신생혈관녹내장에서 항대사제의 병용 여부에 따른 아메드 장치 삽입술의 수술 성공률 비교

임성협,서원문,박준정,윤성욱 대한안과학회 2011 대한안과학회지 Vol.52 No.12

Purpose: To evaluate the outcomes of Ahmed valve implantation in neovascular glaucoma patients who received intraoperative mitomycin C (MMC) and postoperative 5-fluorouracil (5-FU) after 24 months of follow-up. Methods: A total of 40 eyes from 40 patients with neovascular glaucoma who received antiglaucomatous medication without previous glaucoma surgery were included in the present study. The patients were divided into 2 groups. The control group (20 eyes) underwent Ahmed valve implantation only and the study group (20 eyes) underwent Ahmed valve implantation and received intraoperative MMC and postoperative 5-FU. Failure was defined as the first occurrence of any of the following: 1) the first of 3 consecutive visits where intraocular pressure (IOP) was over 18 mmHg; 2) 20% IOP reduction from baseline; 3) the final number of topical medications was not reduced by at least two from baseline; 4) the need for additional surgery; or 5) the occurrence of a serious complication. Results: In the control group, the cumulative success rate was 19.1% at 24 months. The cumulative success rate in the study group was 43.7% at 24 months. Serious complications such as endophthalmitis, valve exposure, or prolonged hypotony were not observed. Conclusions: The adjunctive use of intraoperative MMC and postoperative 5-FU with Ahmed valve implantation resulted in a high success rate and good IOP control and did not cause serious complications during the follow-up period. J Korean Ophthalmol Soc 2011;52(12):1470-1477

디펜바키아의 수액에 의해 초래된 각결막염 1예

임성협,김시정,윤성욱 대한안과학회 2009 대한안과학회지 Vol.50 No.12

목적: 집에서 관상용으로 재배하던 디펜바키아(Dieffenbachia) 수액에 의해 초래된 각결막염을 경험하였기에 이를 보고하고자 한다. 증례요약: 44세 여자 환자가 관상용 식물인 디펜바키아를 가정에서 손질하던 도중 끊어진 가지로부터 수액이 좌안에 튀어 발생한 심한 통증과 시력저하를 주소로 내원하였다. 내원시 시력은 우안 1.0, 좌안 0.4이었고, 세극등검사상 각막 상피의 결손과 미란, 기질층에서 미세 한 바늘 모양의 푸른색 결정체들이 관찰되었으며 중등도의 결막 충혈과 전방 내 염증세포가 관찰되었다. 항생제 점안제와 안연고, 스테 로이드 점안제로 치료하면서 세극등검사를 통해 경과를 관찰하고 치료 반응을 평가하였다. 수상 후 6일째, 모든 증상은 호전되었고, 기질 층의 푸른색의 결정체들은 수상 후 11일째부터 감소되기 시작하여 수상 후 6주째 더 이상 관찰되지 않았으며, 지금까지 6개월간의 경과 관찰에서 좌안시력 1.0으로 각막 반흔 등의 후유증도 관찰되지 않았다. 결론: 디펜바키아의 수액은 눈에 닿았을 경우 심한 통증과 가역적인 시력 손상을 줄 수 있는 각결막염을 유발하므로 취급에 주의를 기울 여야 할 것이다. Purpose: To report a case of keratoconjunctivitis induced by Dieffenbachia plant sap. Case summary: A 44-year-old woman presented with severe ocular pain and decreased visual acuity which developed after she accidentally got Dieffenbachia plant sap in her left eye. During her initial evaluation, visual acuity was 0.4 in her left eye. On slit lamp examination, we found that she had moderate injection of the conjunctiva, an epithelial defect, and fine needle-like blue crystals in the stromal layer of the cornea. The patient was treated with topical steroids and antibiotics. We checked the treatment response using a regular slit lamp examination. Six days after the injury, all of the findings which were observed on the first day had resolved except the needle-like blue crystals in the stromal layer of the cornea. These gradually disappeared from the cornea 11 days after the accident. After six weeks, the crystals in the stromal layer had completely resolved. She maintained good visual acuity during this time. There was no opacity noted in her cornea. Conclusions: We experienced a case of keratoconjunctivitis induced by Dieffenbachia plant sap. This sap caused severe ocular pain and a reversible decrease in visual acuity when in contact with the eye.

유리체강내 트리암시놀론 주입술로 호전된 임신 중 발생한 보그트-고야나기-하라다 병 1예

곽현덕,임성협,김현웅,윤일한,이호영,Hyun Duck Kwak,MD,Sung Hyup Lim,MD,Hyung Woong Kim,MD,PhD,Il Han Yun,MD,PhD,Ho Young Lee,MD 대한안과학회 2013 대한안과학회지 Vol.54 No.10

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) disease in a pregnant patient treated with intravitreal triamcinolone injection. Case summary: A 21-year-old female in the 19th week of gestation presented with bilateral blurring of vision associated with mild headache and tinnitus. Her initial best corrected visual acuity was 0.15 in the right eye and 0.3 in the left eye. Multiple serous retinal detachment and anterior chamber inflammation were observed, and VKH disease was diagnosed. Because of her pregnancy, the patient did not want high-dose systemic prednisolone therapy which may cause an abortion or low birth weight infant when used in a pregnant patient. Therefore, an intravitreal triamcinolone (4 mg/0.1 ml) injection was given in the right eye and topical steroid eye drops were used in the left eye. After 1 day, serous retinal detachment was significantly decreased and anterior chamber inflammation disappeared in the right eye. After 1 week, no serous retinal detachment was observed. In the left eye, serous retinal detachment was decreased after using steroid eye drops. After 10 days, serous retinal detachment disappeared but anterior chamber inflammation was still observed. After 1 month, best corrected visual acuity was 1.0 in both eyes and serous retinal detachment had not recurred. On follow-up, VKH disease had not recurred and a healthy normal weight infant was delivered. Conclusions: Intravitreal triamcinolone injection is an effective and safe treatment for VKH disease in pregnant women.

Accuracy of Biometry for Intraocular Lens Implantation Using the New Partial Coherence Interferometer, AL-scan

문상우,임성협,이호영 대한안과학회 2014 Korean Journal of Ophthalmology Vol.28 No.6

Purpose: To compare the refractive results of cataract surgery measured by applanation ultrasound and thenew partial coherence interferometer, AL-scan. Methods: Medical records of 76 patients and 104 eyes who underwent cataract surgery from January 2013 toJune 2013 were retrospectively reviewed. Biometries were measured using ultrasound and AL-scan and intraocularlens power was calculated using the SRK-T formula. Automatic refraction examination was done 1month after the operation, and differences between the ultrasound group and AL-scan group were comparedand analyzed by mean absolute error. Results: Mean axial length measured preoperatively by the ultrasound method was 23.53 ± 1.17 mm while thelengths measured using the AL-scan were 0.03 mm longer than that of the ultrasound group (23.56 ± 1.15mm). However, there was not a significant difference in this finding (p = 0.638). Mean absolute error was 0.34± 0.27 diopters in the ultrasound group and 0.36 ± 0.31 diopters in AL-scan group, which showed no significantdifference (p = 0.946) in precision of predicting postoperative refraction. Conclusions: Although the difference was not statistically significant, intraocular lens calculations done by theAL-scan were nearly similar in predicting postoperative refraction compared to those of applanation ultrasound,however more precise measurements may be obtained if the axial length is longer than 24.4 mm. Exceptin the case of opacity in the media, which makes obtaining measurements with the AL-scan difficult, ALscancould be a useful biometry in cataract surgery.

에이엘 스캔과 펜타캠을 이용한 전안부 계측값의 비교

윤상문,임성협,이호영,Sang Moon Youn,MD,Sung Hyup Lim,MD,Ho Young Lee,MD 대한안과학회 2014 대한안과학회지 Vol.55 No.6

Purpose: To investigate the clinical availability of AL-Scan<sup>® (Nidek, GAMAGORI, Japan) by comparing anterior segment parameters measured with AL-Scan<sup>® and Pentacam<sup>® (Oculus, Wetzlar, Germany). Methods: Seventy-three patients (117 eyes) who received refractive surgery at our hospital were tested with AL-Scan<sup>® and Pentacam<sup>®. We compared measurements including anterior chamber depth, central corneal thickness, white-to-white, and corneal curvature. Results: When comparing measurements obtained with AL-Scan<sup>® and Pentacam<sup>®, the anterior chamber depth (<em>p</em> < 0.001), central corneal thickness (<em>p</em> < 0.001) and 2.4 mm zone K value (<em>p</em> = 0.038) showed significant differences; the white-to-white (<em>p</em> = 0.348) and 3.3 mm zone K value (<em>p</em> = 0.429) showed no significant differences. All AL-Scan<sup>® and Pentacam<sup>® parameters had a strong positive linear correlation (<em>p</em> < 0.001). The Bland-Altman plots showed a high degree of agreement between AL-Scan<sup>® and Pentacam<sup>® in all parameters except for anterior chamber depth. Conclusions: AL-Scan<sup>® is convenient to use clinically because simultaneous measurements of ocular biometry including axial length, intraocular lens power, and topography are possible. However, because differences in some anterior segment parameters exist when compared with Pentacam<sup>®, measurements with AL-Scan<sup>® may require comparisons with other instruments. J Korean Ophthalmol Soc 2014;55(6):801-808

에이엘 스캔, 자동각막굴절계, 펜타캠의 각막 굴절력 비교 분석

박성진,임성협,이호영.Sung Jin Park. MD. Sung Hyup Lim. MD. Ho Young Lee. MD 대한안과학회 2014 대한안과학회지 Vol.55 No.7

<b>Purpose:</b> To investigate clinical availability of AL-ScanTM (Nidek, Gamagori, Japan) by comparing corneal refractive power with AL-ScanTM, AutokeratometerTM (Topcon KR-1, Tokyo, Japan) and PentacamTM (Oculus, Wetzlar, Germany) devices. <b>Methods</b>: Seventy-one patients (142 eyes) who visited our hospital for refractive surgery were tested using AL-Scan<sup>Ⓡ, Autokeratometer and Pentacam<sup>Ⓡ and corneal refractive power was compared among devices. <b>Results:</b> When comparing measurements with AL-Scan<sup>Ⓡ, Autokeratometer and Pentacam<sup>Ⓡ, the mean corneal refractive power was 43.37 ± 1.32 D (2.4 mm zone), 43.35 ± 1.32 D (3.3 mm zone), 43.36 ± 1.35 D, and 43.35 ± 1.36 D respectively and showed no significant differences. Corneal refractive power had strongly positive linear correlation (<em>p </em>< 0.001) and Bland-Altman plots showed high degree of agreement among AL-Scan<sup>Ⓡ, Autokeratometer and Pentacam<sup>Ⓡ devices. <b>Conclusions:</b> Because measuring ocular biometry with AL-Scan<sup>Ⓡ including axial length, intraocular lens power calculation and topography simultaneously is possible, clinical use is convenient. Corneal refractive power was not different when compared with autokeratometer and Pentacam<sup>Ⓡ, thus, AL-Scan<sup>Ⓡ can be used in the clinical environment. J Korean Ophthalmol Soc 2014;55(7):984-990

망막정맥폐쇄에서 혈압의 일중 변동 양상 분석

박성진,문상우,임성협,윤일한,최규남,이호영,Sung Jin Park,MD,Sang Woo Moon,MD,Sung Hyup Lim,MD,Il Han Yoon,MD,Kyu Nam Choi,MD,Ho Young Lee,MD 대한안과학회 2013 대한안과학회지 Vol.54 No.9

Purpose: The purpose of this study was to determine the diurnal blood pressure variation with retinal vein occlusion (RVO) using 24-hour ambulatory blood pressure monitoring (24-hour ABPM). Methods: The subjects in this study visited the department of ophthalmology from May 2012 to December 2012 and were diagnosed with RVO but had no history of hypertension (HTN). Non-dipper was defined as a nocturnal systolic blood pressure (SBP) decrease less than 10%. These values were used to compare the 24-hour ABPM values of the RVO and the control groups. Results: The 24-hour ABPM values, with the exception of the mean nightly SBP, were statistically different whne the RVO group was compared with the control group. The odds of an RVO patient being a non-dipper compared to dipper were 1.81 times greater than in the control. Additionally, the clinical SBP and DBP in the RVO group were not significantly different when the HTN group and the non-HTN group were compared. In contrast, the mean 24-hour SBP and the mean DBP were significantly different in regard to HTN. Conclusions: Patients with RVO have a tendency to maintain high BP throughout the day and also during the night. A patient with non-dipper status can be at risk for RVO, even if the patient does not have HTN. Therefore, 24-hour ABPM is an effective management approach for HTN in addition to strict BP control in patients with RVO.

나팔꽃 증후군에서 발생한 맥락막신생혈관에서 유리체강내 베바시주맙 주입술을 시행한 1예

황문원,오하나,임성협,김현웅,윤일한,Moon Won Hwang,MD,Ha Na Oh,MD,Sung Hyup Lim,MD,Hyun Woong Kim,MD,PhD,Il Han Yun,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.5

Purpose: We report a case of intravitreal bevacizumab injection for the treatment of choroidal neovascularization in morning glory syndrome. Case summary: A 51-year-old male visited our hospital for a 1.5-year visual disturbance in his right eye. The patient's best-corrected visual acuity was 0.1 in the right eye. After fundus examination, we found characteristic findings of morning glory syndrome with submacular hemorrhage and serous retinal detachment in the right eye. Optical coherence tomography, fluorescein angiography and indocyanine green angiography were performed for evaluation. Retinoschisis, subretinal fluid, and choroidal neovascularization were detected, and thus bevacizumab was injected in the right eye. After intravitreal bevacizumab injection, retinoschisis was improved, and subretinal fluid was decreased. However, retinal pigment epithelial detachment was newly detected, and serous retinal detachment persisted. After 2 months, a second bevacizumab injection was performed. After these intravitreal bevacizumab injections at 1 and 2 months, visual acuity was 0.4 and 0.6, respectively. Visual acuity improved to 1.0 after 3 months. Visual acuity was maintained for at least 6 months with no relapse of choroidal neovascularization. Conclusions: The choroidal neovascularization in morning glory syndrome was effectively treated with intravitreal bevacizumab injections. J Korean Ophthalmol Soc 2014;55(5):770-774

노른자모양황반변성 환자에서 유리체강내 베바시주맙 주입술을 시행한 환자 1예

문상우,이호영,윤일한,임성협,Sang Woo Moon,Ho Young Lee,Il Han Yun,Sung Hyup Lim 대한안과학회 2014 대한안과학회지 Vol.55 No.7

<b>Purpose:</b> To report a patient diagnosed with adult-onset vitelliform dystrophy (AOVD) who received an intravitreal injection of bevacizumab in both eyes. <b>Case summary:</b> A 47-year-old female presented with blurred vision and metamorphopsia in both eyes. On color fundus photograph, small, round, yellowish dots on the foveola and subreitnal fluid were observed. Optical coherence tomography (OCT) showed thick hyperreflective structures in the retinal pigment epithelium (RPE) layer with serous retinal detachment and subretinal fluid. Despite an intravitreal injection of bevacizumab on both eyes, anatomical improvement was not observed on fundus photography and OCT. J Korean Ophthalmol Soc 2014;55(7):1093-1098

중심망막정맥폐쇄 환자에서 덱사메타손 유리체강내 삽입물 주입 시 발생한 분절화 1예

윤상문,박성진,이호영,임성협,윤일한,Sang Moon Youn,MD,Sung Jin Park,MD,Ho Young Lee,MD,Sung Hyup Lim,MD,Il Han Yun,MD,PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.6

Purpose: We report a case of dexamethasone intravitreal implant (Ozurdex?; Allergan, Inc.) fragmentation during the injection procedure in macular edema due to central retinal vein occlusion. Case summary: A 57-year-old man visited our hospital for visual disturbance in his right eye. The patient’s best-corrected visual acuity was 0.02 in the right eye and 1.2 in the left eye. After fundus examination, the patient was diagnosed with central retinal vein occlusion with macular edema, thus bevacizumab was injected in the right eye. However, the macular edema did not improve, and a dexamethasone intravitreal implant was injected in the right eye. Immediately after the dexamethasone intravitreal implant injection, on fundus exam, the drug was observed to be fragmented into 3 pieces without any additional treatment. After 2 months, the patient’s best-corrected visual acuity was 0.4 in the right eye and 1.2 in the left eye. Macular edema decreased according to optical coherence tomography. Conclusions: A case of dexamethasone intravitreal implant fragmentation during an injection procedure has not been previously reported in Korea. Although the drug fragmented, the treatment was effective without complications.