알터나리아 각막염의 임상양상과 예후

유인천,강인성,윤경철,In Cheon You,M,D,In Seong Kang,M,D,Kyung Chul Yoon,M,D,Ph,D 대한안과학회 2007 대한안과학회지 Vol.48 No.4

Purpose: To investigate the risk factor, clinical manifestations, treatment results, and prognosis in Alternaria keratitis. Methods: Thirteen eyes of 13 patients who were diagnosed as Alternaria species by corneal smear and culture were included. The past history, visual acuity, location and size of ulceration, hypopyon, treatment results, and prognosis were analyzed retrospectively. Results: Nine (69.2%) were women, and 4 were men. The mean age was 65.23±8.70 years. Eleven eyes (84.6%) had previous history of corneal traumas by soil or plant material. In 7 eyes (53.8%), the lesions were located at the corneal center. The average size of ulceration was 13.90±21.80 mm2. Four eyes (30.8%) had hypopyon. The initial visual acuity was less than 0.1 in 10 eyes (76.9%). The final visual acuity improved more than 2 lines in 10 eyes (76.9%) and more than 1 line in 12 eyes (92.3%), and did not change in 1 eye (7.7%). The treatment success was achieved in 12 eyes (92.3%). Conclusions: Early diagnosis and specific antifungal treatments of Alternaria keratitis can lead to a good prognosis.

스테노트로포모나스 말토필리아 각막염의 임상양상과 예후

유인천,이승현,박영걸,윤경철,In Cheon You,M,D,Seung Hyun Lee,M,D,Yeoung Geol Park,M,D,Ph,D,Kyung Chul Yoon,M,D,Ph,D 대한안과학회 2007 대한안과학회지 Vol.48 No.7

Purpose: To investigate the risk factor, clinical manifestations, treatment results, and prognoses in Stenotrophomonas maltophilia keratitis. Methods: Ten eyes of 10 patients who were diagnosed with, Stenotrophomonas maltophilia by corneal smear and culture were included in this study. Each patient`s past history, visual acuity, location and size of ulceration, hypopyon, treatment results and prognosis were analyzed retrospectively. Results: Seven pateints (70.0%) were men, and 3 were women. The mean age was 62.9±11.3 years. Only 2 eyes (20.0%) had previous histories of corneal traumas. Polymicrobial infections, including 3 cases infected with Pseudomonas species and 2 cases infected with Fusarium species, were detected in 7 eyes (70.0%). The lesions were located at the corneal center in 6 eyes, and hypopyon was observed in 9 eyes. The average size of ulceration was 28.5±19.6 mm2. Seven eyes (70.0%) underwent surgical treatment. The initial visual acuity was less than 0.02 in 9 eyes (90.0%). The final visual acuity improved in 3 eyes (30.0%) and was less than hand movement in 7 eyes (70.0%). Conclusions: Stenotrophomonas maltophilia keratitis occurs in patients with a compromised ocular surface, is often polymicrobial, and is associated with poor prognoses.

배양 양성 감염각막염의 임상양상 및 항생제감수성 변화: 10년간의 국내 다기관 연구

유인천(In-Cheon You),이상범(Sang-Bumm Lee),서경률(Kyoung Yul Seo),김미금(Mee Kum Kim),윤경철(Kyung-Chul Yoon),고재웅(Jae Wong Koh),이지은(Ji Eun Lee),김성재(Seong-Jae Kim),KOAIDS 대한안과학회 2021 대한안과학회지 Vol.62 No.4

목적: 최근 10년간 감염각막염 중 배양검사상 균주가 확인된 환자에 대하여 여러 임상양상에 대해 알아보고자 한다. 대상과 방법: 2008년 1월부터 2017년 12월까지 전국 8개 병원에서 균주가 확인된 감염각막염 956명의 의무기록을 후향적으로 분석하여, 선행요인, 원인균, 치료 방법, 예후 등을 분석하였다. 결과: 감염각막염의 가장 흔한 선행요인은 안외상(33.2%)이었다. 초기시력은 안전수지 이하가 449안(47.0%)이었다. 각막궤양은 중심부에서 흔하였고, 크기는 4 mm² 이하가 가장 많았다. 전방축농이 동반된 경우는 295안(30.9%)이었다. 배양된 균주는 총 1,039균으로 그람음성균 443균주(42.6%)가 가장 많았다. 가장 흔한 균은 그람음성균은 녹농균, 그람양성균은 피부포도알균, 진균은 푸사륨이었다. 수술 치료는 201안(21.0%)에서 양막이식술 66안, 안구내용제거술 44안 순이었다. 최종시력은 0.2보다 좋은 시력이 422안(44.1%)이었다. 그람양성균은 목시플록사신과 반코마이신에, 그람음성균은 레보플록사신과 세프타지딤에 높은 감수성을 보였지만 일부 장알균과 슈도모나스 등에서 저항성을 보였다. 결론: 국내 감염각막염은 안외상으로 흔히 발생하였고 그람음성균이 가장 많았다. 대표적인 원인균은 피부포도알균, 녹농균, 푸사륨이었다. 입원 후 약물 및 수술적 치료로 시력이 호전된 경우가 많았지만 일부 저항성을 보이는 세균과 진균에 대해서는 주의가 필요하다. 세균에서 불량한 임상결과에 이르는 위험인자는 초기시력 0.02 미만, 전방축농, 65세 이상 나이, 각막중심부 궤양이었고 진균은 70세 이상 나이였다. Purpose: To analyze the clinical manifestations of culture-proven infective keratitis patients over a recent 10-year period. Methods: We retrospectively reviewed the medical records of 956 cases of infective keratitis between January 2008 and December 2017 at eight tertiary hospitals. The study was performed to analyze the risk factors, causative microbial organisms, therapeutic outcomes, and prognosis. Results: The most common risk factor of keratitis was trauma (33.2%). Initial visual acuity (V/A) was finger count or less in 449 eyes (47.0%). The common location of keratitis was central, and the size was 4 mm2 or less. Hypopyon was observed in 295 eyes (30.9%). Of the 1,039 cultured isolates, 443 (42.6%) grew Gram-negative bacteria with the most common being Pseudomonas aeruginosa. The most prevalent Gram-positive bacteria was Staphylococcus epidermidis, and fungi was Fusarium species. Surgical treatments were performed in 201 eyes (21.0%), followed by amniotic membrane transplantation (66 eyes) and evisceration (44 eyes). Final V/A was 20/100 or more in 422 eyes (44.1%). Gram-positive organisms were highly susceptible to moxifloxacin and vancomycin, and Gram-negative organisms were highly susceptible to levofloxacin and ceftazidime. An increase in resistance to these antibiotics was detected for Enterococcus and Pseudomonas. Conclusions: In South Korea, infective keratitis occurs frequently in eyes with trauma. Staphylococcus epidermidis, Pseudomonas aeruginosa, and Fusarium species are commonly identified etiologies of microbial keratitis. The appropriate administered medical and surgical treatments of suspected infectious keratitis can lead to visual improvement with particular care taken to minimize infection related to resistant bacteria and fungal microbes as needed. An initial V/A of 0.02 or less, the presence of hypopyon, age of 65 years or more, and a central lesion were associated with poor clinical outcome of bacterial keratitis. Age of 70 years or more was a significant risk factor for poor clinical outcome of fungal keratitis.

감염성 각막궤양에 의한 절박천공에서 구조 전층각막이식술의 효과

정인영,유인천,박영걸,윤경철,In-Young Jeong,In-Cheon You,Yeoung-Geol Park,PhD,Kyung Chul Yoon 대한안과학회 2007 대한안과학회지 Vol.48 No.7

Purpose: To investigate the effect of tectonic penetrating keratoplasty for the treatment of impending perforations caused by infectious corneal ulcers. Methods: We analyzed preoperative and postoperative visual acuity, lesion location and size, graft size, postoperative outcome, and complications in 19 patients (19 eyes) with impending perforations due to infectious corneal ulcers. All patients underwent tectonic penetrating keratoplasty and had a minimum follow-up period of 6 months. Results: In our study, eight eyes (42.1%) had herpes simplex keratitis, 6 eyes (31.6%) had bacterial keratitis, and 5 eyes (26.3%) had fungal keratitis. Twelve eyes had a lesion located in the central cornea, while 7 eyes had a lesion located in the paracentral cornea. Visual acuity improved in 13 eyes (68.4%) and anatomical success was achieved in 16 eyes (84.2%). Three eyes (15.8%) developed a graft melting secondary to rejection. Complications included bullous keratopathy (3 eyes, 15.8%), graft infection (3 eyes, 15.8%), neovascularization (2 eyes, 10.5%), and secondary glaucoma (1 eye, 5.3%). Conclusions: Tectonic penetrating keratoplasty maintains ocular integrity and effectively treats impending perforations caused by infectious corneal ulcers.

칸디다와 세균의 복합 각막염 5예

양영훈,유인천,Young Hoon Yang,In Cheon You 대한안과학회 2013 대한안과학회지 Vol.54 No.5

Purpose: To report the clinical manifestations and prognoses in 5 cases of mixed Candida and bacterial keratitis and present a literature review on mixed fungal and bacterial keratitis. Case summary: Five eyes of 5 patients (1 male, 4 female) diagnosed as mixed Candida and bacterial keratitis by corneal smear and culture were included in the present study. Patient mean age was 62.80 years. All patients had preexisting ocular or systemic conditions as predisposing factors for mixed Candida and bacterial keratitis. The most common Candida species isolated was Candida albicans (3 eyes, 60%), while Staphylococcus (3 eyes, 60%) was the most common mixed bacterial species. The average size of ulceration was 7.02 mm2. In 2 eyes (40%), the lesions were located at the corneal center. The depth of the infiltration was significant in all cases, and hypopyon was present in 2 eyes (40%). On the initial visit, the visual acuity was counting fingers or worse in all cases. Four eyes (80%) unresponsive to the topical and systemic treatment underwent surgical intervention but only 1 eye (20%), which had responded to the topical and systemic treatment, showed acuity improvement of more than 1 line on the final visit. Conclusions: In managing chronically compromised cornea, the possibility of mixed infections with Candida and bacterial organisms should be considered as keratitis shows poor prognosis.

건성안 환자의 눈물에서 인터페론유도 T 세포 화학주성인자의 농도와 눈물표면인자와의 상관관계

김황균,유인천,윤경철,Hwang Gyun Kim,M,D,In Cheon You,M,D,Kyung Chul Yoon,M,D,Ph,D 대한안과학회 2008 대한안과학회지 Vol.49 No.10

Purpose: This study was performed to evaluate the level of I-TAC in tears of patients with dry eye syndrome and its correlation with the tear surface parameters. Methods: I-TAC levels were measured by enzyme-linked immunosorbent assay (ELISA) in tear samples collected from 33 dry eye patients (16 patients with Sjögren syndrome and 17 patients with non-Sjögren syndrome) and 15 control subjects. The correlations between I-TAC levels and tear surface parameters including tear film break-up time (BUT), basal tear secretion, tear clearance rate (TCR), corneal sensation, keratoepitheliopathy and conjunctival goblet cell density were analyzed. Results: The mean levels of I-TAC were 717±377 pg/ml in patients with dry eye and 444±119 pg/ml in control subjects (P=0.003). The mean levels in Sjögren syndrome patients (1261±324 pg/ml) were significantly higher than those of non-Sjögren syndrome patients (614±131 pg/ml, P=0.003). I-TAC levels correlated significantly with basal tear secretion (P=0.006), TCR (P=0.007), keratoepitheliopathy (P=0.022) and goblet cell density (P<0.001), but did not correlate with BUT (P=0.110) and corneal sensation (P=0.090). Conclusions: The level of I-TAC is elevated in tears of patients with dry eye syndrome including Sjögren syndrome. The level correlates with disease severity and tear surface parameters. J Korean Ophthalmol Soc 2008;49(10):1565-1571

각막이식술 후 재발한 단순포진바이러스 각막염에 대한 분석

정인영,이광훈,유인천,윤경철,In Young Jeong,MD,Kwang Hoon Lee,MD,In Cheon You,MD,PhD,Kyung Chul Yoon,MD,PhD 대한안과학회 2009 대한안과학회지 Vol.50 No.5

Purpose: To analyze the clinical aspects and risk factors for recurrent herpes simplex keratitis (HSK) after penetrating keratoplasty (PKP). Methods: Records from 78 eyes of 41 patients who underwent PKP for HSV keratitis with a mean follow-up duration of 31.83±21.35 months (24~97 months) were reviewed. The clinical aspects of recurrent keratitis, rejection, and survival rate were evaluated. Previous operation history, preoperative inflammation and neovascularization, graft size, suture methods, and antiviral use were analyzed to elucidate the risk factor for recurrent HSK after PKP. Results: HSK recurred in 47.4% of the patients at a mean time of 18.36±21.02 months after PKP. The mean duration of keratitis was 2.16±1.71 months and the mean frequency of recurrence was 1.41±0.69 times. Epithelial keratitis developed in 46.2% of the patients, and epithelial keratitis combined with stromal inflammation developed in 36.5%. Previous graft failure due to recurrent HSK and preoperative inflammation were significant risk factors for recurrent HSK after PKP (p=0.019, p=0.006). There were no statistically significant differences in graft rejection and survival rate between the two groups with and without recurrent HSK. Conclusions: The majority of cases of recurrent HSK after PKP were epithelial keratitis or epithelial keratitis combined with stromal inflammation, and risk factors for the recurrence of HSK were previous graft failure due to recurrent HSK and preoperative inflammation.

난치성 신생혈관 녹내장에서 유리체강내 베바시주맙과 구후 트리암시놀론 동시 주사 효과

김우진,정진구,유인천,이동욱,Woo-Jin Kim,Jin-Gu Jeong,In-Cheon You,Dong-Wook Lee 대한안과학회 2010 대한안과학회지 Vol.51 No.4

Purpose: To identify the regression of neovascularization and relief of other symptoms after intravitreal bevacizumab and retrobulbar triamcinolone injection in neovascular glaucoma patients with no possibility of visual acuity recovery. Methods: A total of 15 eyes in 15 patients with neovascular glaucoma, who had no possibility of visual acuity recovery and could not be treated with surgical intervention despite pain from October 2008 to May 2009, were reviewed retrospectively. Changes in degree of pain, conjunctival injection, revascularization, and visual acuity were evaluated after injection. Results: Ten of the 15 (67%) neovascular glaucoma patients were male, with a mean age of 62.50±12.79 years. The most common prediposing ocular disease was diabetic retinopathy (9; 60%), and the others were central retinal vein occlusion (4: 26%), central retinal artery occlusion (1; 7%), and uveitis (1; 7%). Change in intraocular pressure was significant (p<0.001), as were decreases in the degrees of pain and conjunctival injection (p<0.001, <0.001) after the injections. Regression of neovascularization continued in 13 patients (87%) after two months. Conclusions: Intravitreal bevacizumab and retrobulbar triamcinolone injection is a safe intervention that can substantially relieve pain experienced by neovascular glaucoma patients. J Korean Ophthalmol Soc 2010;51(4):568-574

감염성 안질환의 원인균 및 항생제 감수성에 대한 10년간의 고찰

최현태,이동욱,안민,조남천,유인천,Hyun Tae Choi,Dong-Wook Lee,Min Ahn,Nam Chun Cho,In Cheon You 대한안과학회 2012 대한안과학회지 Vol.53 No.7

Purpose: To investigate the ocular regional incidence, causative species and antibiotic susceptibility in patients with infectious ocular disease whose causative organism was isolated. Methods: A total of 519 eyes in 519 patients with infectious ocular disease, who were diagnosed by smears and cultures from January 2000 to December 2009 were retrospectively reviewed. Results: The mean age of the 519 patients was 54.0 years, and 66.1% of the patients were male. The most common systemic disease was diabetes mellitus. The most common previous ocular disease was keratoconjunctivitis. Specimens were most frequently swabbed from the cornea, where 81.2% were bacteria isolates and 18.8% fungi isolates. The most prevalent causative organism was Staphylococcus epidermidis, and the most prevalent fungus was Fusarium species. Vancomycin, ceftazidime, and fourth-generation fluoroquinolone maintained high antibiotic susceptibility. Methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis were increasing near the end of the reference period, and endophthalmitis was more common in methicillin-resistant Staphylococcus. Conclusions: Identifying the causative organism in infectious ocular disease by smears and cultures is essential. More effective treatment of infectious ocular disease would be possible by analyzing the frequent organism, clinical manifestations, and antibiotic susceptibility. More caution is necessary due to the increase in methicillin-resistant Staphylococcus. J Korean Ophthalmol Soc 2012;53(7):934-940

급성폐쇄각녹내장 환자의 초기치료에서 수정체유화술과 레이저홍채절개술 비교

이창훈(Chang Hoon Lee),유인천(In Cheon You),김유라(You Ra Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.2

목적: 급성폐쇄각녹내장 환자들을 대상으로 수정체유화술과 레이저홍채절개술의 효과를 비교하고자 한다. 대상과 방법: 급성폐쇄각녹내장으로 진단 받은 환자 61명을 대상으로 하여 연구를 진행하였다. 레이저홍채절개술 혹은 수정체유화술을 실시하였으며, 연령, 성별, 치료 시행 전후 안압, 시력, 안압하강제의 사용 개수 및 치료 시행 후 합병증에 대해 술 후 하루, 한달, 6개월, 12개월째 후향적으로 조사하였다. 경과관찰 기간 내 레이저홍채절개술 및 수정체 유화술이 병합된 경우 및 섬유주절제술을 받은 군은 제외하였으며, 발병 후 3일 이내 시술을 시행한 경우만 포함하였다. 결과: 총 61명의 환자 중 45명이 레이저홍채절개술을, 16명이 수정체유화술을 시행 받았다. 술 후 1일째 시력(logMAR)에서는 레이저홍채절개술군이 0.62 ± 0.51로 유의하게 높았으며(p=0.048) 6개월째에는 수정체유화술군이 0.07 ± 0.15로 통계적으로 유의하게 높았지만(p=0.013) 1년째 경과 관찰 시에는 두 군 간의 유의한 차이는 보이지 않았다. 술 후 안압의 경우 1달째에 수정체유화술군의 안압이 9.5 ± 1.3 mmHg로 낮게 관찰되었으나(p=0.032) 이외의 관찰 기간에서 통계적으로 유의한 차이는 보이지 않았다. 술 후 1년째의 안압 하강제의 사용 개수는 레이저홍채절개술군 0.7 ± 0.4개, 수정체유화술군 0.4 ± 0.5개로 유의한 차이를 보였다(p=0.031). 안내염이나 시력상실 등의 심각한 합병증은 두 군에서 모두 관찰되지 않았다. 결론: 급성폐쇄각녹내장의 초기 치료로서 초기 수정체 유화술은 레이저홍채절개술에 비해 술 후 시력 및 안압, 그리고 합병증 발생에 있어 유의한 차이를 보이지 않았으며, 술 후 1년째의 안압 하강제의 사용 개수가 적었다. Purpose: We compared the outcomes of laser iridotomy and primary phacoemulsification when treating acute angle-closure glaucoma. Methods: This study was conducted with 61 patients diagnosed with acute angle closure glaucoma from January, 2005 to January, 2015. The patients received either laser iridotomy or primary phacoemulsification. The age and gender of each patient, differences of intraocular pressure (IOP) before and after treatment, visual acuity, need for IOP lowering agents and complications were analyzed retrospectively at 1-day, 1-month, 6-month and 12-month after the treatment. Patients who received laser iridotomy with phacoemulsification or trabeculectomy were excluded from this study. Additionally, we included only cases in which treatments were given within 3 days after the onset of symptom. Results: Among the 61 patients, 45 patients received laser iridotomy and 16 patients received primary phacoemulsification. One day after the treatment the laser iridotomy group showed better outcome in their visual acuity (log MAR 0.62 ± 0.51; p = 0.048). At 6-month postoperatively, the primary phacoemulsification group showed better visual acuity (log MAR 0.07 ± 0.15; p = 0.013). However, at 12-month postoperatively, the visual acuities were not significantly different between the 2 groups. Regarding IOP, at postoperative 1-month, the group of primary phacoemulsification shows significantly lower IOP (9.5 ± 1.3 mm Hg), compared with the group of laser iridotomy. A significant difference was observed in the number of IOP lowering agents that patients at 12 month after the treatment. There were no severe complications in either group. Conclusions: Following the initial treatment of acute angle-closure glaucoma, the primary phacoemulsification showed no significant differences in postoperative visual acuity, IOP and complications compared to the outcomes of laser iridotomy. Additionally, the need for IOP lowering agents was less in the primary phacoemulsification groups at 1 year after the operation.