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우세준,Ga Eun Cho,Joon Hee Cho 대한안과학회 2019 Korean Journal of Ophthalmology Vol.33 No.2
Purpose: To investigate the short-term efficacy and safety of ranibizumab in the routine clinical setting in patientswith neovascular age-related macular degeneration and to analyze the associated factors for visual outcome. Methods: This was a post-hoc analysis of a ranibizumab regulatory post-marketing surveillance study in which4,136 patients were enrolled and followed for 12 weeks. Change in best-corrected visual acuity (BCVA), sizeof choroidal neovascularization, and the presence of hemorrhage and exudate were analyzed and the associationbetween BCVA change and baseline characteristics were investigated. Data on ocular and systemicadverse events were collected. Results: Mean BCVA improved significantly and mean BCVA change was the logarithm of the minimal angle ofresolution 0.13 ± 0.01 (p < 0.001). A lower baseline BCVA and younger age were significant predictive factorsfor visual improvement or maintenance (≥0 lines). For greater visual acuity gain (≥3 lines), no treatment history,lower baseline BCVA, younger age, and classic-type choroidal neovascularization were significant predictivefactors. No new safety signals were found. Conclusions: In this study, conducted in real-world clinical practice with a large number of neovascular age-relatedmacular degeneration patients, visual and anatomical outcomes improved significantly after three monthlyranibizumab treatments. Treatment-naive patients had a higher chance of greater visual gain (≥3 lines) thannon-naive patients.
조수창,우세준,박규형,황정민 대한안과학회 2013 Korean Journal of Ophthalmology Vol.27 No.1
Purpose: To investigate the morphologic changes in the outer retina of patients with cone dystrophy, using spectral-domain optical coherence tomography (SD-OCT). Methods: The medical records of 15 cone dystrophy patients examined from January 2007 to January 2012 were reviewed retrospectively. All patients underwent ophthalmic evaluation including best-corrected visual acuity (BCVA), color vision testing, fundus examination, full-field standard electroretinography (ERG), multifocal (mf) ERG, and SD-OCT. Qualitative and quantitative SD-OCT data and ERG responses were analyzed and compared among the patient categories and the normal control group. Results: There were 4 major categories of SD-OCT findings, based on the status of the ellipsoid portion of the photoreceptor inner segment (ISe), outer segment (OS) contact cylinder, and retinal pigment epithelium (RPE) layer. Category 0 showed no structural abnormalities. Category 1 showed foveal ISe loss and obscurity of the border between the ISe band and the external limiting membrane (ELM). Category 2 showed foveal thinning and focal foveal ISe disruption with an intact ELM. Category 3 showed foveal thickening and perifoveal disruption of the ISe layer. Category 1 to 3 showed OS contact cylinder layer absence and RPE thickening. The patients in category 0 tended to be younger (mean, 10.0 years) than those in categories 1 to 3 (mean, 17.6 years), although this difference was not statistically significant. Category 1 to 3 patients exhibited statistically significant thinning of the central retina and outer nuclear layer and thickening of the RPE layer relative to the category 0 and normal control group. There was a significant correlation between the central foveal thickness and BCVA in the patients with cone dystrophy. ERG and mfERG responses did not differ significantly among the different cone dystrophy categories. Conclusions: The morphologic features of cone dystrophy as revealed by SD-OCT, could be categorized as either normal or 1 of 3 different types of outer retinal changes. The presence of normal retinal structures in young cone dystrophy patients with functional impairment (category 0) indicates that electrophysiologic studies are superior to current imaging modalities for the early diagnosis of cone dystrophy. The characteristic SD-OCT findings in cone dystrophy patients may aid in differential diagnosis and be useful for future research on the pathology of cone dystrophy.
Intra-arterial Thrombolysis for Central Retinal Artery Occlusion: Two Cases Report
황교준,우세준,박규형,황정민,권오기 대한의학회 2010 Journal of Korean medical science Vol.25 No.6
Central retinal artery occlusion (CRAO) causes severe visual loss in affected eye and vision does not recover in more than 90% of the patients. It is believed that it occurs by occlusion of the central retinal artery with small emboli from atherosclerotic plaque of internal cerebral artery. Retina is a part of the brain, thus basically CRAO is corresponding to acute occlusion of intracerebral artery and retinal ischemia is to cerebral stroke. Therefore, intra-arterial thrombolysis (IAT) has been considered as a treatment method in CRAO. Recently, we treated 2 patients diagnosed as CRAO and could achieve complete recanalization on fundus fluorescein angiogram with IAT. Of them, one recovered visual acuity to 20/25. We report our 2 CRAO cases treated with IAT and discuss technical aspects for IAT and management of patient. To the best of our knowledge, this is the first Korean report of IAT for CRAO.
김재민,우세준,박규형,정흠 대한안과학회 2013 Korean Journal of Ophthalmology Vol.27 No.5
We report two cases of surgical removal of a retained subfoveal perfluorocarbon liquid (PFCL) bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade. Two patients underwent pars plana vitrectomy with PFCL injection for rhegmatogenous retinal detachment. In both cases, a retained subfoveal PFCL bubble was noticed postoperatively by funduscopy and optical coherence tomography. Both patients underwent surgical removal of the subfoveal PFCL through a therapeutic macular hole and gas tamponade. The therapeutic macular holes were completely closed by gas tamponade and the procedure yielded a good visual outcome (best-corrected visual acuity of 20 / 40in both cases). In one case, additional intravitreal PFCL injection onto the macula reduced the size of the therapeutic macular hole and preserved the retinal structures in the macula. Surgical removal of a retained subfoveal PFCL bubble through a therapeutic macular hole combined with intravitreal PFCL injection and gas tamponade provides an effective treatment option.
송현범,우세준,정철규,이윤종,안지윤,박규형,권오기 대한안과학회 2013 Korean Journal of Ophthalmology Vol.27 No.5
Livedoid vasculopathy (LV) is characterized by a long history of ulceration of the feet and legs and histopathology indicating a thrombotic process. We report a case of acute central retinal artery occlusion in a 32-year-old woman who had LV. She showed no discernible laboratory abnormalities such as antiphospholipid antibodies and no history of cerebrovascular accidents. Attempted intra-arterial thrombolysis showed no effect in restoring retinal arterial perfusion or vision. The central retinal artery occlusion accompanied by LV in this case could be regarded as a variant form of Sneddon’s syndrome,which is characterized by livedo reticularis and cerebrovascular accidents.
신주영,우세준,안지윤,박규형 대한안과학회 2013 Korean Journal of Ophthalmology Vol.27 No.6
Purpose: To describe optical coherence tomography (OCT) characteristics of neovascular age-related maculardegeneration (AMD) patients refractory to intravitreal anti-vascular endothelial growth factor (VEGF) injections(ranibizumab, bevacizumab) and their responses to alternative anti-VEGF agents or photodynamic therapy(PDT). Methods: A retrospective review of 267 neovascular AMD patients treated with intravitreal anti-VEGF injections. Results: Twenty patients (7.5%) were refractory to anti-VEGF injections (stationary or increased retinal exudationdespite three or more monthly injections). They were grouped into either the extensive intraretinal fluidgroup (IRF group, 9 patients) or the subretinal fluid only group (SRF group, 11 patients) according to OCTfindings. In the IRF group, response rates to subsequent treatment were 0% (0 / 7) for bevacizumab, 50% (3/ 6) for ranibizumab and 50% (3 / 6) for PDT ± anti-VEGF. Three out of four bevacizumab-refractory patientsshowed response to ranibizumab as a secondary treatment. In the SRF group, response rates were lowerwith 0% (0 / 7) for bevacizumab, 22.2% (2 / 9) for ranibizumab and 28.6% (2 / 7) for PDT ± anti-VEGF. One outof four bevacizumab-refractory patients responded to ranibizumab. The visual outcome was worse in the IRFgroup (median 20 / 1,000) than in the SRF group (median 20 / 100). Conclusions: In anti-VEGF-refractory neovascular AMD, patients with extensive IRF refractory to bevacizumabcan be responsive to ranibizumab while patients with SRF may be refractory to both, suggesting a differentpathophysiology and intraocular pharmacokinetics.