눈꺼풀 바닥편평세포암 1예

염혜리,조원경,백지선,양석우,Hae-Ri Yum,MD,Won-Kyung Cho,MD,Ji-Sun Paik,MD,Suk-Woo Yang,MD 대한안과학회 2011 대한안과학회지 Vol.52 No.12

Purpose: To report a rare case of basosquamous carcinoma of the eyelid, an aggressive tumor with a higher tendency for recurrence and metastasis. Case summary: An 87-year-old woman presented with a painful mass and bloody exudates at the left lateral lower eyelid. Four years previous, the patient was diagnosed with basosquamous carcinoma of the left lower eyelid after biopsy at another hospital. At that time, she was unable to receive operation because she had suffered from a serious heart condition. With time, the left lower eyelid mass continued to grow and symptoms and signs of pain and bloody exudates appeared. The patient underwent surgery for complete tumor resection and repair and the biopsy of a specimen showed tumor-free margins and no metastasis to distal sites. Conclusions: Basosquamous carcinoma is a subtype of basal cell carcinoma with aggressive behavior and a higher tendency for recurrence and metastasis. However, our case showed no recurrence with no metastasis to the nearby lymph nodes, vessels, or nerves. We report a case of basosquamous carcinoma of the eyelid at old age that was cured after operative resection. J Korean Ophthalmol Soc 2011;52(12):1519-1523

소아에서 급성 눈물샘염으로 발현된 비특이성안와염 1예

염혜리,강남여,Hae-ri Yum,Nam-Yeo Kang 대한안과학회 2011 대한안과학회지 Vol.52 No.11

Purpose: To report a case of idiopathic orbital inflammation presenting as unilateral acute dacryoadenitis in a child. Case Summary: A nine-year-old boy presented with painful swelling and redness in the right upper eyelid and temporal conjunctiva without systemic symptoms for five days. Acute orbital cellulitis was suspected but did not respond to systemic antibiotics. An orbital computed tomogram and magnetic resonance imaging revealed a diffusely enlarged and inflamed right lacrimal gland. The patient showed dramatic response to systemic corticosteroids, and acute dacryoadenitis due to idiopathic orbital inflammation was diagnosed. Treatment with oral corticosteroids for two months resolved the inflammation. No relapse was observed during four months of follow-up. Conclusions: Although rare, acute dacryoadenitis as a localized nonspecific orbital inflammation should be considered in the differential diagnosis of acute orbital cellulitis in pediatric patients. J Korean Ophthalmol Soc 2011;52(11):1357-1361

라식 후 백내장 수술을 받은 근시 환자의 술 후 굴절력의 장기 변화

염혜리,김만수,Hae Ri Yum,Man Soo Kim 대한안과학회 2012 대한안과학회지 Vol.53 No.12

Purpose: To evaluate the long-term change of postoperative refraction after cataract surgery in patients with a history of LASIK. Methods: A retrospective chart review was performed on 40 eyes of 28 patients who had undergone cataract surgery with a history of LASIK, and 40 eyes of 31 patients who had undergone cataract surgery without LASIK. We evaluated preoperative target refraction, and postoperative refraction during the 2-year follow-up period. Results: In the group with a history of LASIK, the target refraction was -1.00 ± 0.98 D, the 2-month postoperative spherical equivalent was -0.53 ± 1.92 D, and the 2-year postoperative spherical equivalent was -1.03 ± 1.84 D. In the group with cataract surgery only, the target refraction was -1.44 ± 1.06 D, the 2-month postoperative spherical equivalent was -1.07 ± 1.27 D, and the 2-year postoperative spherical equivalent was -0.97 ± 1.28 D. The difference in mean spherical equivalent at 2 months postoperatively and at 2 years postoperatively between the 2 groups was statistically significant (p = 0.037). The difference in mean spherical equivalent preoperatively and 2 years postoperatively between the 2 groups was statistically significant (p = 0.002). In the group with cataract surgery only, the postoperative refraction shifted to hyperopic refractive power, and was statistically significant. In the group with a history of LASIK, there were no statistically significant differences between preoperative and postoperative refraction. There were no statistically significant differences according to the cataract type in the group with a history of LASIK. The greater the myopic preoperative spherical equivalent was, the shorter the duration between LASIK and cataract surgery, which was significant in the group with a history of LASIK. Conclusions: The long-term refractive change after cataract surgery was statistically significant between the cataract surgery after LASIK group and the cataract surgery alone group.

범발성 혈관내 응고증 환자에서 발현된 양안 망막중심정맥폐쇄 1예

정경인,염혜리,김인태,Kyoung In Jung,Hae Ri Yum,In Tae Kim 대한안과학회 2011 대한안과학회지 Vol.52 No.8

Purpose: To report a case of bilateral central retinal vein occlusion (CRVO) as one of the initial signs of disseminated intravascular coagulation (DIC). Case summary: A 33-year-old woman with a history of pregnancy-induced thrombotic thrombocytopenic purpura presented to our hospital with bilateral visual loss. On her initial visit, visual acuity was counting fingers at 30 cm in both eyes. Based on the findings of a funduscopic examination, the patient was diagnosed with bilateral CRVO. Laboratory tests confirmed the diagnosis of DIC combined with thrombotic thrombocytopenic purpura (TTP). Plasma exchange and transfusion of cryoprecipitate with fresh frozen plasma was performed. The ocular fundus findings did not improve. Despite medical treatment, the patient’s systemic condition deteriorated and she died of metabolic acidosis two weeks later. Conclusions: Bilateral central retinal vein occlusion occurred as a sign of aggravation of preexisting TTP and progression to DIC in the presented case. In patients with severe bilateral retinal venous changes, there should be a very high level of suspicion for presence or progression of systemic disease, with the possibility of effective early systemic evaluation and therapy. J Korean Ophthalmol Soc 2011;52(8):1005-1008

안구회선에서 맹점지도검사의 진단적 유용성

이재훈(Jae Hoon Lee),염혜리(Hae Ri Yum),이세엽(Se Youp Lee),이영춘(Young Chun Lee) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 이차하사근기능항진을 보이는 환자에서 수술 전후 안저사진검사와 맹점지도검사로 회선의 변화를 관찰하여, 맹점지도검사의 회선 측정이 진단적 유용성이 있는지 알아보았다. 대상과 방법: 이차하사근기능항진으로 진단된 11명(12안)을 환자군으로, 안운동 이상이 없는 10명(20안)을 대조군으로 하여 안구운동 검사, 안저사진검사와 험프리 자동시야검사를 시행하였다. 안구운동검사로 하사근기능항진 정도를 평가하였으며, 안저사진검사와 험프리 자동시야검사로 회선량을 각각 측정하였다. 환자군에서 수술은 하사근절제술 혹은 후전술을 시행하였고 수평사시가 동반된 경우에는 수평사시수술을 동시에 시행하였으며, 수술 1달 후 하사근기능항진 정도와 회선량을 측정하여 수술 전과 비교하였다. 결과: 환자군에서 하사근기능항진은 수술 전 +2.42 ± 0.63에서 수술 후 +0.50 ± 0.52로 감소되었으며 회선량은 환자군의 안저사진검사에서 수술 전 +14.15 ± 3.60°에서 수술 후 +7.47 ± 1.65° (p<0.001)로, 맹점지도검사에서 수술 전 +12.19 ± 1.62°에서 수술 후 +9.69 ± 1.75°(p=0.061)로 각각 감소되었다. 대조군에서 측정된 회선량은 안저사진검사에서 평균 +7.44 ± 1.62°, 맹점지도검사에 서 +7.24 ± 1.28°로 각각 측정되었다. 결론: 하사근기능항진 정도와 맹점지도검사에서 측정된 안구회선량은 유의한 상관관계를 보이지 않았으며 수술 전후 회선량 또한 유의한 차이를 보이지 않아 임상적 유용성은 적을 것으로 생각된다. <대한안과학회지 2016;57(6):957-962> Purpose: To evaluate diagnostic the usefulness of blind spot mapping in measuring ocular torsion changes and to investigate the correlations of inferior oblique muscle overaction (IOOA) and excyclotorsion measurements using fundus photographs and blind spot mapping in patients with secondary IOOA. Methods: Eleven patients (12 eyes; IOOA group) diagnosed with secondary IOOA were evaluated for ocular movement, fundus photograph and Humphrey standard automated perimetry, and 10 patients (20 eyes; control group) were subjected to the same tests. An ocular movement examination was performed to evaluate IOOA, and fundus photograph and Humphrey standard automated perimetry were used to measure the ocular torsion. Inferior oblique myectomy or recession was performed along with horizontal strabismus surgery, and preoperative and postoperative IOOA and ocular torsion measurements were compared between the groups. Results: In the IOOA group after surgery, the IOOA decreased from +2.42 ± 0.63 to +0.50 ± 0.52, the ocular torsion decreased from +14.15 ± 3.60° to +7.47 ± 1.65° (p < 0.001) on fundus photographs, and from +12.19 ± 1.62° to +9.69 ± 1.75° (p = 0.061) in Humphrey standard automated perimetry. The control group showed a mean ocular torsion of 7.44 ± 1.62° on fundus photographs and +7.24 ± 1.28° on Humphrey standard automated perimetry. Conclusions: The usefulness of blind spot mapping when the ocular torsion was measured in IOOA patients was considered low, due to the weak correlation between IOOA and extorsion; preoperative and postoperative ocular torsion amount values were not significantly different. J Korean Ophthalmol Soc 2016;57(6):957-962

전체눈근육 마비로 처음 진단된 원발성 뇌하수체 림프종 1예

송석현(Seok Hyeon Song),염혜리(Hae Ri Yum) 대한검안학회 2017 Annals of optometry and contact lens Vol.16 No.4

Purpose: To report a patient with total ophthalmoplegia as the 1st manifestation due to a primary pituitary lymphoma (PPL). Case summary: A 62-year-old woman visited the ophthalmology clinic with 2-week history of right upper eyelid ptosis and binocular diplopia. Ophthalmologic evaluation showed a 7 mm dilated pupil in the right eye, relative afferent pupillary defect (RAPD), exotropia of 70 prism diopters in primary position and eye movement limitation in adduction (-4), elevation (-4), depression (-4), and abduction (-2) of the right eye. The patient suffered from right facial pain and headache, but no definite other systemic symptoms were found. Brain magnetic resonance imaging showed the pituitary macroadenoma. Trans-sphenoidal surgery was performed and the pathology confirmed an infiltration of the pituitary gland by a diffuse large B-cell lymphoma. A bone marrow biopsy, abdomen, pelvis, chest computed tomography, and total body positron emission tomography–computed tomography confirmed the absence of systemic involvement and thus the diagnosis of PPL was posed. The postoperative course was without complications. The patient underwent treatment with systemic chemotherapy. By 2 months postoperatively, the patient had complete resolution of the ptosis, relative afferent pupillary defect, pupil dilatation, diplopia, exotropia and eye movement limitation, and the best corrected visual acuity was approved. Conclusions: Although primary pituitary lymphoma hardly occurs, ophthalmic symptoms like ophthalmoplegia, diplopia, and ptosis can be the first sign of primary pituitary lymphoma. The patient can show recovery from ophthalmic symptoms and nervous symptoms with appropriate diagnosis and treatment.

후천 마비사시의 임상양상

신지수(Ji Soo Shin),김정태(Jung Tae Kim),염혜리(Hae Ri Yum) 대한안과학회 2017 대한안과학회지 Vol.58 No.5

목적: 후천 3, 4, 6번 뇌신경마비의 원인별 분포와 발병양상을 조사하고, 각 뇌신경마비의 회복률, 회복기간 및 이에 영향을 미치는 요소를 알아보고자 하였다. 대상과 방법: 2015년 3월부터 2016년 2월까지 양안 복시를 주소로 건양대학교병원 안과 외래에 내원하여 후천성 3, 4, 6번 뇌신경마비로 진단된 환자 중 2회 이상 추적 관찰이 가능하였던 92명을 대상으로 의무기록을 후향적으로 분석하였다. 이 중 증상 발생 2주 내에 진료를 본 후 6개월 이상 경과관찰이 가능했던 66명을 대상으로 회복률 및 이에 영향을 미치는 요소를 분석하였다. 또한 경과 관찰 중에 모든 방향의 안구운동 제한이 완전히 회복되어 일차 및 이차 안위의 사시각과 복시가 완전히 호전된 경우를 완전 회복으로 보았 다. 안구운동제한의 정도는 중간선을 넘지 못하는 경우를 -4, 정상의 50%의 제한을 보이는 경우를 -2로 하여 -1/2부터 -4까지 나누어 분석하였다. 결과: 총 92명의 환자 중 4번 뇌신경마비가 37명(40.2%)으로 가장 많았고, 다음으로 6번 뇌신경마비 33명(35.9%), 3번 뇌신경마비 18명(19.6%), 복합 뇌신경마비 4명(4.3%) 순이었다. 원인별로는 혈관성 원인이 44명(47.8%)으로 가장 많았고, 외상성 원인이 14명 (15.2%), 특발성 13명(14.1%), 염증성 원인 10명(10.9%), 종양성 원인 9명(9.8%), 동맥류 2명(2.2%) 순이었다. 완전회복은 44명(66.7%) 에서 관찰되었고, 완전회복과 부분회복을 합친 전체회복은 57명(86.3%)에서 관찰되었다. 초진 시 사시각도가 적은 경우, 초진 시 안구 운동제한 정도가 적은 경우 완전회복률이 높은 것으로 나타났다(p<0.001, p=0.005, respectively, 단변수분석). 결론: 본 연구에서 혈관성 원인으로 인한 마비사시의 발생이 가장 높았고, 초진 시 마비의 정도가 경할수록 완전회복률이 높았다. 또한 뇌신경 마비에 대한 빠른 진단 및 신속한 치료를 통해 높은 전체회복률을 보였다. <대한안과학회지 2017;58(5):572-578> Purpose: The purpose of our study was to evaluate the cause of acquired third, fourth, and sixth nerve palsy while also establishing recovery rates and important factors for recovery. Methods: A retrospective chart review was performed for 92 patients who visited the ophthalmologic department of Konyang University Hospital with acquired third, fourth, and sixth nerve palsy from March 2015 to February 2016. Recovery rates and factors for recovery were evaluated in only 66 patients who received first ocular exam within 2 weeks of onset and who were followed up for at least 6 months. Complete recovery was defined as both complete recovery of the angle of deviation and the restoration of eye movement in all directions. For the degree of ocular motor restriction, -4 was defined as not crossing the midline and -2 was defined as 50% eye movement. The degree of ocular motor restriction was analyzed from -1/2 to 4. Results: The fourth nerve was affected most frequently (n = 37, 40.2%), followed by the sixth cranial nerve (n = 33, 35.9%), the third cranial nerve (n = 18, 19.6%), and a combination of 2 or more cranial nerves (n = 4, 4.3%). Vasculopathy (n = 44, 47.8%) was the most common etiology, followed by trauma (n = 14, 15.2%), idiopathic (n = 13, 14.1%), inflammation(n = 10, 10.9%), neoplasm (n = 9, 9.8%), and aneurysm (n = 2, 2.2%). Complete recovery rate occurred for 66.7% (n = 44) of patients, and the overall recovery rate (i.e., at least partial recovery) was 86.3% (n = 57). Significant factors for complete recovery were the initial deviation angle and the limitation of extraocular movement (p < 0.001, p = 0.005, respectively, according to univariate analysis). Conclusions: In this study, paralytic strabismus due to vasculopathy was the most common etiology, and a lower degree of initial deviation resulted in an improved complete recovery rate. In addition, a high overall recovery rate was possible through quick diagnosis and early treatment of cranial nerve palsy. J Korean Ophthalmol Soc 2017;58(5):572-578