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강동현,송상률,김병엽,황규연,김국영 대한안과학회 2020 대한안과학회지 Vol.61 No.1
Purpose: To evaluate clinical findings in phlyctenular keratoconjunctivitis patients and assess the function and morphology of Meibomian glands using an interferometer (LipiView®, TearScience, Morrisville, NC, USA) in such patients. Methods: This retrospective study included 19 eyes of 13 patients diagnosed with phlyctenular keratoconjunctivitis. The lipid layer thickness (LLT) and meibograph of each eye was quantified by tear interferometry. Tear film break-up time (TBUT) and corneal staining score were measured. Meibomian gland morphology (lid margin vascularity, plugging of gland orifices, lid margin irregularity, lid margin thickening, and partial glands) was evaluated based on anterior photographs and meibographs. Results: The mean age was 21.3 years (8-44 years). Mean BUT and Oxford corneal staining scores were 2.6 ± 1.2 seconds and 1.9 ± 0.8, respectively. Abnormal findings of the Meibomian glands were observed in all patients. The mean LLT was 79.6 ± 27.4 μm and the incomplete eye blinking frequency was 3.8 ± 5.9 during 20 seconds. The graphs of the tear lipid layer showed various patterns such as flat, up-hill, down-hill, and mixed. Conclusions: Meibomian gland dysfunctions and changes in the tear film lipid layer were noted in patients with phlyctenular keratoconjunctivitis. These factors are to be considered for the treatment of phlyctenular keratoconjunctivitis in young patients under 10 years of age. 목적: 눈물간섭계를 이용하여 플릭텐각결막염환자의 마이봄샘 형태와 눈물 지질층 두께 변화를 분석하고자 하였다. 대상과 방법: 플릭텐각결막염으로 진단된 환자 13명 19안의 후향적 의무기록 분석을 하였다. 눈물막파괴시간과 각결막 염색검사를 시행하고 눈물간섭계로 눈물 지질층 두께, 부분 눈꺼풀 깜빡임, 마이봄샘을 촬영하여 분석하였다. 눈꺼풀의 모세혈관확장, 마이봄샘개구부의 막힘, 눈꺼풀테의 불규칙성과 두꺼워짐, 마이봄샘의 손실을 보았으며 이를 점수화하였다. 결과: 환자의 평균 연령은 21.3 ± 10.1세로, 평균 눈물막파괴시간 및 옥스포드 각막염색 점수는 각각 2.6 ± 1.2초 및 1.9 ± 0.8이었다. 10세 미만의 환자에서도 마이봄샘의 변화가 관찰되었다. 평균 눈물 지질층은 79.6 ± 27.4 μm이고 불완전 눈꺼풀 깜박임은 20초 동안 3.8 ± 5.9였다. 눈물 지질층의 그래프는 편평형, 오르막형, 내리막형 및 혼합형과 같은 다양한 패턴을 보여주었다. 결론: 이 연구는 마이봄샘 기능이상과 눈물 지질층의 변화가 플릭텐각결막염환자에서 나타남을 보여주었다. 10세 이하의 어린 나이에 플릭텐각결막염환자에서도 치료 과정에서 이런 변화를 고려해야할 것으로 생각한다.
마이봄샘 기능이상을 동반한 안구건조증 환자에서 온열마사지치료기기의 임상적 유용성
김대우,권영아,송상률,김병엽,정재림,Dai Woo Kim,MD,Young A Kwon,MD,Sang Wroul Song,MD,Byoung Yeop Kim,MD,Jae Lim Chung,MD 대한안과학회 2013 대한안과학회지 Vol.54 No.9
Purpose: To evaluate the clinical usefulness of KCL 990<sup>® for the treatment of dry eye with meibomian gland dysfunction (MGD). Methods: Patients (n = 54 eyes, 27 subjects) diagnosed with dry eye with MGD were recruited for a prospective, one-month clinical trial. Patients received a twice-a-day 15-minute treatment using the KCL 990?. Effectiveness parameters included patient symptom scores using the Ocular Surface Disease Index (OSDI) questionnaires, tear osmolarity measured with TearLab<sup>® (TearLab Corporation, San Diego, CA, USA), classical tear break-up time (TBUT), and objective TBUT value using an Optical Quality Analysis System (OQAS<sup>®, Visiometrics, Castelldefels, Spain). Data are presented for pre-treatment (baseline) and at 1 week and 1 month post-treatment. An objective TBUT value was estimated in each eye when the optical scattering index (OSI) started to increase consistently, and data were obtained at pretreatment (baseline) and at 1 month post-treatment. Results: The symptom scores on OSDI questionnaires, tear osmolarity, and tear break-up time improved significantly from baseline to one week (p < 0.05). This improvement was maintained with no significant regression at 1 month (p < 0.05). The objective TBUT value decreased significantly at 1 month (p < 0.05). Conclusions: KCL 990<sup>® contributed to improve not only signs and symptoms of dry eye with MGD, but also the function of the tear film and ocular surface.
비감염결절성 및 진균성공막염으로 오인되었던 매독성공막염 1예
한상윤,이정진,권영아,송상률,김병엽,정재림 대한안과학회 2014 대한안과학회지 Vol.55 No.8
Purpose: To report a case of syphilitic scleritis initially misdiagnosed as noninfectious nodular or fungal scleritis. Case summary: A 63-year-old female, who had severe headaches and ocular pain in her left eye despite treatment with topical and oral NSAIDs for the past 4 months, was transferred from a local clinic. The patient had a history of pterygium excision in the same eye 4 years prior. Upon presentation, she had a scleromalacia with calcified plaque at the nasal conjunctiva. An erythematous nodular elevated lesion was observed in the superonasal sclera. Microbiological smear and cultures were performed to exclude infectious scleritis. Under the suspicion of noninfectious nodular scleritis, the patient was prescribed topical oral steroid and oral NSAIDs. Candida parapsilosis was identified by the microbiological culture. Under the suspicion of fungal scleritis, oral fluconazole and topical amphotericin B were administered, but the lesions did not improve. On the 23rd day of treatment, we discovered the patient had a history of syphilis. The serology test was negative for RPR and FTA-ABS IgM but positive for FTA-ABS IgG. Under the suspicion of syphilitic scleritis, oral doxycycline (200 mg bid) was administered and benzathine penicillin M (2.4 million units) was injected intramuscularly 3 times at 1-week intervals. After the doxycycline and benzathine penicillin therapy, the pain and nodular erythematous lesions were completely resolved. Conclusions: As shown in this case, syphilitic scleritis should be considered when the patient is resistant to other conventional treatments and shows positive serological tests for syphilis. This is important because syphilitic scleritis is usually aggravated by steroid treatment but can be cured by proper anti-syphilitic chemotherapy. J Korean Ophthalmol Soc 2014;55(8):1233-1237