tumor in addition to the findings of a literature review. Solitary fibrous tumors can develop from not only the lacrimal gland, but also orbital soft tissue. Until now, there has been no report of a solitary fibrous tumor arising from orbital soft tissue in Korea. Case summary: A 50-year-old man visited our clinic due to a slow progressing mass on the lateral side of the left eye for 1 year. The patient did not suffer from any discomfort or discharge from the mass. Slit lamp and other ocular examinations were unremarkable. Orbital MRI revealed a solid extra-conal enhanced mass that measured 13x11 mm adhering to the lateral wall of the left orbit. Total surgical excision was Performed under local anesthesia and tumor cells showed a strong and diffuse positivity for CD34 by immunohistochemistry. The findings were consistent with the diagnosis of orbital solitary tumor. Conclusions: The orbital solitary tumor is rare, but it should be considered in the differential diagnosis of any orbital tumor. J Korean Ophthalmol Soc 2010;51(6):881-884

갑상샘암으로 방사성 요오드 절제술을 시행한 환자들 눈물주머니코안연결술의 시행 성적

박진형,정수경,백지선,양석우,Jin Heung Park,Su Kyung Jung,Ji Sun Paik,Suk Woo Yang 대한안과학회 2014 대한안과학회지 Vol.55 No.3

Purpose: To evaluate the outcomes of endonasal or external dacryocystorhinostomy in patients who underwent radioiodine therapy due to thyroid cancer. Methods: We reviewed retrospectively clinical and microbiological records of patients who had endonasal or external dacryocystorhinostomy after taking radioiodine therapy for thyroid cancer between January 2006 and December 2012. Results: Twenty-three female adult patients with an average age of 50 years (range, 25 to 72 years) were identified. Seven patients underwent unilateral surgery and 16 had bilateral surgery. Among 39 eyes, 1 eye had combined nasal septoplasty, 3 eyes had external dacryocystorhinostomy and 36 eyes had endonasal dacryocystorhinostomy. Dacryocystorhinostomy was performed within 12 months after the last 31I dose in 3 cases and 2 (5%) presented with the symptom of epiphora. The major cause of symptomatic recurrence was restenosis of the lacrimal nasal mucosa due to the formation of scar tissue, thus, the patients underwent revision surgeries. The remaining 37 of the 39 eyes (95%) showed improvement of symptoms. Conclusions: Most patients who underwent dacryocystorhinostomy after 31I therapy due to thyroid cancer showed successful outcomes, especially after more than 1 year post-operatively. The major cause of nasolacrimal duct obstruction was a scar tissue formation in the nasal cavity mucosa. J Korean Ophthalmol Soc 2014;55(3):333-336

갑상샘눈병증에서 안와감압술 전후 외안근 부피 변화의 영상분석: Nunery 분류법 제1형과 2형 비교

황규연,조원경,백지선,양석우,Kyu Yeon Hwang,Won Kyung Cho,Ji Sun Paik,Suk Woo Yang 대한안과학회 2013 대한안과학회지 Vol.54 No.1

Purpose: To evaluate the radiographic volume change in extraocular muscles (EOM) following orbital wall decompression for Nunery type 1 and type 2 thyroid-associated orbitopathy (TAO). Methods: Medical records of 31 orbits in 20 patients undergoing postoperative orbital CT after orbital decompression for TAO were retrospectively reviewed. The patients were divided according to Nunery classifications. A type 1 classification was assigned to patients who had no diplopia and essentially normal versions. A type 2 classification was assigned to patients with restrictive motility loss and diplopia within 20 degrees of the primary position. EOM volumes were determined by the summation of each EOM’s cross-sectional areas in the coronal plane of the CT scans and multiplying the sum by the slice thickness. Main outcome measure was a comparison of EOM volume changes between types 1 and 2 TAO and a relationship between EOM volume and change in proptosis. Results: In type 2 TAO, a significant increase in the volume of the medial rectus muscle, lateral rectus, and total EOM was detected postoperatively (p = 0.044, 0.022, 0.049), whereas no significant changes were found in the EOM’s volume changes in type 1 TAO. The reduction of proptosis after orbital decompression in type 1 TAO was significantly greater than in type 2 TAO (p = 0.025). A significant positive association was observed between the preoperative EOM volumes and the reduction of proptosis following orbital wall decompression (r = 0.505). Conclusions: The postoperative EOM volumes following orbital wall decompression was significantly increased in Nunery type 2 patients who had restrictive myopathy.

눈물언덕을 침범한 결막 점액종 1예

백지원,정수경,백지선,양석우,Ji Won Baek,Su Kyung Jung,Ji Sun Paik,Suk Woo Yang 대한안과학회 2013 대한안과학회지 Vol.54 No.6

Purpose: To report a rare case of conjunctival myxoma invading the caruncle. Case summary: A 46-year-old man presented with a medical canthal conjunctival mass in his left eye. The mass was a semi-transparent, yellowish, movable mass 10 mm × 6 mm in size in the subconjunctival space. There was no pain and no tenderness. Excisional biopsy of the mass was performed. Histopathologic examination revealed findings suggestive of myxoma. Conclusions: Relatively transparent, movable, yellowish to pinkish conjunctival masses at medial canthal area without pain or tenderness can be diagnosed as myxoma on biopsy and myxoma can be seen at caruncle.

안구아탈구를 유발한 거대 소아 털모양별아교세포종 1예

김은영,정수경,백지선,양석우,Eun Yeong Kim,Su Kyung Jung,Ji Sun Paik,Suk Woo Yang 대한안과학회 2014 대한안과학회지 Vol.55 No.10

Purpose: To report a relatively rare case of huge pilocytic astrocytoma of the optic nerve and optic chiasm causing eyeball subluxation. Case summary: An eight-year-old male presented with proptosis and visual loss in the left eye for one year. The radiological findings showed a 2.9 x 2.7 x 4.2-cm tumor on the left optic nerve and optic chiasm. For diagnosis and treatment, the patient underwent tumor resection and enucleation. Pathohistological analysis of the tumor specimen revealed pilocytic astrocytoma, which is classified by the World Health Organization as a grade I astrocytic tumor. Conclusions: Astrocytoma is a tumor of the brain that affects children more often than adults. In general, gross-total resection of pilocytic astrocytoma is expected to be curative due to the non-invasive feature of the tumor. Considering pilocytic astrocytoma as differential diagnosis of orbital tumor in children with symptoms of rapidly progressive proptosis and decreased visual acuity is important because occurrence in the optic nerve and optic chiasm is possible. J Korean Ophthalmol Soc 2014;55(10):1543-1548