스펙트럼영역 빛간섭단층촬영 유의지도에서 자동으로 구한 국소적 망막신경섬유층결손면적

서샘,신중원,엄기방,Sam Seo,MD,Joong Won Shin,MD,Ki Bang Uhm,MD,PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.6

Purpose: To evaluate the usefulness of automated measurements of the localized retinal nerve fiber layer (RNFL) defects area in patients with glaucoma. Methods: Fifty one patients with localized RNFL defects in RNFL red-free photographs and 53 healthy subjects were included. All participants were imaged with 3D spectral-domain optical coherence tomography (OCT). The area of defects was measured with the RNFL significance map (red = p < 1% and yellow = p < 5%) using Image J manually and Matlab software automatically. The area under the receiver operating characteristic curve (AUC) was calculated for the RNFL defect area of the RNFL photograph and RNFL maps, circumpapillary RNFL thickness, optic disc parameter, and macular inner retina thickness. Results: High correlation was observed between manually and automatically measured defect areas in the significance map (red area r = 0.904, red and yellow area r = 0.890). The AUC for manually and automatically measured defects area (0.987, 0.966; p < 5%, p = 0.31, respectively) in the significance map was comparable. The latter demonstrated slightly higher but insignificant difference in AUC for inferior quadrant circumpapillary RNFL thickness (0.936; p = 0.22) and was significantly higher than the inferior ganglion cell layer plus inner plexiform layer thickness (0.894) and vertical cup to disc ratio (0.869) (p = 0.018, p = 0.008, respectively). Conclusions: The automated measurements of the RNFL defect area in the significance map performed adequately in detecting localized RNFL defects and had a better performance than macular inner retina and optic nerve parameters.

특발성 망막전막에서 유리체절제술 전후 미세시야계를 이용한 구조와 기능의 상관관계 분석

서샘,임한웅,신용운,강민호,성민철,조희윤.Sam Seo. MD. Han Woong Lim. MD. Yong Un Shin. MD. Min Ho Kang. MD.Min Cheol Seong. MD. Hee Yoon Cho. MD 대한안과학회 2013 대한안과학회지 Vol.54 No.6

Purpose: To investigate the relationship between photoreceptor inner/outer segment (IS/OS) integrity and macular sensitivity after epiretinal membrane (ERM) surgery using spectral-domain optical coherence tomography combined with microperimetry. Methods: 20 eyes of 20 patients with idiopathic ERM who underwent pars plana vitrectomy for ERM removal were prospectively reviewed. The IS/OS defect diameter, BCVA, macular sensitivity, and fixation stability were measured using spectral-domain optical coherence tomography combined with microperimetry. The correlation of these factors was analyzed. Results: The macular sensitivity improved after successful ERM surgery (p < 0.001), but the IS/OS defect diameter has not improved. The preoperative and postoperative macular sensitivity were negatively correlated with preoperative IS/OS defect diameter (p = 0.035, p = 0.006). The fixation stability was not correlated with preoperative IS/OS defect diameter. Conclusions: Macular sensitivity showed significant correlation with IS/OS defect diameter. Macular sensitivity is vital functional parameter allows subjective quantification of the retinal function and reflects morphologic changes.

유리체절제술과 백내장병합수술 후 앞방 깊이와 안구 길이 및 굴절력의 변화 측정

서샘,성민철,임한웅,강민호,조희윤,Sam Seo,MD,Min Cheol Seong,MD,Han Woong Lim,MD,Min Ho Kang,MD,Hee Yoon Cho,MD 대한안과학회 2013 대한안과학회지 Vol.54 No.7

Purpose: To evaluate the changes of anterior chamber depth (ACD), Axial length (AXL) after combined vitrectomy and cataract surgery and to analyze the association with refractive errors. Methods: In 22 eyes who underwent combined vitrectomy and cataract surgery (PPV-Phaco group), 20 eyes who underwent vitrectomy-only (PPV-only group) and 28 eyes who underwent uncomplicated cataract surgery (Phaco-only group), ACD and AXL were measured with IOL master (Carl Zeiss Jena, Germany) preoperatively and 3 months postoperatively. We compared the preoperative desired refraction and postoperative 3 months refraction. Results: ACD were increased in PPV-Phaco group and Phaco-only group (all, p < 0.001) and this change was more prominent in PPV-Phaco group (p = 0.030). In PPV only group, ACD was decreased (p < 0.001). The AXL after surgery was not significant different from the preoperative AXL in PPV-Phaco and PPV only groups (p = 0.612, p = 0.090). But the AXL was decreased in Phaco-only group (p = 0.022). Hyperopic shifting were noticed in PPV-Phaco and phaco-only groups, but myopic shifting was noticed in PPV-only group. However, these changes were not statistically significant (p = 0.292, p = 0.251, p = 0.068). Conclusions: ACD was increased after combined vitrectomy and cataract surgery. AXL was not changed. The hyperopic shifting was noticed after combined vitrectomy and cataract surgery, but was not statistically significant.

응급실에서 지연 진단된 급성폐쇄각녹내장 환자에 대한 고찰

박지웅(Ji Woong Park),서샘(Sam Seo),이종은(Chong Eun Lee) 대한안과학회 2020 대한안과학회지 Vol.61 No.12

Purpose: To analyze the clinical features of delayed diagnosed acute angle-closure glaucoma (AACG) patients who were misdiagnosed with neurologic disease in an emergency room (ER). Methods: This study was conducted with a total of 77 patients (77 eyes) who had been diagnosed with AACG in the ER. Age, gender, laterality, best-corrected visual acuity (BCVA) of the affected eye at the time of the ER visit and at an outpatient clinic follow-up examination, bilateral intraocular pressure (IOP) at time of visit, previous eye-disease history, previous history of ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, referral source, chief complaint, past history of migraine, residence, and specialty of the initial doctor in charge of the ER were statistically analyzed. Results: Among the 77 patients, 34 received a delayed diagnosis and 43 were diagnosed in a timely manner. Higher cases of delayed diagnosis were observed in patients who had lower BCVA at the time of the ER visit (p = 0.001), nonophthalmologic referral source visiting the ER (p < 0.001), a chief complaint of extra-ocular symptoms (p < 0.001), and a non-ophthalmologist as the initial doctor in charge of the ER (p < 0.001). None of the other factors, including IOP, previous eye-disease history, previous ophthalmic surgery, underlying systemic disease including metabolic syndrome, previous neurologic disease history, past history of migraine, or residence showed any statistically significant intergroup difference. Conclusions: Among the AACG patients visiting the ER, many were delayed in their diagnosis and thus required much attention afterwards. Careful examination and a detailed recording of a patient’s medical history by an ophthalmologist is important for accurate and timely diagnosis in the ER. 목적: 응급실에 내원한 급성폐쇄각녹내장 환자 중 신경학적 질환으로 오인되어 지연 진단된 환자들의 임상특징을 분석하고자 한다. 대상과 방법: 응급실을 통해 내원하여 급성폐쇄각녹내장으로 진단 받은 77명(77안)명의 환자들을 분석하였다. 나이, 성별, 안측별 분포, 내원 당시 최대교정시력, 이후 외래로 추적 관찰시 이환된 눈의 최대교정시력, 내원 당시 안압, 안과 질환력, 안과수술력, 대사성증후군을 포함한 전신질환 과거력, 이전 신경학적 질환력, 내원 경로, 주호소 증상, 편두통 과거력, 거주지, 응급실 초진 의사를 확인하여 신경학적 질환으로 오인되어 지연 진단될 위험요인을 통계적으로 분석하였다. 결과: 77명 중에 지연 진단된 군은 34명, 적시 진단된 군은 43명이었다. 두 군에서 응급실 내원 당시 최대교정시력이 낮은 경우(p=0.001), 안과 전문의를 통하지 않은 내원 경로로 응급실로 방문한 경우(p<0.001), 안외 증상이 주호소 증상이었던 경우(p<0.001), 응급실 초진 의사의 전문 과목이 안과가 아닌 경우(p<0.001)에서 지연 진단된 경우가 많았다. 치료 전 안압, 안과 질환력, 안과수술력, 대사성 증후군을 포함한 전신질환 과거력, 이전 신경과적 질환력, 편두통 과거력, 거주지 요인은 지연 진단 여부와 유의한 관계를 보이지 않았다. 결론: 응급실로 내원한 급성폐쇄각녹내장 환자 중 지연 진단되는 경우가 많아 이에 대해 주의를 요한다. 응급실에 내원한 안증상을 동반한 환자에서 안과 의사의 정확한 병력청취가 급성폐쇄각녹내장을 적시에 진단하는 데 도움이 될 것으로 생각된다.

마스크 착용이 골드만압평안압계로 측정한 안압에 미치는 영향

최우석(Woo Seok Choi),이창훈(Chang Hoon Lee),이종은(Chong Eun Lee),서샘(Sam Seo),이규원(Kyoo Won Lee) 대한안과학회 2022 대한안과학회지 Vol.63 No.1

목적: COVID-19 유행으로 인해 마스크 착용이 의무화된 시대에 마스크 착용이 안압 측정에 미치는 영향을 알아보고자 한다. 대상과 방법: 건강한 성인 30명 60안을 대상으로 전향적 연구를 시행하였다. 일회용 덴탈마스크, Korean Filter (KF)94 2단 세로접이형 보건용 마스크, KF94 3단 가로접이형 보건용 마스크, 방진마스크 총 네 가지의 마스크를 착용 후 골드만압평안압계를 이용하여 안압을 측정하였다. 마스크 착용 전에 비하여 안압이 5 mmHg 이상 차이 나는 경우는 두 가지 골드만압평안압계 기종을 이용하여 오차를 분석하였다. 결과: 마스크 착용 전 평균 안압은 13.7 ± 1.7 mmHg였다. 일회용 덴탈마스크, KF94 2단 세로접이형 보건용 마스크, KF94 3단 가로접이형 보건용 마스크, 방진마스크 착용 후 안압은 각각 13.5 ± 2.1, 14.0 ± 2.3, 14.3 ± 2.5, 13.8 ± 1.6 mmHg로 통계적으로 유의한 차이를 보이지 않았다(p=0.635). KF94 3단 가로접이형 마스크 착용군에서 안압 측정 시 마스크와 안압계 연결 부위의 접촉이 있었던 총 3안에서 5 mmHg 이상의 안압 오차를 보였다. 결론: KF94 3단 가로접이형 보건용 마스크 착용 후 골드만압평안압계를 이용한 안압 측정은 안압계의 연결부와 마스크와의 접촉으로 인한 오차가 발생할 가능성이 있다. 이러한 경우 마스크를 눌러서 접촉을 없애거나 다른 형태의 마스크를 착용한 후 안압을 측정하는 것이 정확한 안압 측정에 도움이 되겠다. Purpose: The corona virus disease-19 (COVID-19) pandemic has resulted in mandatory masking of patients and physicians during outpatient visits. This study evaluated the changes in intraocular pressure (IOP) according to mask use. Methods: This prospective study enrolled 30 healthy volunteers (60 eyes). IOP was measured via Goldmann applanation tonometry (GAT) for the subjects wearing one of four commonly used masks: dental, bi-folding Korean Filter (KF)94, tri-folding KF94, and dust masks. Subjects with IOP measurement errors of more than 5 mmHg were rechecked with another GAT type. Results: The mean IOP measured via GAT before mask wearing was 13.7 ± 1.7 mmHg. It was 13.5 ± 2.1, 14.0 ± 2.3, 14.3 ± 2.5, and 13.8 ± 1.6 mmHg with the dental, bi-folding KF94, tri-folding KF94, and dust masks, respectively. There were no significant differences in IOP according to mask type (p = 0.635). IOP errors above 5 mmHg were detected in three subjects who had contact between the GAT feeler arm and tri-folding KF94 mask during IOP measurement. Conclusions: The IOP as measured via GAT is artificially elevated by mechanical interference from the tri-fold KF94 mask. To minimize such mask-induced artifacts in GAT measurements, compress the patient’s mask or change the mask type to prevent any contact during measurement.

점안약 차트 교육을 통한 녹내장 환자의 약물 순응도 향상

최우석(Woo Seok Choi),김종헌(Jong Heon Kim),이창훈(Chang Hoon Lee),이종은(Chong Eun Lee),서샘(Sam Seo) 대한안과학회 2021 대한안과학회지 Vol.62 No.12

목적: 안압하강제를 사용하는 녹내장 환자들을 대상으로 점안약 차트를 이용한 교육이 장기적인 순응도 향상에 미치는 효과를 알아보고자 한다. 대상과 방법: 본 연구는 전향적 다기관 연구로, 안압하강제를 사용 중인 녹내장 환자를 대상으로 점안약 차트를 통하여 올바른 안약 점안 방법을 교육하였다. 점안약 차트 사용 전과 3개월, 6개월 후 설문조사를 시행하여 안약 점안 수행성적(performance score)을 조사하여 순응도의 변화를 분석하고 순응도 향상에 영향을 주는 요인을 분석하였다. 또한, 3개월째 무작위로 안약 점안 방법과 점안약 차트 사용법에 대해 재교육을 실시하여 순응도에 주는 영향을 분석하였다. 결과: 점안약 개수가 적을수록, 연평균 소득과 교육수준이 높을수록, 도시에 주거하는 경우 높은 순응도와 유의한 관련을 보였다(p=0.038, p=0.033, p=0.041, p=0.047). 6개월간 점안약 차트 사용 후 평균안압은 14.3 ± 2.9 mmHg에서 12.4 ± 3.1 mmHg로 유의하게 감소하였고, 수행성적은 23.05 ± 3.52에서 21.30 ± 3.95로 순응도가 유의하게 향상하였다(p<0.001, p=0.021). 다변량분석에서 주 활동영역이 실내이고, 3개월째 점안약 차트를 재교육한 경우 순응도 향상을 보였다(odds ratio [OR]=5.47 p=0.032; OR=4.53 p=0.030). 결론: 녹내장 환자에서 점안약 차트 사용은 안압하강 및 순응도 향상에 효과적인 보조 방법이며, 주로 실내에서 활동하는 환자에서 효과적이었다. 점안약 차트 사용법에 대한 재교육을 통해 효과를 지속적으로 향상시킬 수 있었다. Purpose: To evaluate the effects of an educational intervention using an eye drop chart and supplementary education on glaucoma patients’ adherence. Methods: In this multicenter prospective study, medically treated glaucoma patients were educated on the administration of eye drops using an eye drop chart. At the time of recruitment, all of the patients completed a questionnaire on demographic characteristics and adherence. Three months after the initial educational intervention, the patients were randomly divided into two groups: an education group and a control group. The education group received supplementary education. Immediately thereafter and at 6 months, all of the patients completed the questionnaire on adherence again. Changes in instillation behavior, the relationship between the adherence score and demographic characteristics, and factors contributing to an improvement in adherence and intraocular pressure were then analyzed. Results: The adherence scores were significantly higher in patients with fewer medications, a higher annual income and higher educational level, and an urban residence (p = 0.038, p = 0.033, p = 0.041 and p = 0.047, respectively). Education on the administration of eye drops and use of the eye drop chart improved adherence scores from 23.05 ± 3.52 to 21.30 ± 3.95 (p = 0.021) and significantly reduced the average intraocular pressure from 14.3 ± 2.9 to 12.4 ± 3.1 mmHg (p < 0.001). Working indoors (odds ratio [OR] = 5.47, p = 0.032) and supplementary education at 3 months (OR = 4.53, p = 0.030) were also correlated with improved adherence. Conclusions: An eye drop chart is an effective tool for improving adherence and intraocular pressure control in glaucoma patients. Improvement in adherence was especially notable in patients whose work predominantly involved indoor activity. The effectiveness of the eye drop chart was improved by supplementary education.

개방각녹내장 환자에서 트라보프로스트 0.003% 제제의 효과 및 안전성

성수민(Su Min Sung),김종헌(Jong Heon Kim),이종은(Chong Eun Lee),이규원(Kyoo Won Lee),서샘(Sam Seo) 대한안과학회 2021 대한안과학회지 Vol.62 No.4

목적: 트라보프로스트 0.003%가 트라보프라스트 0.004%와 비교하여 동등한 안압하강 효과를 가지면서 부작용을 줄여줄 수 있는지 알아보고자 한다. 대상과 방법: 2018년 1월부터 2018년 12월까지 본원에서 개방각녹내장으로 트라보프로스트 0.004%를 단독 점안 중인 환자 102명을 대상으로 트라보프로스트 0.003%로 교체하여 점안하였다. 트라보프로스트 0.003%로 교체 전과 교체 3개월 후에 안압과 결막충혈정도, 각막미란 정도, 눈주위 색소침착 정도를 기록하였고, 환자가 느끼는 부작용을 비교하기 위해 충혈, 따가운 느낌, 가려움, 자극감, 시야흐림, 건조감, 이물감에 대한 설문지를 작성하였다. 결과: 트라보프로스트 0.003% 교체 전과 후의 안압은 12.95 ± 4.25 mmHg, 12.94 ± 3.89 mmHg로 유의한 차이가 없었으며 (p=0.974), 각막미란 정도와 눈주위 색소침착은 유의한 차이가 없었으나 결막충혈 정도는 교체 전 1.60 ± 0.88에서 교체 후 1.36 ± 0.84로 유의하게 감소하였다(p=0.001). 설문조사 결과 환자가 느끼는 부작용의 정도는 충혈, 따가운 느낌, 가려움, 자극감, 이물감은 유의한 차이를 보이지 않았으나 시야흐림, 건조감은 점안제 교체 후 유의한 호전이 있었다(p=0.008, p=0.007). 결론: 트라보프로스트 0.003%는 트라보프로스트 0.004%와 동등한 안압하강 효과를 보이며 충혈의 정도를 감소시키고 시야흐림, 건조감의 주관적인 증상 호전을 보여 효과 및 안정성을 확인할 수 있었다. Purpose: To determine whether travoprost 0.003% has a similar intraocular pressure (IOP) reduction effect to that of travoprost 0.004% while reducing side effects. Methods: This was a prospective study from January 2018 to December 2018 that included 102 patients diagnosed with open angle glaucoma who switched from travoprost 0.004% to travoprost 0.003%. We investigated the changes in IOP, conjunctival hyperemia, corneal erosion, and eyelid pigmentation before and at 3 months after switching to travoprost 0.003%. Additionally, a questionnaire survey of these patients was conducted to determine possible side effects, including hyperemia, stinging, pruritus, irritation, blurred vision, dryness, and foreign body sensation. Results: IOP readings before and after switching to travoprost 0.003% were 12.95 ± 4.25 and 12.94 ± 3.89 mmHg, respectively, showing no significant change (p = 0.974). No changes were observed in corneal erosion or eyelid pigmentation; however, conjunctival hyperemia was reduced significantly from 1.60 ± 0.88 to 1.36 ± 0.84 (p = 0.001). No significant changes in hyperemia, stinging, pruritus, irritation, or foreign body sensation were reported; however, a significant improvement was noted for blurred vision and dryness (p = 0.008, p = 0.007, respectively). Conclusions: We were able to show the effectiveness and safety of travoprost 0.003% as being as effective as travoprost 0.004% in reducing IOP and injections while improving blurred vision and dryness.