백내장 수술 후 발생한 Enterococcus faecalis 재발성 안내염 2예

안민원,신민규,박성후,이지은 대한안과학회 2015 대한안과학회지 Vol.56 No.4

목적: Enterococcus faecalis (E. faecalis)에 의한 재발성 안내염 2예를 경험하였기에 보고하고자 한다. 증례요약: 증례1: 75세 여성이 백내장 수술 3일 후 발생한 우안 시력저하와 안구 통증으로 내원하였다. 안내염으로 진단하였고 안내 항생제 주사 후 염증이 조절되었으나 1달 후 재발하여, 유리체절제술을 시행하고 실리콘 기름과 항생제를 안내 주입하였다. 증례2:74세 여성이 백내장 수술 2일 후 발생한 우안 시력저하로 내원하였다. 안내염으로 진단하였고, 안내 항생제 주사 후 염증은 조절되었으나 1달 후 재발하여, 유리체절제술, 후낭절제술, 안내 항생제 주입술 시행하였고, 염증은 조절되었다. 유리체절제술 40일 후 다시재발하여 인공수정체를 제거하고, 실리콘 기름과 항생제를 안내 주입하였다. 두 증례 모두 첫 발생 및 재발에서 시행한 균 배양검사에서 각각 E. faecalis가 동정되었고, 안내 항생제는 vancomycin과 ceftazidime을 사용하였다. 증례 1은 이후 실리콘 기름을 제거하였고, 5개월 후 교정시력 20/400이었다. 증례 2는 이후 실리콘 기름을 제거하고 인공수정체 공막고정술을 시행하였으며, 5개월 후 최대교정시력은 20/40이었다. 결론: 백내장 수술 후 발생한 안내염의 원인균이 E. faecalis일 경우 감염이 조절된 후에 재발할 수 있음을 염두에 두어야 한다. Purpose: To report 2 cases of recurrent Enterococcus faecalis (E. faecalis) endophthalmitis after uneventful phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Case summary: Case 1: A healthy, 75-year-old female presented with a sudden visual loss and ocular pain 2 days after phacoemulsification and IOL implantation. After successful treatment with intravitreal antibiotics injection, the infection was apparently cleared. At 1 month after the initial presentation, recurrent endophthalmitis occurred and was resolved with vitrectomy, silicon oil tamponade, and intravitreal antibiotics injection. Two months after vitrectomy, the silicone oil was removed and the patient’s final visual acuity improved to 20/400 5 months later. Case 2: A healthy, 74-year-old female presented with a sudden visual loss 2days after phacoemulsification and IOL implantation. After successful treatment with intravitreal antibiotics injection, the infection was apparently cleared. One month later, recurrent endophthalmitis occurred and was resolved with vitrectomy, posterior capsulotomy,and intravitreal antibiotics injection. Forty days later, the patient had a similar relapse. The infection resolved with IOL explantation, silicon oil tamponade, and repeated intravitreal antibiotics injections. E. faecalis was identified at the first and recurrent episode. Vancomycin and ceftazidime were used for each intravitreal administration. Silicone oil removal and IOL scleral fixation were performed and the patient’s final visual acuity was 20/40 5 months later. Conclusions: Close monitoring for recurrences is recommended in endophthalmitis due to E. faecalis after phacoemulsification even after a successful initial treatment.

누기에 기생한 동양안충 증례 2안

안민원(Min Won Ahn),유학선(Hak Sun Yu),이종수(Jong Soo Lee) 대한검안학회 2015 Annals of optometry and contact lens Vol.14 No.2

Purpose: To report Two cases of Thelazia callipaeda from the canaliculus after irrigation of lacrimal duct Case Summary : A 82-year-old male patient and a 64-year-old male patient presented with symptoms of epiphora, itching, and a sense of foreign body. Patients did not report having had flies in their eyes, and keep animals such as dogs, cats, and cows. After the irrigation of lacrimal duct, actively moving worms were identified in conjunctiva and were extracted with forceps. Extracted worms were a white thread-like round worm, 10-15 mm in size. The presence of the Thelazia callipaeda worms was confirmed by light microscopic findings. The patients’ symptoms resolved and there were no recurrences. Conclusions : Thelazia callipaeda usually lie in the ocular surface, causing ocular surface disease. After removal the worms, symptoms are resolved. For treat and prevention of the thelaziasis, the continious study about life cycles and routes of infection of Thelazia callipaeda is necessary.

인공수정체 혼탁으로 오인된 지연 낭폐쇄증후군 1예

안민원(Min Won Ahn),김소희(So Hee Kim),이종수(Jong Soo Lee) 대한안과학회 2018 대한안과학회지 Vol.59 No.6

목적: 인공수정체 혼탁으로 오인된 지연 낭폐쇄증후군 1예에 대한 진단 및 치료경험을 보고하고자 한다. 증례요약: 59세 남자가 1년 전부터 진행된 우안 시력저하를 주소로 내원하였다. 고혈압 외에는 특이병력이 없었으며, 10년 전 타 병원에서 양안 백내장수술을 받았다. 안과 개인의원에서 우안 인공수정체 변성으로 인한 혼탁으로 진단받고 인공수정체 교체를 위해 본원으로 전원되었다. 내원 당시 나안시력은 0.06이며, 안압은 22 mmHg, 굴절력은 인공수정체 부위의 혼탁 때문에 측정되지 않았다. 세극등현미경검사에서는 인공수정체의 부위가 우유빛 변성으로 관찰되었다. 전안부 빛간섭광학단층촬영에서 인공수정체 뒤쪽 고반사 물질의 저류가 관찰되었고, 초음파생체현미경검사에서는 수정체 후낭의 팽창이 확인되었다. Neodymium-doped yttrium aluminium garnet (Nd:YAG) 레이저 후낭절개술을 시행한 후 합병증 발생 없이 나안시력이 1.0으로 호전되었다. 결론: 낭폐쇄증후군은 백내장수술 후 1일에서 2주 사이에 드물게 발생하는 합병증인데, 술 후 10년이 지나서도 발생하는 지연 낭폐쇄증후군은 전형적인 임상양상과 달리 나타나기에 인공수정체의 변성으로 인한 혼탁과 감별이 매우 중요하다. Purpose: We report a case of late-onset capsular block syndrome, which resulted in a misdiagnosis of intraocular lens (IOL)opacity. Case summary: A 59-year-old man visited our clinic with reduced visual acuity in the right eye from 1 year prior. He had undergone uncomplicated bilateral cataract surgery by phacoemulsification with IOL implants at another hospital 10 years before. There was no specific history with the exception of hypertension. After being diagnosed in the ophthalmology clinic with IOL degeneration and opacity in the right eye, he was referred to our hospital for IOL replacement. Upon examination, his right uncorrected visual acuity was 0.06 and intraocular pressure was 22 mmHg. The refractive error could not be checked due to IOL opacity. Slit-lamp microscopy revealed a cloudy, milky IOL. Anterior-segment optical coherence tomography of the right eye showed retention of a highly reflective material in the lens capsule behind the IOL. Posterior capsule enlargement of the right eye was confirmed on ultrasound biomicroscopy. After neodymium-doped yttrium aluminium garnet (Nd:YAG) laser capsulotomy was performed, the homogeneous space disappeared and the eye recovered normal visual acuity. Conclusions: Capsular block syndrome is a rare complication that can occur shortly (1 day to 2 days) after cataract surgery. Late-onset capsular block syndrome, which occurs 10 years after surgery differs from typical clinical manifestations. Thus, capsular block syndrome is an important consideration upon the presentation of opacification due to IOL degeneration.

한국인 만성 포도막염 환자에서 Mycophenolate Mofetil

안민원(Min Won Ahn),김현웅(Hyun Woong Kim),이지은(Ji Eun Lee) 대한안과학회 2016 대한안과학회지 Vol.57 No.2

목적: 한국인 만성 포도막염 환자들에서 Mycophenolate mofetil (MMF)의 치료 효과와 안전성에 대해 알아보고자 하였다. 대상과 방법: 2010년부터 2014년까지 2개의 3차 의료기관에서 만성 포도막염 조절을 위해 MMF를 사용하고 6개월 이상 경과 관찰된 25명의 환자를 대상으로 하였다. 환자들의 의무기록을 후향적으로 분석하여 염증의 조절 정도, 스테로이드 감량 효과, MMF 중단 여부로 치료효과를 평가하였고, MMF의 사용과 관련된 부작용을 조사하여 안전성을 평가하였다. 적어도 28일 간격으로 경과 관찰 시 2번이상 염증 조절이 확인되는 경우를 치료 성공이라 정의하였다. 결과: 대상 환자는 평균 나이가 47.5세, 남자 18명, 여자 7명이었다. 포도막염 원인 질환은 베체트병 15명(60%), 보크트-고야나기-하라다병 4명(16%), 교감성안염 2명(8%), 전신홍반성루푸스 1명(4%), 원인 미상의 포도막염 3명(12%)이었다. 해부학적 위치는 20%에서 앞포도막염, 80%에서 뒤 또는 전체 포도막염이었다. MMF 치료 후 6개월 44%, 12개월 50%에서 염증이 조절되었다. 스테로이드를 10 mg/day 이하로 감량하여도 염증이 조절되는 비율은 6개월 36%, 12개월 45%였다. 3명(12%)에서 부작용으로, 2명(8%)에서 염증조절 실패로 MMF를 중단하였다. 결론: MMF는 만성 포도막염 환자에서 부작용이 적으면서 효과적인 면역조절약물이며 한국인에서도 그 효과를 확인할 수 있었다. Purpose: To evaluate the therapeutic effect and safety of mycophenolate mofetil (MMF) on chronic uveitis in Korean patients. Methods: This study included 25 patients with chronic uveitis who used MMF and were followed up more than 6 months in 2 referral centers from 2010 to 2014. The medical records were analyzed retrospectively. The therapeutic effect was assessed based on control of inflammation, corticosteroid sparing effects, and discontinuation of MMF, and the safety was assessed based on side effects. Control of inflammation was defined as no active inflammation observed on at least 2 consecutive visits 28 days apart or more. Results: The 25 patients consisted of 18 males and 7 females. The mean age of the patients was 47.52 years. The etiology of uveitis was as follows: Behcet’s disease in 15 patients (60%), Vogt-Koyanagi-Harada disease in 4 (16%), sympathetic ophthalmia in 2 (8%), systemic lupus erythematosus in 1 (4%), and idiopathic uveitis in 3 (12%). Anatomic classification was anterior uveitis in 20% and posterior uveitis or panuveitis in 80% of patients. Complete control of inflammation was achieved in 44% and 50% of patients within 6 months and 1 year, respectively. Systemic corticosteroid dosage was reduced to 10 mg of prednisone or less while maintaining sustained control of inflammation in 36% and 45% of patients for 6 months and 1 year, respectively. MMF was discontinued in 3 patients (12%) due to side effects and in 2 patients (8%) due to lack of effectiveness. Conclusions: MMF was effective and side effects were uncommon when managing chronic uveitis in Korean patients.

모반 제거용 이산화탄소 극초단파 레이저에 의한 각막 화상 1예

김영희,안민원,이종수 대한안과학회 2014 대한안과학회지 Vol.55 No.9

Purpose: Periocular carbon dioxide ultrapulsed laser surgery can induce ocular damage. Herein we report a rare case of corneal burn after carbon dioxide ultrapulsed laser for nevus removal. Case summary: A 25-year-old female patient presented with ocular pain, decreased visual acuity, and metamorphopsia in the left eye after laser surgery for nevus removal at a dermatology clinic 4 days prior. The patient’s best corrected visual acuity in the left eye was 20/100. Central corneal haziness and corneal epithelial defect were observed on biomicroscopic examination. Antibiotics, steroid and artificial tear eye drops were administered for treatment. Glasses were prescribed to correct refraction errors. After 2 months of treatment, the best corrected visual acuity in the left eye recovered to 20/50, and corneal epithelial defect was mostly healed, however corneal haziness remained. Conclusions: Carbon dioxide ultrapulsed laser is commonly used in dermatological treatments. The use of an eye shield is important during this procedure, and possibility of ocular surface damage from laser treatment should be considered. J Korean Ophthalmol Soc 2014;55(9):1376-1379

The Effect of Preparatory Education Program on Discomfort and Retching of Examinees during Upper Gastrointestinal Endoscopy

이주연,안민원,김은태,김대현,권혁중,조동영,윤형문 대한가정의학회 2012 Korean Journal of Family Medicine Vol.33 No.4

Background: Although upper gastrointestinal (UGI) endoscopy is highly sensitive for the detection of esophago-gastroduodenal lesions, pain and discomfort during the procedure cause examinees to experience stress and anxiety. Moreover,there have been only a few studies on relief of pain and discomfort during UGI endoscopy through preparatory interventions. Therefore, the aim of this study was to investigate the relationship between a preparatory education program and the discomfort and retching experienced by examinees during endoscopy. Methods: A total of 306 examinees who visited a health promotion center and underwent non-sedated endoscopy from May 13 to July 3, 2009 were included in this study. After they were assigned to experimental (n = 154) and control groups (n = 152), their discomfort and retching were measured with a visual analogue scale. The preparatory education program consisted of cognitive intervention, behavioral intervention and information. Results: The preparatory education program relieved discomfort during endoscopy in male subjects, in subjects aged 60 and over, or in subjects with previous endoscopic experience with statistical significance (P < 0.05). It also relieved retching during endoscopy in subjects aged 60 and over with statistical significance (P = 0.023). Multiple logistic regression analysis showed that the preparatory education program significantly relieved the discomfort of examinees during endoscopy (P = 0.028). Conclusion: We found that the preparatory education program used in this study could significantly relieve the discomfort caused by endoscopy, particularly in subjects aged 60 and over, or in male subjects with a high incidence of stomach cancer in Korea.

성인 고도근시안에서 부분결합간섭계를 이용하여 측정한 안축장의 변화

이재정,이인호,안민원,박강윤,박성후,변익수,이지은 대한안과학회 2018 대한안과학회지 Vol.59 No.3

Purpose: To investigate the change in axial length (AL) in highly myopic adults using partial coherence interferometry, and to identify the factors associated with the increase in AL. Methods: Medical records of highly myopic adults (≥ -6 diopters [D] or AL ≥ 26.0 mm) were retrospectively reviewed. The AL of each patient was measured using partial coherence interferometry at least three times over 2 years, and the yearly change in AL was calculated. Associations between age, AL, choroidal thickness, and the rate of AL change were evaluated using multiple regression analysis. Results: In total, 24 patients (4 males, 20 females) and 44 eyes were included in this study. The mean age was 54.9 ± 10.4 years, the initial AL was 29.335 ± 2.006 mm, the choroidal thickness was 72.7 ± 41.80 μm, the average spherical equivalent was -11.86 ± 3.85 D (-5.1~-22.0 D), and the mean follow-up period was 2.2 ± 0.5 years. A significant increase in AL of ≥0.05 mm was observed in 38 eyes (86.4%) at 2 years. The mean AL was significantly increased, to 29.409 ± 2.007 mm (p < 0.001), at 1 year and to 29.476 ± 2.028 mm (p < 0.001) at 2 years. The average rate of AL change was 0.071 ± 0.049 mm (-0.01~0.19 mm) per year. None of the included factors showed an association with the rate of AL change in multiple regression analysis. Conclusions: In this study, an increase in AL in highly myopic adults was more frequent than in previous reports using A-scan. Periodic measurements are therefore recommended for the early detection of complications. 목적: 부분결합간섭계를 이용하여 성인 고도근시 환자에서 안축장의 변화를 알아보고 안축장의 증가와 관련된 인자를 알아보고자 하였다. 대상과 방법: 2012년부터 2016년까지 만 30세 이상의 성인 고도근시(근시 ≥ -6D 또는 안축장 ≥ 26.0 mm)로 2년 이상 경과관찰 중 3회 이상 부분결합간섭계로 안축장 측정이 이루어졌던 눈을 대상으로 하였다. 안축장 변화속도는 일년당 안축장 변화로 계산하였으며, 다중회귀 분석을 시행하여 나이, 안축장, 맥락막 두께와 안축장 증가의 관련성을 평가하였다. 결과: 총 24명(남성 4명, 여성 20명) 44안이 본 연구에 포함되었다. 평균 연령은 54.9 ± 10.4세였으며, 초기 안축장은 29.335 ± 2.006 mm, 맥락막 두께는 72.7 ± 41.80 μm, 초기 평균 구면렌즈대응치는 -11.86 ± 3.85D (-5.1~-22.0D)였다. 평균 경과관찰 기간은 2.2 ± 0.5년이었다. 2년째 대상안 중 38안(86.4%)에서 0.05 mm 이상의 유의한 안축장의 증가가 있었다. 평균 안축장은 1년에 29.409 ± 2.007 mm (p<0.001), 2년에 29.476 ± 2.028 mm (p<0.001)로 유의하게 증가하였다. 안축장 증가속도 평균은 0.071 ± 0.049 mm/year (-0.01~0.19 mm)였다. 다중회귀 분석 결과 안축장 증가의 속도와 관련성이 있는 변수는 없었다. 결론: 성인 고도근시 환자에서 안축장의 증가는 초음파 A-scan을 이용한 이전 보고에 비하여 흔하게 발생하였으며 합병증의 발생에 관한 지속적인 경과관찰이 필요할 것이다.

COVID-19 mRNA 백신 주사 후 발생한 백내장 2예

윤은유,최재원,안민원,박민지 대한안과학회 2022 대한안과학회지 Vol.63 No.12

목적: COVID-19 mRNA 백신 주사 후 진행한 단안 백내장 2예를 보고하고자 한다. 증례요약: 2명의 환자가 mRNA 백신 후부터 시작된 단안의 시력저하를 주소로 내원하였다. 40세 남자 환자는 mRNA-1273 (ModernaⓇ, Cambridge, UK) 2차 주사 후부터 발생된 좌안 시력저하를 주소 내원하였으며 40세 여성 환자는 BNT162b2 (PfizerⓇ, New York, NY, USA) 3차 주사 후 발생한 양안 시력저하를 주소로 내원하였다. 두 증례 모두 안과적 과거력도 없었으며 안저검사에서 뚜렷한시신경병증이나 망막병증은 없었다. 수정체유화술 및 인공수정체 삽입술을 시행 후 2개월의 최대교정시력은 향상되었고 안압은 안정적으로 유지되었다. 결론: COVID-19 mRNA 백신 주사 후 백내장의 발생 및 진행 가능성을 고려해야 할 것으로 생각한다.

헐거운 마스크 착용이 눈물막파괴시간에 미치는 영향에 대한 고찰

이주헌(Jooheon Lee),안민원(Minwon Ahn),최재원(Jaewon Choi),박민지(Minji Park) 대한안과학회 2023 대한안과학회지 Vol.64 No.5

목적: 마스크의 헐거운 착용이 안구의 눈물막파괴시간에 어떠한 영향을 주는지에 대하여 단면 연구 및 실험 방법을 통하여 확인하고자 하였다. 대상과 방법: 안구건조증이 있거나 있지 않은 60인의 60안을 대상으로 연속적으로 마스크 미착용, 마스크 헐겁게 착용, 마스크 밀착착용 등 3가지 조건에서 10분간 각각의 상태 유지 후 비침습적 눈물막파괴시간(non-invasive tear-film break-up time)을 비교 분석하였다. 비침습적 눈물막파괴시간의 측정은 각막지형도(Keratograph)를 이용하였다. 결과: 단면 연구 분석에서 눈물막파괴시간은 마스크 미착용 시를 기준으로 마스크를 헐겁게 착용 시, 마스크 밀착 착용 시 각각 7.53 ± 0.83초, 6.19 ± 0.78초, 7.36 ± 0.68초로 확인되었으며 미착용 시와 밀착 착용 시 비교에서는 유의미한 차이를 보이지 않았으나(p-value=0.517) 마스크를 헐겁게 착용하였을 때 다른 2가지 조건과 비교하여 통계적으로 유의하게 눈물막파괴시간이 감소하였다(p-value=0.013). 결론: 헐거운 마스크 착용은 건성안의 유무와 관계없이 눈물막파괴시간을 감소시키며 건성안 증상을 유발하거나 악화시키는 요인으로 작용할 수 있다. Purpose: We investigated the the effect of wearing a loose mask on tear-film break-up time using cross-sectional and experimental methods. Methods: This was a comparative analysis of non-invasive tear-film break-up time (NIBUT) after wearing no mask, loose mask, and tight mask for 10 minutes each in 60 eyes with or without dry eye syndrome. NIBUT measurements were performed using a keratograph. Results: The NIBUT values were 7.53 ± 0.83 seconds, 6.19 ± 0.78 seconds, and 7.36 ± 0.68 seconds for the no mask, loose mask, and tight mask groups, respectively. There was no significant difference between the no mask and tight mask groups (ρ -value = 0.517), but the loose mask group had a significantly reduced NIBUT compared with the other groups (ρ-value = 0.013 and 0.022, respectively). Conclusions: Wearing a loose mask reduced the tear-film break-up time regardless of the presence or absence of dry eyes and may cause or worsen dry eye symptoms.