백내장 수술시 수정체 상피세포의 제거 범위에 따른 전방 염증도의 변화

서경률(Kyoung Yul SEO),임승정(Seung Jeong Lim),이윤성(Yun Seon Lee),김홍복(Hong Bok Kim) 대한안과학회 1998 대한안과학회지 Vol.39 No.10

인공눈물 점안 후 안구 표면 두께 간섭계를 이용한 눈물 지질층 두께의 변화 분석

김서희(Seo Hee Kim),박시윤(Si Yoon Park),지용우(Yong Woo Ji),서경률(Kyoung Yul Seo),김응권(Eung Kweon Kim),김태임(Tae im Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.12

목적: 농도 및 보존제 유무에 따른 히알루론산 나트륨제제의 인공누액 점안 후 LipiView?? II 간섭계(TearScience Inc., Morrisville, NC, USA)를 이용하여 눈물 지질층 두께의 시간에 따른 변화를 측정, 비교 분석함으로써, 인공눈물의 사용이 LipiView?? II 검사 결과에 미치는 영향을 분석하고자 한다. 대상과 방법: 건성안 환자를 대상으로 전향적 연구를 시행하였다. 모든 대상자에게 눈물막 파괴 시간 측정, 쉬르머 검사, 각막 및 결막형광염색 검사, 마이봄샘 기능부전 평가, ocular surface disease index 설문조사를 실시하였으며, 대상자를 난수표를 이용한 무작위 추출로 인공누액 종류에 따라 세 그룹(1군: 무보존제 0.1% 히알루론산 나트륨제제 인공눈물, 2군: 무보존제 0.3% 히알루론산 나트륨 인공눈물, 3군: 0.003% 염소 벤잘코니움을 포함하는 0.1% 히알루론산 나트륨제제 인공눈물)으로 나눠 각각의 인공눈물을 점안 전, 직후, 1, 3, 6시간 후의 눈물지칠층의 두께를 LipiView?? II 간섭계로 측정 후 비교 분석하였다. 안검염의 유무에 따라 두 군으로 나누어 눈물지칠층의 두께를 추가로 분석하였다. 결과: 눈물 지질층의 두께를 측정한 결과, 인공눈물제제를 점안하고 3시간 뒤 눈물 지질층의 두께 변화가 유의하게 나타났다(p=0.03). 제1군 및 2군에서 시간에 따른 눈물 지질층 두께의 변화가 유의하게 측정되었고(p<0.01, p<0.01), 제3군에서는 눈물 지질층 두께 변화가 관찰되지 않았다(p=0.71). 환자를 안검염 그룹과 비안검염그룹으로 세분화하여 분석해 보았을 때, 비안검염 그룹에서는 인공눈물점안과 상관 없이 눈물지질층의 두께가 일정하였고(p=0.19), 안검염 그룹에서는 제1군과 2군에서 인공눈물 점안 후 시간 경과에 따라 눈물지질층 두께가 변화하였다(p<0.01, p=0.01). 안검염 그룹에서 제1군과 2군의 눈물 지질층의 두께를 비교하면, 인공눈물 점안 직후 및 1시간, 3시간 뒤까지 유의한 차이를 보였으며(p=0.04, p<0.01, p=0.02), 6시간째에는 유의한 차이가 없었다. 제1군과 3군의 경우에는 시간별 차이가 없었다(p=0.08). 결론: LipiView?? II 간섭계를 이용해 측정한 눈물 지질층 두께는 인공눈물의 농도와 보존제의 유무에 따라서도 수치의 차이를 보였으며, 안검염의 유무에 따라서도 인공눈물 점안 후 눈물 지질층의 두께 변화 양상에 차이가 있었다. 이는 LipiView?? II 간섭계로 눈물 지질층을 측정하는 경우 인공눈물 종류와 관계없이 적어도 6시간의 점안을 금해야 하며, 또한 안검염이 있는 환자군과 보존제를 포함하는 인공눈물을 사용하는 환자에서 더욱 유의해야 함을 시사한다. Purpose: The changes in tear film lipid layer thickness (LLT) after artificial tears application using LipiView??II interferometer were assessed. Methods: We performed a prospective study of patients with dry eye disease. All subjects underwent measurement of tear film break-up time, Schirmer test, ocular surface staining, meibomian gland evaluation, and subjective score assessment using the Ocular Surface Disease Index. All subjects were randomly assigned to 1 of 3 groups using table of random numbers (group 1, sodium hyaluronate [HA] 0.1% eye drops without preservatives; group 2, HA 0.3% eye drops without preservatives and group 3, HA 0.1% with benzalkonium chloride 0.003%). LLT was measured before, immediately after and 1 hr, 3 hrs, and 6 hrs after artificial tears application. Additionally, the patients were divided into 2 subgroups depending on the presence of meibomian gland dysfunction (MGD) and further evaluated. Results: Significant change in LLT was observed at 3 hrs after artificial tears instillation. LLT in groups 1 and 2 showed significant changes over time (p < 0.01 and p < 0.01, respectively). However, LLT in group 3 showed no change. LLT was unchanged in patients without MGD. Conversely, in MGD patients, a significant difference in LLT between groups 1 and 2 was observed immediately after and 1 hr and 3 hrs after instillation of artificial tears (p = 0.04, p < 0.01 and p = 0.02, respectively) but not at 6 hrs. However, no significant difference in LLT between groups 1 and 3 was observed in MGD patients. Conclusions: LLT after instillation of artificial tears measured using LipiView??II interferometer was affected by artificial tear concentration and presence of preservatives. Additionally, the presence of MGD can impact the pattern of LLT changes induced by artificial tear instillation. Therefore, LLT measurements using LipiView??II interferometer require at least a 6-hrs interval after use of eye drops, especially for patients with MGD or using artificial tears with preservatives.

비구면 인공수정체와 구면 인공수정체의 술 후 Nd:YAG 레이저 후낭절개술 시행률 비교

전익현,서경률,김응권,김태임,Ikhyun Jun,MD,Kyoung Yul Seo,MD,PhD,Eung Kweon Kim,MD,PhD,Tae Im Kim,MD,PhD 대한안과학회 2011 대한안과학회지 Vol.52 No.4

Purpose: The purpose of the present study is to compare Nd:YAG capsulotomy rates between spherical and aspheric intraocular lenses. Methods: The present retrospective study enrolled patients who received cataract surgery by a single surgeon between March 1, 2006 and October 31, 2009. Patients included in the study were implanted with SA60AT spherical intraocular lenses (Alcon, Fort Worth, TX, USA, 66 eyes), SN60AT spherical intraocular lenses (Alcon, 48 eyes; a total of 114 eyes), or SN60WF aspheric intraocular lenses (Alcon, 187 eyes). The Nd:YAG capsulotomy rates were compared between the two groups 6 months after the operation. Ten patients who were implanted with a spherical intraocular lens in one eye and an aspheric intraocular lens in the contralateral eye were analyzed separately. Results: Nd:YAG capsulotomy was performed in 2 of 114 eyes (1.8%) in the spherical intraocular lens group and 7 of 187 eyes (3.2%) in the aspheric intraocular lens group; no significant difference was found (p = 0.359). Among the 10 patients who were implanted with 2 different intraocular lenses, Nd:YAG capsulotomy was performed in only 1 eye in the aspheric intraocular lens group; no significant difference was found (p = 0.500). Conclusions: The design of the intraocular lens, especially the shape of the posterior optic, does not influence the rate of Nd:YAG capsulotomy. J Korean Ophthalmol Soc 2011;52(4):414-419

라식수술 후 재발된 근시에 있어 보강수술 방법에 따른 교정 효과의 비교

최진영,김현창,서경률,김응권,이형근,Jin Young Choi,Hyun Chang Kim,Kyoung Yul Seo,Eung Kweon Kim,Hyung Keun Lee 대한안과학회 2006 대한안과학회지 Vol.47 No.3

Purpose: To evaluate refraction and visual outcome between the enhancement methods on regressed or undercorrected myopia after primary laser in situ keratomileusis (LASIK). Methods: This prospective comparative study comprised 114 eyes of 114 patients who had enhancement between March 2003 and March 2004. A single surgeon performed all surgeries. Patients were subdivided according to enhancement methods lifting flap group (Group Ⅰ), LASEK enhancement group (Group Ⅱ) and tPRK group (Group Ⅲ). Flap was lifted in 55 eyes and LASEK enhancement was performed in 23 eyes. tPRK was done in 36 eyes. Uncorrected visual acuity (UCVA), best-corrected visual acuity, refractive error was examined prior to, and 1 week and 1, 3, 6 months after enhancement. Results: The mean time between initial LASIK and enhancement were 6.67±2.49 months in Group Ⅰ, 7.86±5.23 months in Group Ⅱ and 6.08±2.38 months in Group Ⅲ. At POD 6 months, the mean postoperative UCVA were 0.96±0.14 (0.026±0.079 logMAR), 0.97±0.15 (0.016±0.078 logMAR) and 0.89±0.21 (0.079±0.196 logMAR) snellen equivalent respectively and this did not differ significantly (p=0.166). The mean spherical equivalents were -0.60±0.69D (diopter), -0.91±0.75D and -0.88±0.60D respectively at POD 6 months and this also did not differ significantly (p=0.172). Conclusions: All three enhancement methods were useful procedure for correcting residual refractive errors after the primary LASIK. They provided good UCVA, predictable results and few complications.

점안마취 하에서 시행하는 백내장수술에서 백내장 종류별 진행 정도와 수술단계별 통증의 비교

고재상,안지민,서경률,김응권,김태임.Jae Sang Ko. MD. Ji Min Ahn. MD. Kyoung Yul Seo. MD. PhD. Eung Kweon Kim. MD. PhD.Tae Im Kim. MD. PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.3

Purpose: To investigate the relationship between maturity of a cataract and the pattern of pain during cataract surgery under topical anesthesia. Methods: This study comprised 105 eyes of 75 patients undergoing cataract surgery under topical anesthesia. The pain scale during each procedure was scored from 0 to 10 in numeric pattern and analyzed with the cataract maturation degree. Additionally, pain scores were compared between the first and the second eye in 14 consecutive cataract patients. Results: The average pain score during cataract surgery was 0.86 ± 0.55, and the average maximal pain experience score during surgery was 3.24 ± 1.51, which was generally tolerable. Phacoemulsification was marked as the most painful step among cataract surgery procedures (1.93 ± 1.64), followed by the removal of the surgical draping (1.31 ± 1.53) and the initial instillation of topical anesthetic (1.29 ± 1.28). Progression and cataract typing was not related to pain either during overall cataract surgery procedures or when separately analyzed during procedures. There was no significant difference between the pain scores reported in consecutive cataract surgeries. However, in subjective comparison of consecutive surgeries, more patients reported greater pain in the second operation. Conclusions: The pain score reported during cataract surgery procedures under topical anesthesia was within a generally tolerable range. Cataract progression does not appear to be related to pain during the operation. In consecutive surgeries, pain measured by a numerical scale and subjective pain experience showed different results.

두 가지 장비를 이용한 각막 지형도 검사의 비교

이동민,안지민,서경률,김응권,김태임.Dong Min Lee. MD. Ji Min Ahn. MD. Kyoung Yul Seo. MD. PhD.Eung Kweon Kim. MD. PhD. Tae Im Kim. MD. PhD 대한안과학회 2012 대한안과학회지 Vol.53 No.11

Purpose: To compare the corneal measurements of Sirius and Pentacam in normal cornea and post-corneal refractive surgery patients. Methods: Subjects were tested by Pentacam (OCULUS, Wetzlar, Germany), and Sirius (CSO, Firenze, Italy). Measurements included central corneal thickness, thinnest corneal thickness, anterior chamber depth, anterior chamber volume, iridocorneal angle, corneal volume, pupil size, and curvature of cornea. Results: A total of 88 eyes from 44 patients were included in the present study. When comparing Sirius and Pentacam in the normal cornea, corneal thickness (p = 0.693), thinnest corneal thickness (p = 0.386), anterior chamber depth (p = 0.155), anterior chamber volume (p = 0.650), and pupil diameter (p = 0.124) did not differ significantly. Corneal curvature (p ˂ 0.001), corneal volume (p = 0.023), and iridocorneal angle (p ˂ 0.001) were statistically different. When comparing Sirius and Pentacam in post-corneal refractive surgery patients, corneal thickness (p = 0.056) did not differ significantly. There was a statistical difference in corneal curvature (p ˂ 0.001), thinnest corneal thickness (p = 0.019), anterior chamber depth (p ˂ 0.001), anterior chamber volume (p ˂ 0.001), iridocorneal angle (p ˂ 0.001), corneal volume (p ˂ 0.001), and pupil diameter (p ˂ 0.001). Conclusions: Anterior segment measurements with Pentacam and Sirius showed differences in post-corneal refractive surgery patients.

익상편수술시 결막소판술과 자가결막이식술의 재발률 비교

조정우,정소향,서경률,김응권,Jung-Woo Cho,M,D,Soh-Hyang Chung,M,D,Kyoung-Yul Seo,M,D,Eung-Kweon Kim,M,D 대한안과학회 2005 대한안과학회지 Vol.46 No.9

Purpose: To compare postoperative recurrence rates between conjunctival autotransplant ation and the conjunctival mini-flap technique in pterygium surgery and to identify factors associated with postoperative recurrence. Methods: In a retrospective survey of patients who underwent pterygium surgery between March, 2001 and February, 2004 at Severance Hospital, 49 eyes with pterygium removed by the conjunctival mini-flap technique and 41 eyes that underwent pterygium removal surgery by the conjunctival autotransplantation technique were studied. Results: During the mean follow-up period of 8.79±3.9 months, recurrence of pterygium was observed in 3 of 49 eyes (7.1%) that received the conjunctival mini-flap technique. There were 9 recurrent cases out of 41 eyes (21.9%) that were treated by the conjunctival autotransplantation technique. There was no statistical significance between recurrence rate and age, sex, or previous operation in either of the respective surgical techniques. Conclusions: This study showed that the conjunctival mini-flap technique has a lower recurrence rate than the conjunctival autotransplantation technique. We also found that the conjunctival mini-flap technique is an effective and safe technique that does not generally cause serious complications.

건성안 진단에서 눈물띠 측정 스트립의 유효성

김문경(Moon Kyoung Kim),지용우(Yong Woo Ji),이형근(Hyung Keun Lee),서경률(Kyoung Yul Seo),김응권(Eung Kweon Kim),김태임(Tae im Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.10

목적: 건성안 환자에서 strip meniscometry를 이용한 눈물 측정치와 기존의 눈물 검사들과의 상관성을 분석하여 strip meniscometry 검사의 진단적 유효성을 평가하고자 한다. 대상과 방법: 연구에 포함된 대상자를 strip meniscometry를 이용한 눈물띠 측정, 쉬르머 검사, 눈물막 파괴시간, 빛간섭단층촬영을 이용한 눈물띠 측정 등을 시행한 후 건성안군(n=46안)과 정상안군(n=30안)을 비교분석하였으며, Spearman 상관분석을 이용하여 strip meniscometry 측정치와 그 외 검사와의 상관성을 평가하였다. 결과: Strip meniscometry를 이용한 눈물띠 수치는 쉬르머 검사(r=0.6080), 눈물막 파괴시간(r=0.5980), 빛간섭단층촬영을 이용한 눈물띠 깊이(r=0.6210), 너비(r=0.6080), 면적(r=0.6370) 수치와 모두 유의한 상관관계를 가졌다(p<0.01). 또한 정상안군(7.07 ± 2.61 mm) 에 비해 건성안군(4.58 ± 1.94 mm)에서 strip meniscometry 측정치가 유의하게 낮았다(p<0.05). 결론: Strip meniscometry는 건성안 환자 및 정상안 환자에서 유의한 차이를 보이며 기존의 눈물 검사와도 유의한 상관관계를 가진다. Strip meniscometry는 쉬르머 검사에 비해 적은 검사시간이 필요하고 비침습적인 방법이므로 건성안 환자의 평가에 유용한 수단이 될 수 있을 것으로 기대된다. <대한안과학회지 2016;57(10):1521-1526> Purpose: To evaluate the efficacy of strip meniscometry test for dye eye syndrome (DES) by measuring the correlation between strip meniscometry and conventional test measurements. Methods: All subjects were examined using the Schirmer test, tear breakup time (TBUT) and strip meniscometry using SMTube (Echo Electricity Co., Ltd., Fukushima, Japan). Tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus area (TMA) were measured using Fourier-domain optical coherence tomography. The DES group (n = 46 eyes) was compared with the normal group (n = 30 eyes) and correlation was assessed using Spearman’s correlation coefficient. Results: Strip meniscometry measurement was significantly correlated with Schirmer score (r = 0.6080, p < 0.01), TBUT (r = 0.5980, p < 0.01), TMH (r = 0.6210, p < 0.01), TMD (r = 0.6080, p < 0.01) and TMA (r = 0.6370, p < 0.01). Strip meniscometry was significantly lower in the DES group (4.58 ± 1.94 mm) than the normal group (7.07 ± 2.61 mm, p < 0.05). Conclusions: Strip meniscometry was significantly correlated with other conventional test measurements for dry eye syndrome. Strip meniscometry is less time consuming and a less invasive method than the Schirmer test. Strip meniscometry could be an efficient tool to evaluate patients with dry eye syndrome in a clinical setting. J Korean Ophthalmol Soc 2016;57(10):1521-1526

공막 석회화 절제 가위를 이용한 미용적 결막절제술 후의 공막석회화 제거

우영제,김홍석,서경률,Young Jae Woo,MD,Hong Seok Kim,MD,Kyoung Yul Seo,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.11

Purpose: To research the advantage of using calcium plaque scissors in conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy. Methods: We analyzed 55 eyes that had undergone conjunctival flap surgery for calcified scleromalacia occurring after cosmetic conjunctivectomy. Surgical blade was used in 30 eyes (Group 1) and calcium plaque scissors in 25 eyes (Group 2). Time after conjunctivectomy, plaque size, operation time and visual acuity before and after the flap surgery were analyzed and compared. Additionally, necessity of additional scleral surgery was evaluated. Optical coherence tomography (OCT) of the sclera was performed both pre- and postoperatively and the results were compared.Results: An average of 3.9 ± 1.0 years elapsed until conjunctival flap surgery and follow-up time was 5.2 ± 3.8 months. Post conjunctivectomy time and plaque size were similar in both groups (<EM>p </EM>= 0.87 and 0.49, respectively). The surgery time in Group 2 was shorter than in Group 1 (17.5 ± 6.3 minutes and 21.9 ± 8.5 minutes, respectively, <EM>p</EM> = 0.20). Uncorrected visual acuity was similar in both groups before and after conjunctival flap surgery (<EM>p</EM> = 0.53 and <EM>p</EM> = 0.20, respectively). In Group 1, one sclera transplantation and three Ologena™ insertion surgeries were performed as an additional scleral surgery. Based on OCT, calcium plaque scissors were confirmed as a new surgical tool for calcium plaque removal with minimal scleral damage. Conclusions: Using calcium plaque scissors when performing conjunctival flap surgery for calcium plaque removal that occurred after cosmetic conjunctivectomy reduces the necessity of an additional scleral surgery and surgery time. J Korean Ophthalmol Soc 2014;55(11):1618-1624

익상편환자에서 생체접착제를 이용한 변형된 결막소판술의 임상결과

김문경(Moon Kyoung Kim),전익현(Ik hyun Jun),김태임(Tae im Kim),김응권(Eung Kweon Kim),서경률(Kyoung Yul Seo) 대한안과학회 2017 대한안과학회지 Vol.58 No.7

목적: 익상편 환자에서 결막봉합 부위에 생체접착제를 이용한 변형된 결막소판술을 시행한 후 장기간의 임상결과를 보고하고자 한다. 대상과 방법: 2014년 1월부터 2015년 8월까지 단일기관에서 생체접착제를 이용한 변형된 결막소판술을 시행 받은 익상편환자 148명을 대상으로 후향적으로 분석하였다. 생체접착제를 이용한 변형된 결막소판술을 받은 환자에서의 재발률 및 수술 소요시간을 분석하였다. 동일 수술을 받은 환자에서 재발한 군과 재발하지 않은 군을 비교하여 관련인자를 평가하였다. 결과: 대상자의 평균 나이는 60.2 ± 1.1세(29-86)이며, 평균 수술 소요시간은 11.8 ± 5.8분(5-36)이었다. 총 대상 148명 중 재발률은 4.0% (6/148)로 나타났으며 재수술률은 0.6% (1/148)로 나타났다. 생체접착제를 이용한 변형된 결막소판술을 시행 받은 환자에서 재발한 군과 재발하지 않은 군을 비교해 본 결과, 재발한 군에서 환자의 연령이 어렸고, 익상편의 중증도가 높았으며, 양안성으로 발병한 경우가 많았다(p<0.05). 결론: 생체접착제를 이용한 변형된 결막소판술은 기존의 익상편 수술만큼 안전하며 재발률이 낮은 수술방법이다. 생체접착제를 이용함으로써 수술시간의 단축 및 봉합사의 감소로 수술 후 불편감을 줄여줄 수 있어 익상편 수술방법으로 고려할 수 있는 술식이다. <대한안과학회지 2017;58(7):797-803> Purpose: To analyze the long-term clinical outcomes after use of fibrin glue using a modified mini-flap technique for pterygium surgery. Methods: This study is a retrospective, clinical outcome study of 148 subjects that underwent the modified mini-flap technique with fibrin glue from January 2014 to August 2015. We analyzed the recurrence rate and surgical time of modified mini-flap surgery with fibrin glue. We also analyzed associating factors between the recurrence group and non-recurrence group who underwent the same surgery technique. Results: Mean age was 60.2 ± 1.1 (ranging from 29 to 86) years, and mean surgical time was 11.8 ± 5.8 (ranging from 5 to 36) minutes. The recurrence rate of pterygium patients who underwent the fibrin glue using a modified mini-flap technique was 4.0% (6/148), and the re-operation rate was 0.6% (1/148). From the comparison of associating factors between recurred and non-recurred groups, the recurred group was younger, had more severe disease, and had a higher rate of bilaterality than the non-recurred group (p < 0.05). Conclusions: The new approach using fibrin glue with a modified mini-flap technique shows a low recurrence rate compared to the other type of pterygium surgery. The use of fibrin glue shortened operation time and decreased patient discomfort due to fewer remnant sutures. Fibrin glue use in a modified mini-flap technique can be considered as a feasible surgical option for pterygium patients. J Korean Ophthalmol Soc 2017;58(7):797-803