백내장 수술 시 DisCoVisc의 특성과 유용성

임성아,오태훈,김현승,Sung A Lim,Tae Hoon Oh,Hyun Seung Kim 대한안과학회 2013 대한안과학회지 Vol.54 No.3

Purpose: To compare the efficacy and intraoperative characteristics of DisCoVisc with those of Hyal 2000 (sodium hyaluronate 1.0%) in cataract surgery. Methods: Cataract surgery was performed on 60 eyes in 49 patients who were diagnosed with moderate cataracts. 30 eyes were performed with DisCoVisc and a control group with 30 eyes using Hyal 2000 (sodium hyaluronate 1.0%). Phacodynamics was evaluated including ultrasound (US) time, mean US intensity, cumulative dissipated energy (CDE), and amount of used balanced salt solution. Corneal endothelium and corneal thickness were measured preoperatively and 1 day and 1 month and 2 months postoperatively. Results: There were no statistically significant differences in phacodynamic parameters in the two groups. The central corneal thickness change from preoperatively to postoperatively in the DisCoVisc group was +0.07 ± 2.44 μm and Hyal 2000 group +0.84 ± 2.93 μm (p = 0.032) at 2 months. Corneal endothelial cell loss (ECL)(%) at 2 months was 7.67 ± 8.01% in DisCoVisc group and 13.23 ± 15.5% in the Hyal 2000 group (p = 0.005). Conclusions: There was signicant difference between DisCoVisc and Hyal 2000 in the changes of CCT, ECD (Endothelial cell density). (DisCoVisc is effective and provides advantages both cohesive OVDs and dispersive OVDs).

2.2 mm 미세각막절개 백내장수술 시 회전진동방식 초음파유화술과 직선운동방식 초음파유화술을 이용한 임상결과 비교

임성아,황형빈,김현승,Sung A Lim,Hyung Bin Hwang,Hyun Seung Kim 대한안과학회 2013 대한안과학회지 Vol.54 No.10

Purpose: To compare clinical outcomes of a 2.2 mm microcoaxial cataract surgery, using torsional mode and longitudinal mode. Methods: In this comparative study, patients with bilateral cataract were assigned to get microcoaxial cataract surgery by torsional mode of infiniti in one eye and longitudinal mode of Stellaris<sup>® in the other eye. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), mean amount of balanced salt solution (BSS) used and surgical complications. Patients were seen 1, 7, 30, and 60 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell count and surgically induced astigmatism (SIA). Results: The study evaluated 68 eyes of 34 patients (nuclear opalescence (NO)2: 40 eyes, and NO3: 28 eyes). CDE was significantly lower in torsional mode (3.52 ± 2.93) than in longitudinal mode (6.20 ± 3.32) (p = 0.001). Torsional mode (60.88 ± 21.18 ml) had more BSS use than longitudinal mode (34.58 ± 13.54 ml) (p < 0.001). There were no significant differences in postoperative BCVA, CCT change, endothelial change, and SIA (p > 0.05). Conclusions: The torsional mode may provide lower level of phacoemulsification energy than the longitudinal mode and Torsional mode is considered effective and safe phacoemulsification. However the surgical outcomes were not significantly different in 2.2 mm microcoaxial cataract surgery of moderate cataract. So surgeon can choose any phaco machine based on experience and preference.

트라보프로스트(Travoprost) 점안제 사용 후 발생한 수부지간(趾間)의 색소침착 1예

박민지(Minji Park),임성아(Sung A Lim),김만수(Man Soo Kim) 대한검안학회 2015 Annals of optometry and contact lens Vol.14 No.2

Purpose: To report a case of interdigital skin hyperpigmentation of the hand following the use of travoprost. Case summary: 0.004% travoprost was administered to a 57-year-old man to treat secondary glaucoma that occurred after keratoplasty in his both eyes. After 3 weeks of treatment with 0.004% travoprost. We detected the appearance of skin hyperpigmentation in both eyelids and in the interdigital skin of both hands. Thus, to establish whether 0.004% travoprost was the cause of the hyperpigmentation, we discontinued 0.004% travoprost and observed for a decrease in the amount of pigmentation. The hyperpigmentation of both eyelids and interdigital skin markedly decreased at 1 and 5 months, respectively, after the discontinuation of 0.004% travoprost. Conclusions: Eyelid hyperpigmentation is a commonly known side effect of prostaglandin analogs. The type of interdigital skin hyperpigmentation reported here is a very rare side effect of 0.004% travoprost, highlighting the importance of this first case report from Korea.

이식거부반응으로 오인할 뻔한 거대세포 바이러스 각막내피염 1예

김래영(Rae Young Kim),임성아(Sung A Lim),김만수(Man Soo Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 전층 각막 이식 후 발생한 거대세포 각막내피세포염을 경험하여 이를 보고하고자 한다. 증례요약: 2013년에 수포성 각막병증으로 우안 전층 각막이식술 후 내피세포 기능 저하에 따른 이식 실패로 2014년 4월 우안 두 번째 전층각막이식술 시행 후 경과관찰 중이던 45세 남자가 수술 후 7개월째 우안의 간헐적 충혈을 호소하며 본원 외래로 내원하였다. 환자는 재각막이식 후 7개월째로 우안의 각막부종 및 산재된 각막후면 침착물, 전방에 +1 정도의 염증 소견 및 내피세포 밀도 감소를 보여 이식거부반응을 의심하였으나 임상적으로 거대세포바이러스 각막내피염을 배제할 수 없어, 확진을 위해 진단적 우안 전방천자술을 시행하였고 real time polymerase chain reaction (RT-PCR)에서 거대세포바이러스 감염이 확진되어 Gancyclovir 경정맥주사 및 점안액을 사용하여 치료하였으며 이후 임상적 소견이 호전되었고 재발 소견은 보이지 않았다. 결론: 거대세포 각막내피염은 전형적으로 동전모양의 각막 침착물 소견을 보이며 전방 천자를 통한 RT-PCR로 진단할 수 있다. 각막이식술을 시행 받은 환자의 경우 장기간의 스테로이드 사용에 따라 바이러스와 관련된 각막내피염에 대한 위험도가 증가되며, 거대세포 바이러스 각막내피염은 임상 증상 및 소견에 있어서 충혈, 시력저하, 각막 부종, 전방염증반응 등 이식편 거부반응과 유사한 점이 있으므로 동전모양 각막 후면 침착물과 같은 특징적 소견을 보이는 경우 반드시 거대세포바이러스 각막내피염을 의심해 보아야 한다. <대한안과학회지 2016;57(6):994-998> Purpose: To report a case of cytomegalovirus (CMV) corneal endotheliitis following penetrating keratoplasty. Case summary: A 45-year-old male with a history of re-penetrating keratoplasty due to corneal opacity and graft failure after previous penetrating keratoplasty of his right eye in April 2014, visited our clinic for intermittent injection of the right eye for several weeks (7 months postoperative). Corneal edema, diffuse keratic pigmentation and anterior chamber reaction with decreased endothelial cell density were observed in his right eye using the slit lamp examination. Seven months after keratoplasty, corneal graft rejection were determined but clinical findings showed features of CMV-related corneal endotheliitis. Under the impression of CMV corneal endotheliitis, diagnostic paracentesis was performed for CMV real time polymerase chain reaction (RT-PCR). Additionally, the patient was admitted for intravenous ganciclovir and topical ganciclovir therapy. The next day, the RT-PCR results confirmed CMV infection. After 2 weeks of intravenous ganciclovir treatment, the patient was discharged and prescribed oral ganciclovir for 1 month. A month later, the coin-shaped corneal lesion nearly disappeared. There was no evidence of complication or recurrence. Conclusions: CMV corneal endotheliitis typically presents with coin-shaped keratic pigmentation and can be confirmed with RT-PCR using aqueous humor collected from the anterior chamber. Due to the long period of systemic and topical steroid therapy, the risk of viral endotheliitis is relatively high in patients with a history of penetrating keratoplasty. Corneal graft rejection is similar to corneal endotheliitis in symptoms and clinical features such as ciliary injection, decreased visual acuity, corneal edema or anterior chamber reaction. In patients after penetrating keratoplasty, CMV RT-PCR should be considered if the clinical features suggest viral endotheliitis. J Korean Ophthalmol Soc 2016;57(6):994-998

두 가지 토릭 인공수정체 삽입 후 임상결과 분석

양순원(Soon Won Yang),이재훈(Jae Hoon Lee),임성아(Sung A Lim),정소향(So Hyang Chung) 대한안과학회 2016 대한안과학회지 Vol.57 No.2

목적: TECNIS Toric 인공수정체(Abbott Medical Optics Inc., Santa Ana, CA, USA)와 AT TORBI Toric 인공수정체(Carl Zeiss Meditec AG, Jena, Germany) 삽입술을 시행한 환자들의 임상결과 및 고위수차를 비교하고자 하였다. 대상과 방법: 본 연구는 1.25D 이상 및 4.5D 이하의 각막난시를 동반한 백내장으로 난시교정용 인공수정체를 삽입한 26명의 32안을 대상으로 후향적으로 고찰하였다. 백내장 수술은 동일한 술자에 의해 2.2 mm 이측 절개로 시행하였다. 수술 후 3개월까지 나안 및 교정시력, 굴절력, 잔여난시, 인공수정체 축 회전 및 고위수차를 관찰하였다. 난시는 Cartesian astigmatism (J0) 및 oblique astigmatism(J45)을 이용한 power vector 분석을 이용하였다. 결과: 수술 3개월째 최대교정시력 및 잔여난시는 두 군 간에 통계적으로 유의한 차이는 없었다(p>0.05). TECNIS Toric 삽입군에서 J0는 수술 전 0.71 ± 0.84D에서 수술 후 0.05 ± 0.39D로 유의하게 감소하였고(p=0.029), AT TORBI Toric 삽입군에서 J0는 수술전 0.88 ± 1.27D에서 수술 후 –0.02 ± 0.16D로 유의하게 감소하였다(p=0.032). 고위수차 분석에서 구면수차를 제외하고는 두 군간에 통계적으로 유의한 차이는 없었으며, AT TORBI Toric 삽입군에서 높은 구면수차를 보였다(p=0.047). 결론: 난시를 동반한 백내장 환자에서 두 가지 난시교정용 인공수정체 삽입술은 우수한 난시교정 및 시력교정 효과를 보였으며 결과는 3개월까지 안정적이었다. Purpose: In this study evaluated clinical outcomes and higher-order aberrations in patients with implanted Tecnis ZCT toric intraocular lens (IOL) (Abbott Medical Optics Inc., Santa Ana, CA, USA) and the Zeiss AT TORBI toric IOL (Carl Zeiss Meditec AG, Jena, Germany) in eyes with low to moderate corneal astigmatism. Methods: We conducted a retrospective study of 32 consecutive eyes of 26 patients with a visually significant cataract and moderate corneal astigmatism (higher than 1.25 diopter [D] and lower than 4.5 D) undergoing cataract surgery with implantation of the aspheric Tecnis ZCT toric IOL (Abbott Medical Optics Inc.) and the Zeiss AT TORBI toric IOL (Carl Zeiss Meditec AG). Phacoemulsification was performed by the same experienced surgeon using 2.2 mm temporal incision. Visual, refractive and aberrometric changes were evaluated during a 3-month follow-up. Power vector analysis of Cartesian astigmatism (J0) and oblique astigmatism (J45) was performed. Results: At the 3-month follow-up, corrected distance visual acuity (CDVA) and residual astigmatism showed no statistically significant differences between groups (p = 0.203 and p = 0.364, respectively). Pre- and postoperative J0 were 0.71 ± 0.84 and 0.05 ± 0.39 in the Tecnis Toric group and, 0.88 ± 1.27 and -0.02 ± 0.16 in the AT TORBI group, respectively, which showed statistically significant differences (p = 0.029 and p = 0.032, respectively). Pre- and post-operative differences of J0 and J45 were not statistically significant (p = 0.234 and p = 0.603, respectively). No eye had IOL rotation ≥10°. Ocular aberrometry values were statistically significantly differenct between the groups, except for spherical aberration, which was higher in the AT TORBI group(p = 0.0047). Conclusions: Both IOLs showed good postoperative uncorrected distance visual acuity, CDVA and refractive results in this study. Rotational stability was excellent for both IOLs until the 3-month follow-up.

레이저 홍채절개술에 의한 수포성 각막병증 환자의 특성과 인공수정체 수포성 각막병증과의 비교

최승용(Seung Yong Choi),최순일(Soon Il Choi),임성아(Sung A Lim),김만수(Man Soo Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.1

Purpose: To investigate the clinical features and prevalence of patients with laser iridotomy-induced bullous keratopathy in Korea. Methods: Using a retrospective study, the patients with laser iridotomy-induced bullous keratopathy who underwent penetrating keratoplasty were selected. We investigated the duration from iridotomy to corneal decompensation, preoperative anterior chamber depth, axial length, keratometry, and survival time of the grafted cornea. The data were compared with the data of patients with pseudophakic bullous keratopathy as controls. Results: Laser iridotomy-induced bullous keratopathy was found in 17 eyes, which represented 2.3% of penetrating keratoplasty cases (727) and 8.5% of bullous keratopathy cases (201), with a mean age of 66.9 years. The laser iridotomy-induced bullous keratopathy group showed a higher female ratio (15 out of 17), shorter mean axial length (22.09 ± 0.79 mm) and anterior chamber depth (1.91 ± 0.36 mm) than the control group (15 out of 50, 24.30 ± 2.54 mm and 3.27 ± 0.66 mm, respectively) with a statistical significance (p = 0.002, p < 0.001 and p < 0.001, respectively). Mean survival time of the grafted cornea was 39.9 ± 8.6 months in the group of laser iridotomy-induced bullous keratopathy, which was shorter than the control group (47.8 ± 3.1 months) without statistical significance (p = 0.47). Conclusions: In Korea, laser iridotomy-induced bullous keratopathy shows non-negligible prevalence and should be further investigated.

기증 각막 한 개로 두 가지 각막이식술을 실시한 4예

김효원(Hyo Won Kim),황호식(Ho Sik Hwang),임성아(Sung A Lim),김만수(Man Soo Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 기증 각막 한 개를 이용하여 두 명의 환자에게 내피층각막이식술(descemet membrane keratoplasty, DMEK)과 심부표층각막이 식술(deep anterior lamella keratoplasty, DALK)을 각각 실시한 4예를 보고하고자 한다. 증례요약: 기증각막 4개를 내피층과 나머지 조직으로 분리하였다. 내피층은 분리되는 즉시 4명의 수포성 각막병증 환자에게 각각 이식하였고, 나머지 조직은 각막보존액에 넣어서 보관하였다. 그 후 보존된 나머지 각막편으로 2명의 지질각막병증과 2명의 원추각막환자에게 각각 심부표층각막이식술을 시행하였다. 술 후 이식된 각막편은 8명의 환자에서 모두 안정적으로 관찰되었다. 결론: 기증 각막 한 개로 내피층은 내피층각막이식술을 실시하고 나머지 조직으로 심부표층각막이식술을 실시한 4예를 국내에서 처음으로 보고한다. 기증 각막이 부족한 우리나라에서 하나의 기증 각막으로 2명의 환자에게 시술함으로써 각막이식이 필요한 환자들에게 더 많은 혜택을 줄 수 있을 것으로 생각된다. 〈대한안과학회지 2016;57(6):988-993〉 Purpose: To report four cases of split cornea transplantation involving separate Descemet membrane keratoplasty and Deep anterior lamella keratoplasty from a single cornea. Case summary: Four donor corneas were separated into the endothelium and other layers. The endothelial layers were transplanted into 4 pseudophakic bullous keratopathy patients, and the other layers were stored in corneal storage media. Deep anterior lamella keratoplasties were performed with the stored corneas in 2 lipid keratopathy and 2 keratoconus patients. Postoperatively, all grafted corneas were stable. Conclusions: The authors report the first 4 cases of split cornea transplantation in Korea, which is experiencing a shortage of donated corneas. Split cornea transplantation will be of benefit to a large number of patients by separating a single cornea into separate layers to be implanted into two patients. J Korean Ophthalmol Soc 2016;57(6):988-993