단안의 수평선상의 보크트선이 동반된 원추각막 1예

정소향,김용민,이승재,김응권.So-Hyang Chung. M.D.. Yong-Min Kim. M.D.. Seung-Jae Lee. M.D.. Eung-Kweon Kim. M.D..Ph.D 대한안과학회 2005 대한안과학회지 Vol.46 No.12

Purpose: Vogt’s striae are defined as vertical stress lines that occur deep in the affected stroma of keratoconus. The purpose of this study was to report a case of horizontal Vogt’s striae in keratoconus. Methods: A 21-year-old male without history of trauma or contact lens wearing presented with decreased visual acuity in both eyes. He complained of chronic habitual eye rubbing due to ocular itching. The best corrected visual acuity of his right eye was 20/30 and was 20/40 in his left eye. A scissoring reflex was seen in both eyes upon retinoscopic examination. On slit lamp examination, multiple and fine parallel horizontal lines in the deep stroma and Descemet’s membrane were noted in his left eye. Corneal topography showed bilateral inferotemporal steepening with corneal thinning. The horizontal lines, which disappear after pressing the eyeball, are thought to be stress lines resembling Vogt’s striae. Results: To our knowledge, there have been no reports demonstrating horizontal stress lines resembling Vogt’s striae in keratoconus patients. Here, we report a case of horizontal Vogt’s striae in a keratoconus patient.

아벨리노각막이상증으로 진단된 한국인 환자의 각막병변의 분류 및 임상양상

정소향,김창염,김응권,So-Hyang Chung,Chang-Yeom Kim,Eung-Kweon Kim 대한안과학회 2005 대한안과학회지 Vol.46 No.6

Purpose: To classify Avellino corneal dystrophy (ACD) into 3 groups by slit lamp photography and to evaluate the inter-group differences. Methods: DNA analysis was performed in one member from each of 45 families who were clinically diagnosed as ACD. Corneal opacities were classified into mild (group I), moderate (group II), and severe (group III) based on slit lamp photograph. Results: Six patients were confirmed as homozygous ACD and ninety-two as heterozygous ACD. One homozygous patient was revealed to have a novel phenotype. The age increased with increasing severity, and the proportion of females in group III was significantly higher than that of the other two groups (p=0.001). The prevalence of laser in situ keratomileusis (LASIK) increased in group III (p=0.001), and the incidence of pterygium increased in group I compared with the other two groups (p=0.025). Conclusions: ACD was aggravated with age, while pterygium and LASIK altered the natural course of ACD.

양안 라식 수술 후에 발생한 단안의 급성 각막수종의 임상증례

정소향,조정우,김응권,So-Hyang Chung,Jung-Woo Cho,Eung-Kweon Kim,Ph,D 대한안과학회 2005 대한안과학회지 Vol.46 No.7

Purpose: To report a case of a patient who underwent penetrating keratoplasty due to acute hydrops six years after undergoing a bilateral LASIK procedure. Methods: A 19-year old male patient with -2.75 diopter myopia received a bilateral LASIK operation at a local clinic. Forty-seven months later, -2.00 cyl axis 130o astigmatism was induced in his left eye and additional surgery was performed to correct the LASIK-induced astigmatism. The patient was referred to our hospital 16 months after the secondary operation due to reduced visual acuity in his left eye. He was diagnosed with keratectasia and acute hydrops, and penetrating keratoplasty was performed. Results: The retrospective analysis of the corneal topography prior to the LASIK surgery revealed that the inferior minus superior(I-S) value was 1.25 in the right eye and 1.3 in the left eye. At the time of the first evaluation at out hospital, a slit lamp examination showed an approximate 8x7.5mm sized area filled with aqueous humor between the corneal flap and residual stroma, and Descemet`s membrane rupture was observed. Furthermore, the histopathological section of the patient`s cornea confirmed keratocytes with myxoid degeneration and edematous change. Conclusions: In young patient, particularly those with suspicious asymptomatic keratoconus, LASIK and further enhancement surgery afterwards should be considered and approached in a cautious and deliberate manner.

반복각막진무름 후 혼합 세균각막염 1례

이상협,김태임,정소향,정재림,정성근,김응권,Sang Hyup Lee,Tae-im Kim,So Hyang Chung,Jae Lim Chung,Sung Kun Chung,Eung Kweon Kim 대한안과학회 2007 대한안과학회지 Vol.48 No.3

Purpose: We report a case of keratitis of Stenotrophomonas maltophilia and Coagulase negative Staphylococcus in a recurrent corneal erosion patient. Methods: A 29-year-old female patient was referred to our clinic for an intractable corneal ulcer in her left eye. Results: Her best corrected visual acuity in her left eye was 10/400 and the cornea showed a 2×2 mm corneal infiltration at the 6 o’clock position along with endothelial plaque. Initially, 5% cefazolin, 1.4% tobramycin, 3.3% vancomycin, and 0.125% amphotericin were administered every 2 hours, and Natacyn? was administered every 4 hours, but corneal infiltration was still aggravated. After nine days of medical treatment, the advancement of the conjunctival flap was performed. The lesion had not improved, and corneal scrape and culture were repeated. Stenotrophomonas maltophilia and Coagulase negative Staphylococcus were identified. Treatment with clindamycin and Cravit?, to which isolated organisms are susceptible, was started, and the lesion improved. During the treatment, her right eye showed a painful epithelial defect in the morning, and a few days later recurrent corneal epithelial bullae developed in her left eye. She was diagnosed with recurrent corneal erosion in both eyes. The infection lesion improved by using 2% clindamycin and Cravit?, but the corneal bullae were not controlled, and therefore all eyedrops gradually tapered. After the cessation of eyedrops, corneal epithelial bullae disappeared. When she visited our clinic 12 days after discharge, her vision was 20/30 and her corneal lesion had improved completely.

두 가지 장비를 이용한 각막곡률 및 각막고위수차의 비교

신지영,이민영,정소향,Ji Young Shin,Min Young Lee,So Hyang Chung 대한안과학회 2014 대한안과학회지 Vol.55 No.12

Purpose: To investigate the correlations of keratometry and corneal high order aberrations (HOAs) between the Keratron Scout videokeratoscope and the Pentacam HR Scheimpflug camera. Methods: From December 2012 to February 2013, keratometry and corneal HOAs were determined using the Keratron Scout videokeratoscope and Pentacam HR Scheimpflug camera in 23 healthy individuals (46 eyes). Results: Average keratometry showed high correlation with 95% confidence interval -0.155 ± 0.37 between the Keratron Scout and Pentacam HR. When comparing HOAs of the Keratron Scout and total corneal HOAs of Pentacam HR, total root-meansquare (RMS), and spherical aberration were positively correlated between the 2 devices (r = 0.67, <EM>p </EM>< 0.001 and r = 0.74, <EM>p</EM> < 0.001, respectively). When comparing HOAs of Keratron Scout and anterior corneal HOAs of Pentacam HR, total RMS, spherical aberration and coma were positively correlated between the 2 devices (r = 0.62, <EM>p </EM>< 0.001, r = 0.81, <EM>p </EM>< 0.001, and r = 0.52, <EM>p</EM> = 0.047, respectively). Conclusions: Although the 2 devices are based upon different principles, the Keratron Scout videokeratoscope and Pentacam HR Scheimpflug camera showed positive correlations in keratometry, total RMS, spherical aberration, and coma. Both devices may be useful for clinical applications. J Korean Ophthalmol Soc 2014;55(12):1758-1764

펨토초레이저를 이용한 각막이식술과 일반적인 전층각막이식술의 임상결과 비교

정경인,최진아,나경선,정소향,차흥원,김응권,주천기,Kyoung In Jung,Jin A Choi,Kyung Sun Na,So Hyang Chung,Hungwon Tchah,Eung Kweon Kim,Choun-Ki Joo 대한안과학회 2010 대한안과학회지 Vol.51 No.8

Purpose: To compare the outcomes of IntraLase femtosecond laser-enabled keratoplasty (IEK) versus conventional penetrating keratoplasty (C-PKP). Methods: This retrospective study included 18 eyes of 17 patients who underwent C-PKP and 26 eyes of 25 patients who underwent IEK. Postoperative clinical results were compared between two groups. Results: The mean logMAR best spectacle-corrected visual acuity (BSCVA) was 0.70, 0.58, and 0.61 in the IEK group, and 1.06, 1.01, and 0.90 in the C-PKP group at postoperative 2, 4, and 6 months respectively. The difference between the two groups was statistically significant at 2 and 4 months postoperatively (p=0.033, 0.011). The mean refractive cylinder was 4.08 diopters (D), 4.01D, and 4.44D in the IEK group, while 5.75D, 5.75D, and 5.21D in the C-PKP group for each month, and the difference between the groups was statistically significant at 2 and 4 months postoperatively (p=0.037, 0.027). The complication rate showed no significant differences up to 6 months of follow-up between the two groups. Conclusions: The IEK showed better results in BSCVA and refractive astigmatism in the early postoperative period, in comparison with the C-PKP, and can be considered as a valuable method in penetrating keratoplasty. J Korean Ophthalmol Soc 2010;51(8):1054-1063

매뉴얼 트레파인과 펨토초레이저를 이용한 전층각막이식의 장기 임상결과 비교

소하림(Ha-Rim So),김선주(Seon-Joo Kim),주천기(Choun-Ki Joo),황유숙(You-Sook Hwang),변용수(Yong-Soo Byun),정소향(So-Hyang Chung),김현승(Hyun-Seung Kim) 대한안과학회 2020 대한안과학회지 Vol.61 No.12

목적: 펨토초레이저를 이용한 전층각막이식을 시행하여 임상결과를 매뉴얼 트레파인을 이용한 전층각막이식과 비교하여 보고하고자 한다. 대상과 방법: 매뉴얼 트레파인을 이용한 전층각막이식을 받은 21안, 펨토초레이저를 이용한 전층각막이식을 받은 29안에 대해 최대교정시력, 굴절난시, 각막난시, 각막내피세포수, 이식 거부, 기능부전 등의 술 후 임상결과를 비교하였다. 결과: 수술 후 1, 3, 6, 12, 18개월에 측정한 최대교정시력은 매뉴얼군은 logMAR 1.21, 1.28, 1.25, 1.14, 1.43, 펨토초레이저군은 logMAR 0.82, 0.71, 0.78, 0.49, 0.56으로 모든 기간에서 펨토초레이저군이 매뉴얼군에 비해 높은 시력을 유지하였다. 굴절난시는 매뉴얼군은 5.13, 6.35, 5.28, 5.18, 6.36 diopters (D), 펨토초레이저군은 6.09, 6.33, 5.14, 5.23, 4.89 D, 각막난시는 매뉴얼군은 5.40, 6.45, 6.30, 5.64, 5.78 D, 펨토초레이저군은 6.17, 6.24, 5.72, 5.02, 4.83 D이며 굴절난시는 수술 후 18개월째, 각막난시는 수술 후 12, 18개월째에 펨토초레이저군에서 유의하게 난시 도수가 낮았다. 각막내피세포수, 이식 거부 및 기능부전은 두 군에서 유의한 차이를 보이지 않았다. 결론: 펨토초레이저를 이용한 전층각막이식은 매뉴얼 트레파인을 이용한 전층각막이식과 비교하여 시력회복이 좋고 굴절난시와 각막난시가 적으며, 창상부의 안정성이 더 좋은 장점이 있으므로 전층각막이식 시에 고려할 수 있는 하나의 수술 방법이다. Purpose: We compare the clinical outcomes of femtosecond-laser penetrating keratoplasty and penetrating keratoplasty performed using a manual trephine. Methods: The clinical outcomes of 21 eyes that underwent penetrating keratoplasty using a manual trephine and 29 eyes that underwent femtosecond-laser penetrating keratoplasty were compared in terms of best-corrected visual acuity, refractive and corneal astigmatisms, endothelial cell counts, and graft rejection and failure. Results: The best-corrected visual acuities measured 1, 3, 6, 12, and 18 months after surgery were logMAR 1.21, 1.28, 1.25, 1.14, and 1.43 for the manual trephine group and logMAR 0.82, 0.71, 0.78, 0.49, and 0.56 for the femtosecond-laser group; the latter group thus exhibited better visual acuity at all times. The refractive astigmatism values were 5.13, 6.35, 5.28, 5.18, and 6.36 diopters (D) for the manual trephine group and 6.09, 6.33, 5.14, 5.23, and 4.89 D for the femtosecond-laser group. The corneal astigmatism values were 5.40, 6.45, 6.30, 5.64, and 5.78 D for the manual trephine group and 6.17, 6.24, 5.72, 5.02, and 4.83 D for the femtosecond-laser group. The refractive astigmatism was significantly lower at 18 months after surgery and the corneal astigmatism was significantly lower at both 12 and 18 months after surgery in the femtosecond-laser group. None of endothelial cell count, graft rejection or failure rate, differed significantly between the two groups. Conclusions: Femtosecond-laser-enabled keratoplasty affords better visual recovery, less refractive and corneal astigmatism, and better wound stability than does penetrating keratoplasty using a manual trephine.

라식 수술 후 10년 뒤 외상 후 발생한 층상각막염 1예

이지혜(Jee Hye Lee),정소향(So Hyang Chung) 대한검안학회 2015 Annals of optometry and contact lens Vol.14 No.1

Purpose: We report a case of late onset interlamellar keratitis associated with corneal trauma 10 years after laser in situ keratomileusis. Case summary: A 33-year-old man who underwent laser in situ keratomileusis 10 years ago and laser epithelial keratomileusis 5 years ago for enhancement in both eyes presented with a red eye and decreased visual acuity in his left eye due to trauma with a foreign body. There was a horseshoe-shaped epithelial defect and infiltration in the interface below as the same shape of epithelial defect. He was treated with Moxifloxacine 0.5% (Vigamox??, Alcon, Fort worth, USA) for 2 days and the epithelial defect was healed. For remained interlamellar keratitis, he was commenced on Prednisolone Acetate 1% (Pred forte??, Allergan, Irvine, USA) 4 times a day with gradual resolution of the lamellar keratitis over a course of 3 weeks. Prednisolone Acetate 1% was then slowly tapered for 2 months with clearance of corneal opacity. Conclusions: In the case of lamellar keratitis associated with corneal epithelial defect due to trauma, regarding as non-infectious keratitis, early treatment with topical steroid can help eliminate visual loss associated with this condition.

반복각막미란에서 앞기질천자술과 술 후 장기간 5% NaCl 안약 병용치료의 효과

신다영(Da-Young Shin),정소향(So Hyang Chung) 대한안과학회 2017 대한안과학회지 Vol.58 No.5

목적: 본 연구에서는 반복각막미란에서 앞기질천자술과 술 후 5% NaCl 안약을 최소 6개월간 장기 병용치료한 효과를 알아보고자 한다. 대상과 방법: 2012년도 1월부터 2016년도 4월 사이에 가톨릭대학교 서울성모병원에서 반복각막미란을 진단받은 환자에서 앞기질천자 술을 시행하고 시술 후 5% NaCl 안약을 6개월간 4회 유지하도록 한 환자 21명(21안)을 대상으로 치료결과의 의무기록을 후향적으로 분석하였다. 환자들의 나이, 성별, 각막 외상, 안과적 수술병력의 여부, 시술 후 재발 여부와 재발 시 추가 치료 필요 여부, 술 후 합병증 발생에 대해 조사하였다. 결과: 총 21명의 환자 평균 나이는 42.05 ± 13.83세(19-68세)였고, 성별의 비율에 차이는 없었으며 평균 관찰 기간은 8.48 ± 2.76개 월(6-15개월)이었다. 21명 환자의 21안 중 14안(66.7%)에서 각막 외상, 2안(9.52%)에서 굴절수술을 받은 과거력이 있었고 각막이상증이 있는 경우가 1안(4.8%), 당뇨가 있었던 환자가 2안(9.5%)이었고 원인을 알 수 없는 경우가 5안(28.81%)이었다. 21안 중 치료 후재발한 환자는 3안(14.3%)이었고 2안은 보존적 치료 후 증상 소실되었으며 1안에서만 재시술이 필요하였다. 재시술을 받은 환자에서도 1회 추가 시술 후에는 재발하지 않았다. 앞기질천자술로 인한 각막혼탁 외에는 감염, 염증 등의 부작용은 없었으며 1명에서 각막혼 탁으로 인한 눈부심을 호소하였다. 결론: 반복각막미란 환자에서 앞기질천자술과 술 후 5% NaCl의 장기간 병용 요법은 보존적 치료에 반응하지 않는 난치성 반복각막미 란환자의 재발을 예방하는 효과적인 치료법임을 알 수 있었다. <대한안과학회지 2017;58(5):503-508> Purpose: The purpose of this study is to evaluate the efficacy of the combined treatment of anterior stromal puncture with the concurrent use of 5% NaCl eye drops for 6 months for recurrent corneal erosion syndrome. Methods: A retrospective chart review was conducted for 21 patients (21 eyes) who underwent the combined treatment of anterior stromal puncture with 5% NaCl eye drops qid for 6 months to treat recurrent corneal erosion syndromes. The patients’ age, gender, history of corneal trauma, history of ocular surgery, recurrence rate, need for additional treatments after recurrence and complication were analyzed. Results: The mean age was 42.05 ± 13.83 years (19-68 years) with no significant difference in gender, and the mean follow up period was 8.48 ± 2.76 months (6-15 months). Among the 21 eyes 14 eyes (66.7%) had a previous history of corneal trauma, 2 eyes (9.52%) had previous refractive surgery, 1 eye (4.8%) had corneal dystrophy, 2 eyes (9.5%) had diabetic mellitus and 5 eyes (28.81%) had an unknown origin. Furthermore, 3 eyes (14.3%) developed recurrences and 2 eyes were resolved with conservative treatment while 1 eye needed additional anterior stroma puncture. There was no recurrence after retreatment with anterior stroma puncture. No significant complications such as infection or inflammation developed with the exception of corneal opacity in which one patient developed glare due to corneal opacity. Conclusions: The combined treatment of anterior stromal puncture with 5% NaCl eye drops for a prolonged time might be effective at preventing the recurrence of refractory recurrent corneal erosion syndrome with conservative treatments. J Korean Ophthalmol Soc 2017;58(5):503-508

만성 안구 이식편대숙주병 환자에서 0.03% Tacrolimus 안약의 치료효과

최순일(Soon Il Choi, MD),정소향(So Hyang Chung, MD, PhD) 대한안과학회 2015 대한안과학회지 Vol.56 No.10

목적: 불응성 만성 안구 이식편대숙주병 건성안 환자에서 0.03% tacrolimus 안약의 치료효과를 알아보고자 하였다. 대상과 방법: 만성 안구 이식편대숙주병으로 건성안이 동반된 환자 12명의 24안, 점안 스테로이드제 및 0.05% cyclosporine제로 건성안 증상과 징후가 호전되지 않은 환자들을 대상으로, 상기 두 가지 안약을 2주간 중단 후 0.03% tacrolimus 안약을 하루에 2회씩 한 달간 점안하였다. 눈물약, 눈물 연고 및 안검 세척제는 점안 전 용법과 동일하게 사용하였다. 안구표면질환지수, 눈물막 파괴 검사, 눈물분비량 및 각결막 염색검사를 시행하였다. 결과: 각결막염색과 눈물막파괴 검사, 안구표면질환지수는 점안 4주째 통계적으로 유의하게 향상되었다(p<0.05). 눈물분비량은 유의한 변화가 나타나지 않았다(p>0.05). 결론: 불응성 만성 안구 이식편대숙주병 환자에서 0.03% tacrolimus 안약은 큰 부작용 없이 건성안 증상 및 징후를 호전시킬 수 있다. Purpose: To evaluate the therapeutic effects of 0.03% tacrolimus eye drops on dry eye associated with chronic ocular graft-versus-host disease (GVHD). Methods: This study included 24 eyes of 12 patients with refractory dry eye associated with chronic ocular GVHD who were unresponsive to topical steroid and 0.05% topical cyclosporine. The topical steroid and cyclosporine were discontinued for 2 weeks before treatment and 0.03% tacrolimus eye drops were applied twice a day for 1 month. Artificial tears, ointment, and lid cleanser were used in the same manner before initiating tacrolimus treatment. Ocular staining score, tear break-up time, ocular surface disease index (OSDI), and Schirmer I test score were evaluated. Results: Ocular staining score, tear break-up time, and OSDI improved with statistical significance (p < 0.05) after 28 days of treatment. Schirmer I test did not show statistical improvement after treatment. Conclusions: The use of 0.03% tacrolimus eye drops were effective for refractory dry eye associated with chronic ocular GVHD.