술 전 눈물길 더듬자 검사에서 저항을 보이는 위치에 따른 실리콘관 삽입술의 치료 효과

양찬민,박인기 대한안과학회 2015 대한안과학회지 Vol.56 No.7

목적: 코눈물관 폐쇄 환자를 대상으로 술 전에 눈물길 더듬자 검사를 시행했을 때 저항이 있는 부위에 따른 실리콘관 삽입술의 치료효과에 대해서 알아보고자 하였다. 대상과 방법: 높은 눈물띠 높이와 눈물소관 관류술을 통해 역류를 보이는 코눈물관 폐쇄가 의심되는 환자 72명 102안을 대상으로 눈물길 더듬자 검사를 시행했을 때 코눈물관의 근위부에만 저항이 있는 군(Group I), 원위부에만 저항이 있는 군(Group II), 근위부,원위부 모두 저항이 있는 군(Group III)으로 분류하여 각 군별 실리콘관 삽입술의 치료 효과를 비교하였다. 치료 효과는 실리콘관 제거후 마지막 방문 시 환자의 증상이 완전히 없어지고, 눈물띠 높이가 정상화되었을 때 수술 성공으로 간주하였다. 결과: 실리콘관 삽입술의 성공률은 근위부에만 저항이 있는 군(Group I)에서 53.1%, 원위부에만 저항이 있는 군(Group II)에서 78.8%,근위부와 원위부 모두에 저항이 있는 군(Group III)에서 27.0%였고, 원위부에만 저항이 있는 군에서 성공률이 유의하게 높았다(p=0.001). 결론: 누낭조영술을 시행하지 않고도 눈물길 더듬자 검사에서 코눈물관의 원위부에만 저항이 느껴지는 경우 코눈물관 불완전 폐쇄뿐만 아니라 완전 폐쇄에서도 실리콘관 삽입술의 효과가 좋을 것으로 예측할 수 있다. Purpose: To evaluate clinical outcomes of silicone tube intubation according to the site of resistance to lacrimal duct probing in complete or partial nasolacrimal duct obstruction patients. Methods: This study included 102 eyes of 72 patients who were diagnosed with complete or partial nasolacrimal duct obstruction and who underwent silicone tube intubation. According to the site of resistant to nasolacrimal duct probing, eyes were divided into proximal resistance (Group I), distal resistance (Group II) and both side resistance (Group III). The success rate was estimated based on functional (symptom relief) and anatomical (normalization of tear meniscus) success. Results: The success rates in Group I, Group II, and Group III were 53.1%, 78.8%, and 27.0%, respectively, showing that Group II attained the highest success rate (Pearson chi-square test, p = 0.001). Conclusions: In cases of only distal resistance to lacrimal probing without dacryocystography, silicone tube intubation should be performed with expectation of good clinical outcomes, even if complete nasolacrimal obstruction was suspected on syringing.

오노디 세포내 곰팡이 덩이에 의한 시신경병증 1예

한영수,양찬민,신재호,박인기,Young Soo Han,Chan Min Yang,Jae Ho Shin,In Ki Park 대한안과학회 2014 대한안과학회지 Vol.55 No.3

Purpose: To report a rare case of optic neuropathy caused by a fungal ball in an Onodi cell. Case summary: A 63-year-old female was referred to our clinic with relapsed visual loss and ocular pain in the right eye. She had been diagnosed as optic neuritis 14 days before and given pulse steroid therapy. She recovered to normal but relapsed 7 days before. In medical referral there was no suspected multiple sclerosis but only a few inflammation in the paranasal sinuses. On our initial examination, best corrected visual acuity was counting finger at 10 cm in the right eye, and 1.0 in the left eye, along with relative afferent pupillary defect in the right eye. The fundoscopic examinations disclosed disc swelling; nearly total visual field defect was observed on visual field examination and visual evoked potential test revealed decreased amplitude at P100 wave in the right eye. Clinical impression was relapsed optic neuritis. After the administration of pulse steroid therapy, her disc swelling was decreased and visual acuity was recovered to 0.6, however, visual acuity was exacerbated to 0.4 in 2 weeks. We checked outside brain magnetic resonance imaging (MRI) and the result showed optic neuropathy caused by a fungal ball in an Onodi cell. The patient was referred to otorhinolaryngologist and fungal ball was removed by endoscopic sinus surgery. 3 weeks after surgery the patient's visual acuity was 0.9, no disc swelling was found and visual evoked potential was recovered to normal. Conclusions: An Onodi cell lesion should be considered in the differential diagnosis of optic neuritis, identified by imaging studies and promptly removed by surgery for visual recovery. J Korean Ophthalmol Soc 2014;55(3):426-431

Comparison of Intraocular Lens Power Calculation Methods Following Myopic Laser Refractive Surgery: New Options Using a Rotating Scheimpflug Camera

조규연,임동희,양찬민,정의상,정태영 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.6

Purpose: To evaluate and compare published methods of calculating intraocular lens (IOL) power following myopic laser refractive surgery. Methods: We performed a retrospective review of the medical records of 69 patients (69 eyes) who had undergone myopic laser refractive surgery previously and subsequently underwent cataract surgery at Samsung Medical Center in Seoul, South Korea from January 2010 to June 2016. None of the patients had pre-refractive surgery biometric data available. The Haigis-L, Shammas, Barrett True-K (no history), Wang-Koch-Maloney, Scheimpflug total corneal refractive power (TCRP) 3 and 4 mm (SRK-T and Haigis), Scheimpflug true net power, and Scheimpflug true refractive power (TRP) 3 mm, 4 mm, and 5 mm (SRK-T and Haigis) methods were employed. IOL power required for target refraction was back-calculated using stable post-cataract surgery manifest refraction, and implanted IOL power and formula accuracy were subsequently compared among calculation methods. Results: Haigis-L, Shammas, Barrett True-K (no history), Wang-Koch-Maloney, Scheimpflug TCRP 4 mm (Haigis), Scheimpflug true net power 4 mm (Haigis), and Scheimpflug TRP 4 mm (Haigis) formulae showed high predictability, with mean arithmetic prediction errors and standard deviations of -0.25 ± 0.59, -0.05 ± 1.19, 0.00 ± 0.88, -0.26 ± 1.17, 0.00 ± 1.09, -0.71 ± 1.20, and 0.03 ± 1.25 diopters, respectively. Conclusions: Visual outcomes within 1.0 diopter of target refraction were achieved in 85% of eyes using the calculation methods listed above. Haigis-L, Barrett True-K (no history), and Scheimpflug TCRP 4 mm (Haigis) and TRP 4 mm (Haigis) methods showed comparably low prediction errors, despite the absence of historical patient information.

0.05% 사이클로스포린 마이크로에멀젼과 나노에멀젼에서 치료 후 건성안 지표 및 점안감 비교

신은혜,임동희,양찬민,정태영 대한안과학회 2019 대한안과학회지 Vol.60 No.3

Purpose: To evaluate and compare the efficacy and sensation of instillation between 0.05% cyclosporine nanoemulsion group and microemulsion group. Methods: This is a double-blind, prospective randomized clinical trial. Patients had 2 weeks of wash-out period before the study. They were randomly assigned to either nanoemulsion group or microemulsion group and treated with each group’s cyclosporine eye drop. Artificial eye drop and topical steroid were used together according to severity of dryness of cornea. We checked every patient’s Break-up time (BUT), Schirmer test, Staining Score and Ocular surface disease index (OSDI) on baseline, 1 month and 3 months after. Patients also self-checked frequency of use of artificial eye drop and topical steroid. Sensation of instillation was also checked. Results: Both nanoemulsion eye-drop and microemulsion eye-drop improved BUT, Schirmer test, Staining Score and OSDI throughout 12 weeks. The nanoemulsion type reduced OSDI significantly compared to the microemulsion type. The mean frequency of use of artificial tear and topical steroid was similar in both groups. Foreign body sense score was higher in microemulsion group. Conclusions: 0.05% cyclosporine nanoemulsion type has simillar efficacy and subjectively less foreign body sensation. 목적: 건성안증후군환자에게 나노에멀젼 방식과 마이크로에멀젼 방식의 0.05% 사이클로스포린 점안액을 사용한 후 건성안증후군 지표 변화 및 점안감 비교를 통한 나노에멀젼 방식의 효과를 확인하고자 하였다. 대상과 방법: 본 임상시험은 단일기관, 무작위배정, 이중 눈가림의 전향적 연구 방식을 채택하였다. 서면 동의를 받은 시험자 군에 대해 2주간의 휴약 기간을 가진 뒤 나노에멀젼 군과 마이크로에멀젼 군으로 무작위 배정하여 12주간 점안하였고, 인공눈물과 국소스테로이드 점안제를 건성안증후군 정도에 따라 병행하였다. 연구 시작 전, 연구 1달 뒤, 연구 3달 뒤의 눈물막파괴시간, 쉬르머검사, 각막염색지수, 안구표면질환지수를 기록하였고, 병행약물의 점안일지와 점안감에 대하여 기록하였다. 결과: 0.05% 사이클로스포린의 나노에멀젼 방식과 마이크로에멀젼 방식 모두 각 군 내 12주간 건성안증후군 지표가 개선되었으며, 두 군 간 변화를 비교 시 안구표면질환지수가 나노에멀젼 방식에서 더 많이 감소하였다. 연구 기간 동안 인공눈물 및 국소 스테로이드점안액 병용 평균 횟수는 두 군에서 유의한 차이가 없었다. 점안감은 마이크로에멀젼 군에서 이물감 점수가 높았다. 결론: 0.05% 사이클로스포린 나노에멀젼 방식은 마이크로에멀젼 방식의 대조약과 비교 시 건성안증후군 치료 효과가 비슷하며, 주관적 점안감이 좀 더 좋은 약제로 사료된다.

옥스카르바제핀 복용 후 발생한 양안의 백내장

김효정,정나연,양찬민,정태영,임동희 대한안과학회 2019 대한안과학회지 Vol.60 No.5

Purpose: To report a case of bilateral posterior subcapsular cataract after taking oxcarbazepine (Trileptal®, Novartis, Basel, Swiss). Case summary: A 19-year-old female visited our clinic with decreased vision in both eyes. Her best-corrected visual acuity was 0.3 in the right eye and 0.5 in the left eye, and slit-lamp examination revealed a bilateral cortical opacity and subcapsular cataract. She had been taking oxcarbazepine for epilepsy for 10 years, which was discontinued 3 years ago. Her mother had undergone cataract surgeries when she was approximately 46 years of age. No other risk factors for cataract were present. Conclusions: In the present case, bilateral cortical opacity and subcapsular cataract were assumed to be associated with the use of oxcarbazepine. We suggest that oxcarbazepine could induce a cataract and recommend a regular follow-up by a qualified ophthalmologist. 목적: 젊은 환자에서 항경련제인 옥스카르바제핀(Oxcarbazepine, Trileptal®, Novartis, Basel, Swiss) 복용 후 발생한 수정체 피막하 백내장 증례를 경험하였기에 이를 보고하고자 한다. 증례요약: 19세 여자 환자가 1년 전부터 발생한 양안 시력저하를 주소로 내원하였다. 교정시력은 우안 0.3, 좌안 0.5였고, 세극등검사상 양안 수정체 피질 백내장 및 피막하 백내장 소견이 발견되었으며 이외에 특이 소견은 관찰되지 않았다. 백내장 위험인자에 대해 환자의 과거력, 약물력, 가족력 등에 대해 문진하였고, 과거력상 뇌전증 진단하에 10년간 옥스카르바제핀을 복용하였고 3년 전부터 중단한 상태였으며, 어머니가 46세경 백내장수술을 받은 가족력이 있었다. 그 외 백내장을 유발할만한 위험인자는 발견되지 않았다. 결론: 옥스카르바제핀이 백내장을 유발하였을 가능성이 있으므로 백내장 발생 시 옥스카르바제핀 복용도 가능한 원인 중 하나로 고려되어야 하며, 옥스카르바제핀을 복용하고 있는 환자의 경우 정기적인 안과 검진이 필요할 것으로 생각된다.

펨토초레이저 백내장수술 도입 초기의 단기 임상경과 및고식적 백내장수술과의 비교

최재환(Jae Hwan Choi),양찬민(Chan Min Yang),정나연(Na Yeon Chung),임동희(Dong Hui Lim),정태영(Tae-Young Chung) 대한안과학회 2018 대한안과학회지 Vol.59 No.5

Purpose: To evaluate the short-term clinical outcome of femtosecond laser-assisted cataract surgery at the initial phase and to compare it with results from conventional phacoemulsification. Methods: This retrospective study was performed on 50 eyes who underwent femtosecond laser-assisted cataract surgery and 50 eyes who underwent conventional phacoemulsification. The short-term outcomes included uncorrected and corrected distance visual acuity and spherical equivalent. The complications of femtosecond laser-assisted cataract surgery were evaluated, and the prevalences of complications between the initial 25 eyes and latter 25 eyes of the cases were compared to evaluate the importance of the learning curve. Results: There were no significant differences in uncorrected (p = 0.78) and corrected (p = 0.89) distance visual acuity between groups 1 month postoperatively. There was no difference in spherical equivalent (p = 0.09). The phacoemulsification time was not different between groups (p = 0.15). However, there was a significant decrease in cumulative dissipated energy in the femtosecond laser-assisted cataract surgery group (p = 0.04). There were complications during femtosecond laser-assisted cataract surgery, such as subconjunctival hemorrhage, miosis, early entry corneal incision, and incomplete corneal incision. The prevalence of complications in the latter 25 eyes was less than that of the first 25 eyes treated with femtosecond laser-assisted cataract surgery; the prevalence of subconjunctival hemorrhage was reduced significantly (p = 0.02). Conclusions: The short-term clinical outcomes of the femtosecond laser-assisted cataract surgery group at the initial phase were not different, and in some cases, better than those of the conventional phacoemulsification group. A learning period is therefore required during the initial phase of femtosecond laser-assisted cataract surgery. J Korean Ophthalmol Soc 2018;59(5):419-427

결막 결석에 의한 상윤부각결막염 양상을 보인 1예

손보권(Bo Kwon Son),양찬민(Chan Min Yang),김태기(Tae Gi Kim),진경현(Kyung Hyun Jin) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 결막 결석에 의한 상윤부각결막염 양상을 보인 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 40세 남자 환자가 한 달 전 발생한 지속적인 좌안의 이물감, 통증 및 결막 충혈 증상으로 내원하였다. 세극등 검사에서 좌안 상부 안구결막의 충혈 및 이완, 상부 각막상피의 결손 및 띠모양의 각막혼탁이 관찰되었다. 상부 안검결막에서 다양한 크기의 결막 결석과 심한 염증이 발견되어 결막 결석의 기계적 자극에 의해 상윤부각결막염 양상을 보이는 것으로 생각하였다. 결석을 30게이지 주사바늘을 이용하여 제거한 후 치료용 콘택트렌즈를 착용하였으며 인공누액, 항생제, 스테로이드를 점안하였다. 치료 7일 후 상부 안구결막 충혈, 상부 각막상피의 결손, 미란 및 각막혼탁이 호전되었다. 이후 4개월간의 외래 경과 관찰 기간 동안 재발 및 특별한 합병증의 발생은 없었으며 상부 각막에 약간의 혼탁 소견만 남았다. 결론: 심한 결막 결석의 기계적 자극은 상윤부각결막염 양상으로 나타날 수 있다. 따라서 상윤부각결막염 양상을 보이는 환자를 진료시에 결막 결석의 가능성을 고려하고 상부 안검결막을 면밀히 관찰해야 한다. <대한안과학회지 2016;57(6):983-987> Purpose: To report a case of conjunctival lithiasis with clinical manifestations of superior limbic keratoconjunctivitis. Case summary: A 40-year-old male complained of pain, foreign body sensation and injection in the left eye lasting 1 month. The slit-lamp examination revealed injection of the superior bulbar conjunctiva, linear corneal band opacity, fine punctate staining and epithelial defect in the superior cornea area. After eversion of the left upper eyelid, there were many various-sized conjunctional concretions and inflammation in the superior tarsal conjunctiva. Therefore, we considered conjunctival lithiasis-induced clinical manifestations of superior limbic keratoconjunctivitis and then removed the conjunctival concretions using a 30-gauge needle. After the procedures, artificial tears, antibiotic eye drops, steroid eye drops and a therapeutic contact lens were applied. After 1 week, all symptoms and signs improved and there was no recurrence for 4 months. Conclusions: Mechanical stimulation by severe conjunctival lithiasis can induce clinical manifestations of superior limbic keratoconjunctivitis. Therefore, in patients with clinical manifestations of superior limbic keratoconjunctivitis, conjunctival lithiasis should be considered by observing the superior tarsal conjunctiva more closely. J Korean Ophthalmol Soc 2016;57(6):983-987

눈꺼풀속말림, 두줄속눈썹 환자에서 시축을 침범한 양안 각막 아밀로이드증

노성래(Sung Rae Noh),양찬민(Chan Min Yang),김태기(Tae Gi Kim),진경현(Kyung Hyun Jin) 대한검안학회 2017 Annals of optometry and contact lens Vol.16 No.2

Purpose: To report a rare case of bilateral secondary corneal amyloidosis with visual disturbance secondary to entropion and distichiasis. Case summary: A 41-year-old man was referred to our clinic for the evaluation of decreased visual acuity in both eyes. Upon admission, the patient’s best-corrected visual acuity was 0.6 OD and count finger OS. External evaluation revealed entropion in both lower eyelids as well as distichiasis involving all 4 eyelids cause irritation to cornea. Slit-lamp examination revealed corneal opacity in the right peripheral cornea and left center cornea. The appearance of corneal opacity is gray-whitish circle with diameter 5 mm in right and 4 mm in left, also presented with gelatinous irregular surface and neovascularization in the right eye. Penetrating keratoplasty was performed for decreased visual acuity in the left eye. Histopathologic analysis of corneal button revealed deposition of amorphous, eosinophilic material just beneath the corneal epithelium. These opacities stained with Congo red and demonstrated apple green birefringence and dichroism. Secondary localized amyloidosis of the cornea was diagnosed without any systemic involvement. Entropion repair and hyfrecation was performed 1 month after penetrating keratoplasty. By the 4 years after penetrating keratoplasty, the patient’s best-corrected visual acuity was 0.9 OD and the patient showed no evidence of corneal graft rejection and recurrence of amyloidosis. Conclusion: Irritation by eyelashes can cause corneal opacity and amyloidosis in patients with distichiasis or entropion.

돼지 인플루엔자와 다른 질병과의 복합감염예에 대한 병리학적 관찰

배유찬,윤경진,Bruce H . Janke,황의경,박중원,이남일,엄현종,양찬민,박은정,최상호 한국수의병리학회 1997 학술대회 Vol.1997 No.-

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