아메드밸브 삽입술 후 전방 내 실리콘관 첨단의 위치와 각막내피세포 변화

오원혁,김태우,박기호,김동명,Won Hyuk Oh,Tae Woo Kim,Ki Ho Park,Dong Myung Kim 대한안과학회 2013 대한안과학회지 Vol.54 No.3

Purpose: To evaluate the impact of location of a silicone tube tip in the anterior chamber on corneal endothelium after Ahmed glaucoma valve implantation. Methods: We measured the distance from the tip of a silicone tube in the anterior chamber to the posterior surface of the cornea by anterior segment optical coherence tomography (OCT) in 24 eyes of 21 patients who underwent Ahmed glaucoma valve implantation. All surgeries were performed by a single surgeon. The corneal endothelial cells of central, superior, superotemporal, and superonasal area of the cornea were examined by specular microscope before and after surgery. Results: The distance from the tip of the silicone tube in the anterior chamber to the posterior surface of the cornea and the corneal endothelium were measured at 19.2 ± 11.8 months (2.8-41.2 months) after surgery. At the central corneal area, a statistically significant decrease in the number of corneal endothelial cells (2278 ± 565/mm2 vs. 2177 ± 529/mm2, p = 0.043) after surgery was observed, but no relationship was found between the amount of decrease and distance from the tip to the posterior surface of the cornea. At the superotemporal corneal area where the tip of the silicone tube was located in the anterior chamber, there was more significant loss of corneal endothelial cells than in the other areas after surgery (p = 0.006). Moreover, the amount of endothelial cell loss at the superotemporal area was negatively correlated to the distance from the tip to the posterior surface of the cornea (partial correlation coefficient by time -0.558, p = 0.031). Conclusions: To minimize the loss of corneal endothelial cells after Ahmed glaucoma valve implantation, ensuring a sufficient distance from the tip of the silicone tube to the posterior surface of the cornea is important.

모야모야병 환자에서 안과검사를 통해 모야모야증후군으로 진단한 1예

오원혁 대한안과학회 2018 대한안과학회지 Vol.59 No.1

Purpose: To report a case of moyamoya syndrome after an additional diagnosis of neurofibromatosis type 1 (NF 1) using an ophthalmic examination in a middle-aged patient with moyamoya disease. Case summary: A 60-year-old male with no specific past medical history except moyamoya disease visited our hospital for an ophthalmic examination. Two years prior, he had been diagnosed with moyamoya disease by brain imaging performed after a head trauma. At the first visit, his best corrected visual acuity was no light perception in the right eye (OD) and 20/25 in the left eye (OS). The intraocular pressure was 8 mmHg (OD) and 10 mmHg (OS). On fundus examination, the right eye showed a dense opacity of an ocular media and the left eye showed no abnormality except an increased cup-to-disc ratio. However, infrared imaging showed multiple whitish lesions in the left eye. Fluorescein angiography showed a patchy choroidal filling delay. During the follow-up, slit-lamp microscopy revealed Lisch nodules and multiple café au lait spots and neurofibromas were found in the skin which led to the diagnosis of NF 1. Conclusions: When examining patients with moyamoya disease, ophthalmologists should check not only ocular comorbidity associated with moyamoya disease but also ocular comorbidity with other systemic diseases that can accompany moyamoya disease. NF 1 is the most common systemic disease associated with moyamoya syndrome. In this case, appropriate follow-up was essential to monitor the development of ocular or systemic vasculopathies and their complications. 목적: 중년의 모야모야병 환자에서 안과검사를 통해 제1형 신경섬유종증을 추가 진단하여 모야모야증후군으로 진단한 예를 보고하고자 한다. 증례요약: 내원 2년 전 두부외상 후 시행한 뇌영상검사에서 모야모야병으로 진단 받은 60세 남자가 내원하였다. 초진 시 최대 교정시력 우안 무광각, 좌안 20/25, 안압은 우안 8 mmHg, 좌안 10 mmHg였다. 안저검사에서 우안은 매체혼탁으로 안저가 관찰되지 않았고, 좌안은 시신경유두함몰비 증가 이외 특이 소견이 없었지만, 적외선안저영상에서 다수의 흰색 병변, 형광안저혈관조영술에서 군데군데 맥락막충만지연이 관찰되었다. 경과 관찰 중 세극등현미경검사에서 리쉬결절을 발견한 이후, 피부에서 다발성 담갈색반점 및 신경섬유종을 확인하여 제1형 신경섬유종증으로 진단할 수 있었다. 결론: 모야모야병을 가진 환자를 진료할 때 모야모야병에 의한 안구 이상뿐 아니라 모야모야병과 연관될 수 있는 전신질환의 동반 여부를 세심한 안과검사를 통해 확인해야 한다. 특히 제1형 신경섬유종증은 모야모야증후군과 연관성이 높은 질환으로, 이 경우에는 눈을 포함한 전신의 혈관병증 및 그 합병증 발생에 대한 경과 관찰이 필요하다.

Vogt-Koyanagi-Harada병에 합병된 황반하 맥락막신생혈관에 대한 Verteporfin을 이용한 광역학요법

오원혁 ( O Won Hyeog ),유형곤 ( Yu Hyeong Gon ),정흠 ( Jeong Heum ) 대한안과학회 2004 대한안과학회지 Vol.45 No.5

망막박리가 발생한 미숙아망막병증에서 두르기공막돌륭술의 임상 결과

오원혁 ( O Won Hyeog ),유영석 ( Yu Yeong Seog ) 대한안과학회 2004 대한안과학회지 Vol.45 No.5

망막박리가 발생한 미숙아망막병증에서 두르기공막돌륭술의 임상 결과

오원혁 ( O Won Hyeog ) , 유영석 ( Yu Yeong Seog ) 대한안과학회 2004 대한안과학회지 Vol.45 No.5

Vogt-Koyanagi-Harada병에 합병된 황반하 맥락막신생혈관에 대한 Verteporfin을 이용한 광역학요법

오원혁 ( O Won Hyeog ) , 유형곤 ( Yu Hyeong Gon ) , 정흠 ( Jeong Heum ) 대한안과학회 2004 대한안과학회지 Vol.45 No.5

유두주위오목으로의 망막탈출에 의한 시신경섬유층 결손 1예

박재용,오원혁 대한안과학회 2018 대한안과학회지 Vol.59 No.7

Purpose: To report a case of glaucoma suspect with peripapillary pit, which enlarged in size with retinal herniation through the pit, and resulted in retinal nerve fiber layer defect and corresponding visual field defect. Case summary: A 34-year-old male was referred to our glaucoma clinic for glaucoma evaluation. The intraocular pressure was 15 mmHg in the right eye and 14 mmHg in the left eye. The refractive error in spherical equivalence was -12.75 diopters (D) in the right eye and -11.50 D in the left eye. The axial length was 28.70 mm in the right eye and 28.15 mm in the left eye. On optical coherence tomography (OCT), the retinal nerve fiber layer thickness was within normal limits in both eyes. A peripapillary pit was found in both eyes, which measured 155 μm in the right eye and 625 μm in the left eye in maximal horizontal diameters. Two year follow-up OCT images showed that the peripapillary pit in the right eye enlarged to 239 μm and retinal herniation occurred through the pit, resulting in a retinal nerve fiber layer defect and a corresponding visual field defect. However, the peripapillary pit in the left eye had no significant change. Conclusions: Glaucoma patients or suspects, with peripapillary pits need close observation because of the possibility of a retinal nerve fiber layer defect in the direction of the pit. 목적: 녹내장의증으로 경과 관찰하던 환자에서 유두주위오목이 커지면서 그 방향으로 망막이 탈출하여, 시신경섬유층 결손과 함께 연관된 시야장애가 나타난 증례를 경험하였기에 이를 보고하고자 한다. 증례요약: 34세 남자 환자가 녹내장의증으로 본원 녹내장 클리닉으로 의뢰되었다. 환자의 안압은 우안 15 mmHg, 좌안 14 mmHg였다. 굴절이상은 구면렌즈대응치로 우안 -12.75디옵터, 좌안은 -11.50디옵터였으며, 안축장은 우안 28.70 mm, 좌안 28.15 mm였다. 빛간섭단층촬영에서 망막신경섬유층의 두께는 양안 모두 정상 범위 안에 있었다. 양안에서 유두주위오목이 관찰되었으며, 최대수평직경은 우안 155 μm, 좌안 625 μm였다. 2년 뒤 시행한 빛간섭단층촬영에서 우안 유두주위오목은 239 μm로 커지면서 그 방향으로 망막이탈출하여 시신경섬유층결손 및 이에 상응하는 시야장애가 발생하였다. 하지만 좌안 유두주위오목에는 변화가 없었다. 결론: 유두주위오목이 있는 녹내장 또는 녹내장의증 환자에서 유두주위오목 방향으로 시신경섬유층결손이 발생할 수 있으므로 면밀한 경과관찰이 필요하다.

경골 Pilon 골절의 AO/ ASIF 식 수술적 치료

김기용,빈성일,오원혁 대한골절학회 1992 대한골절학회지 Vol.5 No.1

The intra-articular fractures of the distal tibia extending into the ankle joint, the so called tibial pilon fractures, present a challenge to the surgeon because of their severity of comminution and impaction. They usually result from vertical compression forces and rotational forces which lead to a force directed through the talus into the tibial plafond. Although historically the results of various type of treatment of these fractures have been less than optimal, there has been a recent trend that suggests success in the majority of cases through operative treatment following the principles outlined by the AO/ASIF group; (1) Reconstruction of the correct length of the fibula; (2) Reconstruction of the articular surface of the tibia; (3) Introduction of a cancellous autograft to fill in the bone defect in the metaphysis of the tibia; (4) Stabilization of the medial aspect of the tibia by a plate, and then early range of motion exercises of ankle joint and delayed weight bearing. The results of treatment of 8 cases tibial pilon fractures exciusively treated by internal fixation following the principles of the AO/ASIF group were analysed at the Department of Orthopedic Surgery, Asan Medical Center from Oct. 1989 to Jun. 1991. The results were as follows: 1. The major cause of injury was fall down (6 out of 8 cases). 2. The assocated injuries were fractures of calcaneus (2), talus (2), vertebra(1), pat.ella(1), tarsal bones (1) anrl midtarsal joint dislocation (1). 3. The ipsilateral fibular fractures were combined in 5 out of 8 cases. 4. The types of fractures were type B (3 cases), type C (5 cases) according to AO/ASIF classification. 5. Open reduction and internal fixation was performed with cloverleaf plate (5 cases) and May anatomical bane plate (3 cases). 6. The good results were 5 cases and fair results were 3 cases.

양안 이측 시신경위축환자에서 황반부 망막신경절세포층 두께와 시기능과의 연관성

김범기,박재용,오원혁,최진 대한안과학회 2020 대한안과학회지 Vol.61 No.1

목적: 양안 이측 시신경위축을 보이는 환자에서 황반부 망막신경절세포층 두께를 측정하여 최대교정시력 및 시야판독결과 지표들과의 연관성을 확인하고자 하였다. 대상과 방법: 양안 이측 시신경위축을 보이는 15명의 30안과 연령과 성별이 일치된 정상인 15명의 30안이 연구에 포함되었다. 빛간섭단층촬영을 이용하여 후극부 볼륨스캔을 시행하였고, 당뇨망막병증 조기치료연구 황반부 기준선을 적용하여 9개 구역에서 망막신경절세포층 두께를 측정하였다. 망막신경절세포층 두께와 최대교정시력, 시야판독결과지표 사이의 연관성을 분석하였다. 결과: 망막신경절세포층 두께는 환자군에서 대조군과 비교하였을 때 모든 구역에서 유의하게 더 얇았다(p=0.000). 내상측, 내이측, 내하측, 내비측 구역의 망막신경절세포층두께는 최대교정시력과 유의한 상관관계를 보였으며(R=0.650, R=0.626, R=0.616, R=0.636. p=0.000), 외상측, 외이측, 외하측, 외비측 구역의 망막신경절세포층 두께는 시야검사의 표준편차와 유의한 상관관계를 보였다(R=0.470, R=0.349, R=0.496, R=0.469. p<0.05). 결론: 양안 이측 시신경위축을 보이는 환자에서 내측 구역의 망막신경절세포층 두께는 최대교정시력과 관련이 있었고, 외측구역의 망막신경절세포층 두께는 시야검사의 평균 편차와 관련이 있었다. Purpose: To investigate correlations between macular retinal ganglion cell (RGC) layer thickness and best-corrected visual acuity (BCVA) and visual field parameters in patients with bilateral temporal optic atrophy. Methods: Thirty eyes of 15 patients with bilateral temporal optic atrophy and 30 eyes of 15 normal subjects that were age- and sex-matched were included in the study. We measured the thicknesses of the RGC layers of posterior poles using optical coherence tomography volume scanning. The RGC layer was divided into nine zones based on the Early Treatment of Diabetic Retinopathy Study baseline. Possible correlations of the RGC layer with the BCVA and visual field parameters were determined. Results: The RGC layer thickness was significantly thinner in all patients compared to those in the control group (p = 0.001). The RGC layer thicknesses in the inner superior, inner temporal, inner inferior, and inner nasal areas were significantly correlated with the BCVA (r = -0.650, r = -0.626, r = -0.616, and r = -0.636, respectively; p = 0.000). The RGC layer thicknesses in the outer superior, outer temporal, outer inferior, and outer nasal areas were significantly correlated with the mean deviation of the visual field test (r = 0.470, r = 0.349, r = 0.496, and r = 0.469, respectively; p < 0.05). Conclusions: In patients with bilateral temporal optic atrophy, the RGC layer thickness in the medial region was correlated with the BCVA, and the RGC layer thickness in the lateral region was correlated with the mean deviation of the visual field test.

메타졸아미드 복용 후 발생한 전방각 폐쇄에 의한 급성 안압상승 1예

정경도,김범기,오원혁 대한안과학회 2017 대한안과학회지 Vol.58 No.12

Purpose: To report a case involving an unexpected increase in intraocular pressure (IOP) and acute angle closure after oral administration of methazolamide. Case summary: A 38-year-old male visited the emergency department complaining of decreased visual acuity (VA) and ocular pain. These symptoms developed after he took two tablets of 50 mg methazolamide because his IOP was above normal after a short course of systemic steroid treatment. His uncorrected VA dropped to 0.04 and the refractive error was -6.5 diopters in both eyes. The anterior chamber was very shallow, and the IOPs were 46 mmHg in the right eye and 42 mmHg in the left eye. Macular retinal folds were observed in both eyes in infrared fundus images. The patient was instructed not to take methazolamide, which was suspected as the cause of this idiosyncratic drug reaction. He was prescribed topical anti-glaucoma medications and cycloplegics to relieve the acute angle closure, and all symptoms disappeared after these treatments. Conclusions: Methazolamide is a sulfa derivative like topiramate, which can cause acute angle closure involving edema of the ciliary body and anterior displacement of the lens–iris diaphragm. Clinicians should consider this possible IOP increase before prescribing methazolamide. 목적: 안압 하강을 목적으로 메타졸아미드를 복용한 후 전방각 폐쇄로 안압이 상승하였던 1예를 경험하였기에 보고하고자 한다. 증례요약: 38세 남자가 양안의 시력저하, 안구통 등으로 응급실에 내원하였다. 1주 전 유행각결막염으로 인근 안과의원에서 스테로이드 제제 등을 처방 받아 복용하였고, 응급실 내원 당일 오전 같은 의원에서 안압이 올랐다고 듣고, 메타졸아미드를 처방 받아 복용한 후 저녁부터 상기 증상이 발생하였다고 하였다. 응급실 내원 시 나안시력은 양안 0.04, 자동굴절검사에서 -6.5디옵터였다. 전방이 얕아져 있었고, 안압은 우안 46 mmHg, 좌안 42 mmHg였다. 적외선안저영상에서 양안 황반 주름이 관찰되었다. 원인 약물로 의심하였던 메타졸아미드의 복용을 중단하고, 점안 안압하강제, 조절마비제를 처방한 후 모든 증상은 소실되었다. 결론: 메타졸아미드는 전방각 폐쇄를 유발한다고 알려진 토피라메이트 등과 같은 술폰아미드계 약물로, 섬모체부종을 유발하고 수정체홍채가로막을 전방으로 이동시켜 전방각 폐쇄와 급성 근시를 유발한다. 메타졸아미드를 처방할 때에는 역설적 안압상승의 가능성을 염두에 두어야 하겠다.