Large-diameter Deep Anterior Lamellar Keratoplasty: An Alternative Treatment for Mooren Ulcer

조양경,Sun-Young Lee,조의주,Balamurali K Ambati 대한안과학회 2020 Korean Journal of Ophthalmology Vol.34 No.5

눈안삽입콘택트렌즈 삽입술 후 각막내피세포의 변화

조양경,이현수,김만수,Yang Kyeung Cho,Hyun Soo Lee,Man Soo Kim 대한안과학회 2009 대한안과학회지 Vol.50 No.2

Purpose: To evaluate the stability of corneal endothelial cells after ICL (implantable contact lens) implantation. Methods: Retrospective review of 50 eyes were subjected to implantation of ICL by one surgeon from December 2003 to April 2008. During the follow-up period, the number of eyes with regular follow-up decreased and remained at 18 eyes at the time of a three-year follow-up. Patients were examined preoperatively and at one, three, and six months and one, two, and three years postoperatively. The main outcome measures were the change in corneal endothelial cell density (CD), coefficient of variation (CV), and hexagonality (HA). This analysis was done in all eyes and especially in the 18 eyes with regular follow-up for three years and 11 eyes with changes in CV and HA corresponding to the normal endothelial wound healing process for three years. Results: Corneal endothelial CD, CV, and HA were not significantly changed compared with their preoperative values throughout the three-year follow-up period for all eyes. In the early postoperative period, there was a slight decrease in CD, but it increased after the second year of follow-up (range: -3.12%~+2.84%); there was a slight increase in CV, but it decreased after the six-month follow-up (-6.63%~+5.56%); and there was a slight decrease in HA, but it increased after the three-month follow-up (range: -0.88%~10.64%). Similarly, there were no significant changes in corneal endothelial cell density in the 18 eyes with regular follow-up or the 11 eyes with changes in CV and HA corresponding to normal endothelial wound healing process for three years. Conclusions: The results show stability of corneal endothelial cells after ICL implantation.

동공크기에 따른 초음파유화흡인술의 결과

조양경,김은철,김만수,Yang Kyung Cho,Eun Chul Kim,Man Soo Kim 대한안과학회 2007 대한안과학회지 Vol.48 No.6

Purpose: To evaluate surgical results of phacoemulsification cataract surgery with respect to pupil size and iris retractors and to compare the effects of iris retractors according to the pupil size. Methods: This retrospective study included 90 eyes that underwent phacoemulsification cataract surgery. All of the eyes had a maximally dilated pupil size of 7 mm or smaller. Results: When the patients were evaluated according to pupil size, we found no difference in BCVA (best-corrected visual acuity) and phaco power × time between patients who had surgery involving iris retractors and those who did not. However, in patients with pupil sizes 3 mm or smaller, we did observe a statistically significant decrease in endothelial cell density (CD) when the iris retractor was used compared to when the retractor was not used (p<0.05). A comparison of preoperative and postoperative BCVA measurements revealed a significant BCVA increase in eyes with pupils larger than 3 mm. In contrast, in eyes with pupils smaller than 5 mm, significant decreases in CD were found when the preoperative and postoperative measurements were compared. Conclusions: In this study, we found that the iris retractor is useful for protecting corneal endothelial cells when the pupil size is smaller than 3 mm.

전층각막이식후 초음파유화흡인술의 결과

조양경,김만수,Yang Kyeung Cho,M,D,Ph,D,Man Soo Kim,M,D,Ph,D 대한안과학회 2007 대한안과학회지 Vol.48 No.2

Purpose: To evaluate the factors that affect visual outcome and transplanted corneal endothelial cell density in eyes that have undergone cataract surgery after penetrating keratoplasty, and to compare surgical outcomes with those of a control group. Methods: We conducted a retrospective review of case records of 20 eyes that had undergone cataract surgery between January 2003 and April 2006 after previous penetrating keratoplasty (group I) and 20 eyes that had undergone cataract surgery alone with low cornea endothelial cell density (group II). Results: For both groups, the grade of nucleosclerosis affected postoperative best corrected visual acuity (BCVA) and the total phaco energy (phaco power×time) did not affect either BCVA or endothelial cell density. In group I, the factor that most affected change in corneal endothelial cell density after cataract surgery was the time interval between keratoplasty and phacoemulsification. Comparison of the surgical results showed an increase in BCVA for both groups, and the difference between the two groups was not statistically significant. However, group I showed a significantly greater decrease in corneal endothelial cell density than did group II. Conclusions: Our results suggest that the corneal endothelial cells of the eye having previously undergone penertrating keratoplasty are vulnerable to surgical insult occurring in procedures such as cataract surgery, and that the time interval between the two procedures can affect the change in endothelial cell density.

후층판각막이식술후 이식편의 부착 및 각막기능의 회복에 관한 연구

조양경,김만수,Yang Kyung Cho,M,D,Man Soo Kim,M,D 대한안과학회 2006 대한안과학회지 Vol.47 No.7

Purpose: Posterior lamella keratoplasty has been described as a new procedure to treat corneal conditions involving endothelial dysfunction by selective transplantation of only the posterior corneal tissue composed of the endothelium, Descemet membrane, and posterior stroma. This study has been conducted to evaluate the recovery of endothelial function and adhesion mechanism of transplanted posterior corneal tissue to the donor stroma after posterior lamella keratoplasty. Methods: Dog corneal endothelium and posterior stroma were transplanted to recipient dog cornea stripped of endothelium and posterior stroma. The recovery of endothelial function and corneal thickness were measured by specular microscopy; pachymetry and slit lamp examination were done immediately after posterior lamella keratoplasty and at 1, 2, 4, 8 weeks post-operative. Eight weeks after operation, enucleation was performed and the histopathologic changes in the transplanted area of enucleated eyes were examined by light microscopy, fluorescent microscopy, and electron microscopy. Results: Corneal thickness, endothelial function, and corneal transparency were recovered by the end of experiment. The newly produced collagen fibrils were absent at the corneal posterior flap and anterior stromal bed interface. The collagen fibrils adjacent to the flap interface were irregularly arranged and morphologically transformed in some cases (2 of 8 cases) and were linearly arranged in a parallel manner in others (6 of 8 cases). Conclusions: It can be suggested that the stability of transplanted posterior corneal flap is maintained by incomplete wound healing and recovery of corneal endothelial function.

Risk Factors for Endothelial Cell Loss after Phacoemulsification: Comparison in Different Anterior Chamber Depth Groups

조양경,장화석,김만수 대한안과학회 2010 Korean Journal of Ophthalmology Vol.24 No.1

Purpose: To assess the risk factors for endothelial cell loss after phacoemulsification with implantation of intraocular lens according to anterior chamber depth (ACD). Methods: This prospective study included 94 eyes of 94 patients undergoing phacoemulsification cataract surgery. To assess the risk factors for corneal endothelial cell loss, we examined seven variables at 1 day, 1 week, 6 weeks, and 12 weeks postoperatively in each ACD-stratified group. Results: Multiple linear regression analysis showed that the only variable influencing the percentage decrease in corneal endothelial cell density throughout the postoperative follow-up period in the long ACD group (ACD III) was nucleosclerosis. The variables influencing the percentage decrease in corneal endothelial cell density in the short ACD group (ACD I) at one day and one week postoperatively were corneal incisional tunnel length and nucleosclerosis. Conclusions: Risk factors for endothelial cell loss after phaoemulsification were different according to ACD. Long corneal tunnel length can be one of the risk factors for endothelial cell loss in short ACD eyes.

Perioperative Modulating Factors on Astigmatism in Sutured Cataract Surgery

조양경,김만수 대한안과학회 2009 Korean Journal of Ophthalmology Vol.23 No.4

Purpose: To evaluate the factors that affect postoperative astigmatism and post-suture removal astigmatism, and to evaluate the risk factors associated with astigmatism axis shift. Methods: We performed a retrospective chart review of 130 eyes that had undergone uneventful phacoemulsification cataract surgery. Preoperative astigmatism was divided into four groups (Groups Ⅰ, Ⅱ, Ⅲ, and Ⅳ) according to the differences between the axis of preoperative astigmatism (flattest axis) and the incision axis (105 degrees). We analyzed the magnitude and axis of the induced astigmatism after the operation and after suture removal in each group. We also analyzed the factors which affected the postoperative astigmatism and post-suture removal astigmatism in each sub-group of Groups Ⅰ, Ⅱ, Ⅲ, and Ⅳ, excluding postoperative or post-suture removal axis shift (specifically, Group ⅠWAS, ⅡWAS, ⅢWAS, and ⅣWAS). We identified the variables associated with the prevalence of postoperative astigmatism axis shift and those associated with the prevalence of post-suture removal axis shift. Results: An increase in the magnitude of postoperative astigmatism was associated with an increase in the preoperative magnitude of astigmatism in Groups ⅠWAS, ⅡWAS, and ⅢWAS (p<0.05), and with an increase in the corneal tunnel length in Group ⅠWAS. A decrease in the magnitude of postoperative astigmatism was associated with an increase in the corneal tunnel length in Groups ⅢWAS and ⅣWAS (p<0.05). An increase in the magnitude of post‐suture removal astigmatism was associated with an increase in the magnitude of postoperative astigmatism in Groups ⅠWAS and ⅣWAS (p<0.05), and with late suture removal in Group ⅣWAS (p<0.05). A decrease in the magnitude of post‐suture removal astigmatism was associated with late suture removal in Groups ⅠWAS and ⅡWAS. A logistic regression analysis showed that the prevalence of post‐ suture removal astigmatism axis shift was associated with increased corneal tunnel length, decreased magnitude of postoperative astigmatism, and early suture removal. Conclusions: In order to reduce postoperative and post‐suture removal astigmatism, we recommend a short corneal tunnel length and late suture removal in patients with Group ⅠWAS characteristics, late suture removal in Group ⅡWAS‐like patients, long corneal tunnel length in Group ⅢWAS‐like patients, and long corneal tunnel length and early suture removal in patients with characteristics of Group ⅣWAS.

Dry Eye After Cataract Surgeryand Associated Intraoperative Risk Factors

조양경,김만수 대한안과학회 2009 Korean Journal of Ophthalmology Vol.23 No.2

Purpose: To investigate changes in dry eye symptoms and diagnostic test values after cataract surgery and to address factors that might influence those symptoms and test results. Methods: Twenty-eight eyes from 14 patients with preoperative dry eye (dry eye group) and 70 eyes from 35 patients without preoperative dry eye (non-dry eye group) were studied prospectively. In each group, we measured values such as tear break-up time (tBUT), Schirmer I test (ST-Ⅰ), tear meniscus height (TMH), and subjective dry eye symptoms (Sx), and evaluated the postoperative changes in these values. We also evaluated the influence of corneal incision location and shape on these values. The correlations between these values and microscopic light exposure time and phacoemulsification energy were investigated. Results: In the dry eye group, there were significant aggravations in Sx at 2 months postoperatively and in TMH at 3 days, 10 days, 1 month, and 2 months postoperatively, compared with preoperative values. All dry eye test values were significantly worse after cataract surgery in the non-dry eye group. With regard to incision location, there was no difference in tBUT, Sx, ST-Ⅰ, or TMH in either the dry eye group or the non-dry eye group at any postoperative time point. Regarding incision shape, there was no difference in tBUT, Sx, ST-Ⅰor TMH at any postoperative time point in the dry eye group. In the superior incision sub-group of the non-dry eye group, tBUT and Sx were worse in the grooved incision group at day 1. In the temporal incision sub-group of the non-dry eye group, Sx were worse in the grooved incision group at 1 day, 3 days, and 10 days postoperatively. In both groups, significant correlations were noted between microscopic light exposure time and dry eye test values, but no correlation was noted between phacoemulsification energy and dry eye test values. Conclusions: Cataract surgery may lead to dry eye. A grooved incision can aggravate the symptoms during the early postoperative period in patients without dry eye preoperatively. Long microscopic light exposure times can have an adverse effect on dry eye test values.

후층판각막이식술 후 이식편의 부착 및 각막기능의 회복에 관현 연구

조양경,김만수 대한안과학회 2006 대한안과학회지 Vol.47 No.7

목적 : 후부층판각막이식술은 향후 전층각막이식을 대체할 수 있을 것으로 예상되어 최근 많은 연구가 행해지고 있다. 본 연구에서는 무딘절개도를 이용한 후부층판각막이식술후 각막기능의 회복과 이식편의 부착기전을 알아보고자 하였다. 대상과 방법 : 실험동물로 개 8마리의 16안을 대상으로 4마리의 8안을 공여안으로 하고 다른 4마리의 8안을 수여안으로 하여 후부층판각막이식술을 시행하고 8주간 각막두께를 측정하고, 세극등현미경 및 경면현미경 관찰로 임상적인 성공 여부를 알아보고, 안구를 적출하여 수술 부위의 조직을 광학현미경, 형광현미경과 전자현미경을 이용하여 관찰하였다. 결과 : 수술 후 시간이 경과함에 따라 각막 혼탁과 부종은 서서히 감소하였으나 수술 후 8주에도 경한 각막혼탁을 보였고, 경면현미경관찰에서 각막내피의 모양과 크기가 점차적으로 회복되었다. 전체 8안중 2안에서 활성화된 각막간질세포와 수여각막과 이식편사이의 콜라겐 섬유조직의 섞임이나 변형 및 방향의 변화가 보였으나 8안중 6안에서는 활성화되지 않은 각막간질세포와 후부각막간질의 콜라겐섬유의 방향이 나란히 배열된 소견을 보였으며 이식안 전체에서 수술 후 8주째까지 완전한 창상치유를 보이는 각막은 관찰할 수 없었고 이식면에 새로운 콜라겐 섬유가 형성되거나 유착에 관여하는 물질이 침착되는 소견은 없었다. 결론 : 무딘절개도를 이용한 후부층판각막이식술에서 이식절편의 해부학적 안정성은 불완전한 상처치유과정과 각막내피세포의 회복에 의해 유지될 것으로 사료된다. Purpose: Posterior lamella keratoplasty has been described as a new procedure to treat corneal conditions involving endothelial dysfunction by selective transplantation of only the posterior corneal tissue composed of the endothelium, Descemet membrane, and posterior stroma. This study has been conducted to evaluate the recovery of endothelial function and adhesion mechanism of transplanted posterior corneal tissue to the donor stroma after posterior lamella keratoplasty. Methods: Dog corneal endothelium and posterior stroma were transplanted to recipient dog cornea stripped of endothelium and posterior stroma. The recovery of endothelial function and corneal thickness were measured by specular microscopy; pachymetry and slit lamp examination were done immediately after posterior lamella keratoplasty and at 1, 2, 4, 8 weeks post-operative. Eight weeks after operation, enucleation was performed and the histopathologic changes in the transplanted area of enucleated eyes were examined by light microscopy, fluorescent microscopy, and electron microscopy. Results: Corneal thickness, endothelial function, and corneal transparency were recovered by the end of experiment. The newly produced collagen fibrils were absent at the corneal posterior flap and anterior stromal bed interface. The collagen fibrils adjacent to the flap interface were irregularly arranged and morphologically transformed in some cases (2 of 8 cases) and were linearly arranged in a parallel manner in others (6 of 8 cases). Conclusions: It can be suggested that the stability of transplanted posterior corneal flap is maintained by incomplete wound healing and recovery of corneal endothelial function.

콘택트렌즈 착용 후 발생한 알칼리제네스 자일로속시던스에 의한 각막염 1예

조양경,지동현,김현경,나태윤,Yang Kyung Cho,Dong Hyun Gi,Hyun Kyung Kim,Tae Yoon La 대한안과학회 2010 대한안과학회지 Vol.51 No.11

Purpose: To report a case of corneal ulcer due to Alcaligenes xylosoxidans in a soft contact lens wearer. Case summary: A 20-year-old female patient presented with a corneal ulcer. The patient had been wearing soft contact lenses over 6 months. The ulcer had a typical appearance, similar to that of immune infiltration due to contact lenses. However, the corneal scraping and culture yielded Alcaligenes xylosoxidans, which is susceptible to ceftazidime and levofloxacine in the antibiotic susceptibility test. After treatment with topical antibiotics, her eye improved, with only a mild corneal scar remaining. Conclusions: Alcaligenes xylosoxidans should be considered as a potential causal pathogen of keratitis upon wearing soft contact lenses. Additionally, any lesion should be suspected as a bacterial corneal ulcer, even if appearing as an immune infiltration due to contact lenses. J Korean Ophthalmol Soc 2010;51(11):1525-1527