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사공민,정화선 대한안과학회 2004 대한안과학회지 Vol.45 No.3
Purpose: The preoperative axial length measured by ultrasonography in the phthisis bulbi and the postoperative surgical outcome was evaluated in order to determine the surgical procedure of an evisceration or enucleation. Methods: The preoperative axial length was measured by ultrasonography in 30 eyes of 30 patients with phthisis bulbi from January 2000 to October 2002. Enucleation was performed on 20 eyes with a relatively short preoperative axial length. The axial length of the enucleated globe was measured and compared with the preoperative axial length. Evisceration was performed in 10 eyes with a relatively long preoperative axial length. The size of the implant, the thickness of prosthesis, and the complications were evaluated postoperatively. Results: In the 20 eyes that underwent enucleation, the preoperative axial length was 6.8~16.6 mm (mean 12.4 mm) and the axial length of the enucleated globes was 9.0~20.0 mm (mean 15.3 mm). The size of implants was 16.5~20.0 mm (mean 19.5 mm). In the 10 eyes that underwent evisceration, the preoperative axial length was 13.5~22.7 mm (mean 19.1 mm). The size of the implants was 18.5~20.0 mm (mean 19.4 mm). During a follow-up period of 6-30 months (mean 16.0 months), none of the eyes showed any complications such as conjunctival dehiscence or implant exposure or extrusion. Conclusions: The preoperative axial length measurement was helpful in deciding if enucleation or evisceration of the phthisis bulbi should be performed. Evisceration was performed sufficiently in cases of a preoperative axial length of 16 mm or more. 목적 : 안구로 환자에 있어서 안구적출술 또는 안구내용제거술을 실시하기 전에 초음파를 이용한 안축장을 측정하여 수술방법을 결정하고 술후 효과에 대해 알아보고자 하였다. 대상과 방법 : 2000년 1월부터 2002년 10월까지 본원에서 안구로 진단을 받은 환자 30명 (남자 15명, 여자 15명), 30안에 대해 초음파를 이용한 안축장을 측정하였다. 안구적출술을 실시한 20안의 경우는 적출된 안구의 안축장을 측정하여 초음파 측정치와의 차이를 살펴보았고, 안축장이 상대적으로 길었던 10안의 경우는 안구내용제거술을 시행하였다. 술후 30안에 대한 삽입물의 크기, 의안의 두께, 술후 효과, 합병증 등을 살펴보았다. 결과 : 안구적출술을 시행한 20안의 술전 안축장은 6.8~16.6 mm (평균 12.4 mm)이었고 술후 적출한 안구의 안축장은 9~20 mm (평균 15.3 mm)이었으며 삽입물의 직경은 16.5~20 mm (평균 19.5 mm)이었다. 안구내용제거술을 시행한 10안은 술전 안축장이 13.5~22.7 mm (평균 19.1 mm)이었고 삽입물의 직경은 18.5~20 mm(평균 19.4 mm)이었다. 경과관찰 기간 중 결막의 창상열개, 삽입물 노출 및 돌출 등의 심각한 합병증은 볼 수 없었다. 결론 : 안구로 환자에 대한 수술방법을 결정하기 위해 초음파를 이용한 안축장 측정이 많은 도움이 되었으며, 술전 안축장 16 mm 이상인 경우는 안구내용제거술을 실시하기에 충분하였다.
Application of Intravitreal Bevacizumab for Circumscribed Choroidal Hemangioma
사공민,이준엽,장우혁 대한안과학회 2009 Korean Journal of Ophthalmology Vol.23 No.2
We report 3 cases of circumscribed choroidal hemangioma (CCH) effectively managed with intravitreal bevacizumab. One patient (case 1) who had recurrent CCH (1.6 ㎜ in thickness) with prior laser photocoagulation was treated with intravitreal bevacizumab alone. Two patients (case 2 and 3) who had CCH (2.4 ㎜ and 2.2 ㎜ in thickness, respectively) with recent visual impairment were treated with bevacizumab followed by photodynamic therapy (PDT). Ophthalmic evaluations included visual acuity, ophthalmoscopic examination, fluorescein angiography, ultrasonography, and optical coherence tomography. Patients were followed up for 6-9 months. After therapy, all patients showed improved visual acuity due to complete resorption of subretinal fluid and macular edema. Ultrasonography demonstrated a reduction of the thickness of CCH in case 1 and complete regression of the lesions in case 2 and 3. No patient showed tumor recurrence. Intravitreal bevacizumab, alone or in combination therapy with PDT, may be a useful alternative for the treatment of symptomatic CCH with subretinal fluid.
사공민,김진선,장우혁 대한안과학회 2009 Korean Journal of Ophthalmology Vol.23 No.3
We report three cases of neovascular glaucoma secondary to central retinal artery occlusion (CRAO) which were effectively managed with intravitreal bevacizumab (IVB) followed by panretinal photocoagulation (PRP). Neovascular glaucoma without peripheral anterior synechiae developed between one and five weeks following CRAO onset. All patients received 0.75 ㎎ (0.03 ㎖) IVB. In all patients, complete regression of the iris and anterior chamber angle neovascularization was confirmed within one week. PRP was applied two weeks after the injection. The follow-up period was four to seven months (average, five months). Intraocular pressure was controlled in all patients using topical antiglaucoma medications alone. However, one patient experienced a recurrence of neovascularization three months after the initial combination treatment. This patient received another IVB injection and additional PRP, and the recurrent neovascularization resolved. There were no local or systemic adverse events in any patients. Therefore, intravitreal bevacizumab may be an effective adjunct in the treatment of neovascular glaucoma associated with CRAO.
사공민,윤영선,김명미 대한안과학회 2005 대한안과학회지 Vol.46 No.1
Purpose: To evaluate the clinical course and surgical outcome of infantile exotropia with large and constant angle, as defined by the onset of exotropia before 6 months. Methods: We reviewed the records of 11 patients who were diagnosed with infantile exotropia and received surgery between July 1987 and December 2003. Age at onset and surgery, visual acuity, refractive error, pre- and post-operative angle of strabismus, and binocular sensory status after surgery were evaluated for each patient. Results: The mean age at onset, diagnosis, and first surgery was 2.3 months (range, birth to 5 months), 14.9 months (range, 4 to 33 months), and 36.3 months (range, 11 to 45 months), respectively. The mean size of preoperative exodeviation was 57.3 prism diopters (PD) (range, 40 to 100 PD). Six patients (54.5%) required reoperation to correct residual or recurred exotropia, oblique dysfunction, and/or DVD. Two (18.2%) of the six required a third operation. Sensory tests including Lang test were performed in seven patients but all failed in Lang test and showed no fusion even with successful surgical treatment. Conclusions: Infantile exotropia should be observed for a long period and needs proper reoperation because it may be frequently associated with residual or recurred exotropia, oblique dysfunction, and/or DVD after initial operation. However, improvement of binocular function can rarely be expected even with successful surgical alignment.