국소마취제 점안 후 중심 각막 두께 측정치의 비교 : 프로파라케인과 옥시부프로케인

최경섭,남상민,이형근,김응권,서경률,Kyoung-Sub Choi,Sang-Min Nam,Hyung-Keun Lee,Eung-Kweon Kim,Kyoung-Yul Seo 대한안과학회 2005 대한안과학회지 Vol.46 No.5

Purpose: To compare changes in human central corneal thickness after instillation of proparacaine with those after oxybuprocaine instillation, over a period of 10 minutes. Methods: Eighteen healthy young participants were recruited. Baseline central corneal thicknesses were measured every 30 seconds for 10 minutes using a noncontact specular microscope. Changes in central corneal thickness were measured every 20 seconds for 10 minutes after the administration of one drop of 0.5% proparacaine into the right eye, and one drop of 0.4% oxybuprocaine into the left eye. Results: Mean baseline central corneal thickness was 531±45 ㎛ in the right eye and 531±42 ㎛ in the left. The central corneal thickness after proparacaine instillation increased to 8.6 ㎛ (4.5-12.6 ㎛, 95% CI) and then returned to baseline within 80 seconds. Central corneal thickness after oxybuprocaine instillation increased to 7.7 ㎛ (3.6-11.2 ㎛, 95% CI) and then returned to baseline within 80 seconds. There was a second transient increase about 5 minute after proparacaine instillation but no additional transient increase after oxybuprocaine instillation. Conclusions: The severity of oxybuprocaine‘s effect on central corneal thickness is similar to that of proparacaine. Central corneal thickness instability may occur for 5 minutes after proparacaine administration. Therefore, changes in central corneal thickness after topical anesthetics instillation should be considered when measuring central corneal thickness.

굴절조절내사시에서 대상부전과 추가치료의 발생 및 위험요인

최경섭,장지호,장윤희,이종복,Kyoung Sub Choi,M,D,Jee Ho Chang,M,D,Yoon Hee Chang,M,D,Jong Bok Lee,M,D 대한안과학회 2006 대한안과학회지 Vol.47 No.1

Purpose: To examine the occurrence and risk factors of decompensation and the additional treatment of increased hyperopia in refractive accommodative esotropia. Methods: Seventy children with refractive accommodative esotropia were followed up for at least 2 years. Time of decompensation and additional treatment, initial refractive error, initial deviation, and controlled deviation were all studied. Results: Decompensation and additional treatment occurred on average at 21.8 months and 22.2 months in eight patients, respectively, and constant survival was achieved after 4 years of full correction of the refractive error, as shown on a Kaplan-Meier survival curve. In the decompensation, additional treatment and control groups, initial refractive errors were 3.97±1.07D, 4.06±1.92D and 4.60±1.29D, respectively; initial deviations were 36.25±12.75PD, 31.25±10.61PD and 26.02±8.62PD, respectively; and controlled deviations were 4.50±6.30PD, 4.50±4.63PD and 2.65±4.10PD, respectively. There was a significant difference in initial deviation between the decompensation and control groups (p=0.011). Conclusions: The treatment of decompensation and increased hyperopia warranted careful follow-up in the first 4 years after treatment, and patients with large initial deviation risked decompensation.

40세 이상 당뇨환자에서 당뇨 안 검진과 관련된 요인 분석: 제4기 국민건강 영양 조사자료

임형택,최경섭.Hyung Taek Lim. MD. Kyoung Sub Choi. MD. PhD 대한안과학회 2012 대한안과학회지 Vol.53 No.4

Purpose: To identify factors associated with care of diabetic retinopathy. Methods: The fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) is a nationwide survey. This survey included 1, 257 people aged 40 years and older with a history of diabetic mellitus who answered questions, “Within one year, have you ever received eye examination (fundus photography) for screening diabetic retinopathy?” Factors that affect care of diabetic retinopathy were identified using multiple logistic regression analysis. Results: Among the 1,257 people aged 40 years and older, 464 (36.9%) received screening for diabetic retinopathy. People aged 65 years and older (aOR = 0.7, 95% CI: 0.51-0.85) with university education (aOR = 0.5, 95% CI: 0.32-0.74) were more likely to undergo screening for diabetic retinopathy compared to those in the reference category (40-64 years old and those who had elementary school or lower education). People living in rural areas were less likely to undergo screening for diabetic retinopathy compared to those living in urban areas (aOR = 1.7, 95% CI: 1.32-2.24). Diabetic retinopathy screening was also associated with self-reported health status (ref: unhealthy [aOR = 1], fair [aOR = 1.7, 95% CI: 1.25-2.23], and healthy [aOR = 1.8, 95% CI: 1.30-2.44]). Conclusions: To increase nationwide screening rates for diabetic retinopathy, more attention should be given to underserved groups, particularly people aged between 40 and 64 years, those with a low education level, those living in rural areas, and those with a positive attitude toward self-reported health status. These issues highlight the need for a new emphasis in health education and public health policies aimed towards these underserved groups. J Korean Ophthalmol Soc 2012;53(4):516-521

분지망막정맥폐쇄에서 폐쇄부위에 따른 유리체강 내 베바시주맙주입술의 치료효과

김주연(Joo Yoen Kim),최경섭(Kyoung Sub Choi) 대한안과학회 2017 대한안과학회지 Vol.58 No.10

목적: 분지망막정맥폐쇄로 인한 황반부종에서 유리체강내 베바시주맙의 치료효과를 폐쇄부위에 따라 비교해 보았다. 대상과 방법: 분지망막정맥폐쇄로 인한 황반부종으로 유리체강내 베바시주맙 치료를 받은 환자 58안(58명)을 대상으로 후향적 의무기록 분석을 통한 연구를 진행하였다. 분지망막정맥폐쇄 환자를 망막정맥폐쇄부위에 따라 두 군(major, macular)으로 나누어 보았다. 모든 환자들에서 치료 전 및 치료 후 12개월간 최대교정시력과 중심망막두께를 측정하였다. 결과: Major branch retinal vein occlusion (BRVO) 군(39안)은 12개월 경과관찰 기간 동안 최대교정시력(logMAR)이 0.66 ± 0.47에서 0.34 ± 0.28로 호전되었으며(p=0.011), macular BRVO 군(19안)도 0.60 ± 0.41에서 0.30 ± 0.22로 호전되었다(p=0.014). 중심망막두께도 major BRVO 군은 12개월 경과관찰 기간 동안 498.5 ± 194.3 μm에서 311.3 ± 178.5 μm로 감소되었으며(p=0.004), macular BRVO 군은 442.4 ± 155.8 μm에서 297.2 ± 145.7 μm로 감소되었다(p=0.002). 그러나 두 군 간에 최대교정시력의 호전이나 중심망막두께의 감소에 의미 있는 차이는 없었다. 12개월 경과관찰 기간 중 평균주사횟수에서 macular BRVO 군이 2.6 ± 1.6회로 3.5 ± 1.4회인 major BRVO 군보다 유의미하게 적었다(p=0.021). 결론: 분지망막정맥폐쇄의 폐쇄부위에 따른 두 군(major, macular) 간에 있어서 황반부종에 대한 유리체강내 베바시주맙 치료는 시력 예후나 중심망막두께의 변화에 있어서 큰 차이를 보이지는 않았다. 다만 macular BRVO 군에는 주사횟수가 major BRVO 군보다 유의미하게 적었으며 향후 이러한 임상적 특징은 분지망막정맥폐쇄 환자의 치료 시 고려할 만한 사항으로 생각된다. Purpose: To compare therapeutic outcome of intravitreal bevacizumab in treating macular edema between major and macular branch retinal vein occlusion (BRVO). Methods: This retrospective, observational study included 58 eyes from 58 patients with macular edema secondary to BRVO. All patients were treated with intravitreal bevacizumab injection at baseline, followed by further injections as required with monthly follow-up. Central foveal thickness and best-corrected visual acuity (BCVA) were evaluated after treatment between major and macular BRVO during 12 months of follow-up. Results: The mean best-corrected visual acuity (BCVA) in the major BRVO group (39 eyes), expressed as the logarithm of the minimum angle of resolution (logMAR), decreased from 0.66 ± 0.47 to 0.34 ± 0.28 after 12 months of treatment (p = 0.011). Similarly, in the macular BRVO group (19 eyes), the BCVA decreased from 0.60 ± 0.41 to 0.30 ± 0.22 (p = 0.014). The central foveal thickness decreased in the major BRVO group from 498.5 ± 194.3 μm to 311.3 ± 178.5 μm and in the macular BRVO group from 442.4 ± 155.8 μm to 297.2 ± 145.7 μm (p = 0.004 and 0.002, respectively). However, there was no significant difference between the groups with regard to either BCVA improvement or decrease in central foveal thickness. The mean injection number of macular BRVO (2.6 ± 1.6) was significantly lower than that of major BRVO (3.5 ± 1.4, p = 0.021). Conclusions: The visual acuity improvement achieved after 12 months of intravitreal bevacizumab injection did not differ significantly between major and macular BRVO. However, significantly fewer injections were required for macular BRVO than major BRVO.

분지망막정맥폐쇄에 동반된 불응성 황반부종에서 유리체내 트리암시놀론 주사의 단기 치료 효과

안현민(Hyun Min Ahn),최경섭(Kyoung Sub Choi) 대한안과학회 2016 대한안과학회지 Vol.57 No.11

목적: 분지망막정맥폐쇄에서 유리체내 베바시주맙 주입술에 반응하지 않는 불응성 황반부종에 대한 치료로 유리체내 트리암시놀론 주입술의 효과를 알아보고자 하였다. 대상과 방법: 분지망막정맥폐쇄로 인한 황반부종으로 진단 받고 2회 이상 매달 연속된 유리체내 베바시주맙 주입술을 시행 받은 환자 중 치료 효과가 나타나지 않아 유리체내 트리암시놀론 주입술을 시행 받은 23명 23안의 의무기록을 후향적으로 조사하였다. 트리암시놀론 주입술 전과 주입술 후 1개월, 3개월째 최대교정시력 및 빛간섭단층촬영(optical coherence tomography, OCT) 상 소견을 분석 하였다. 결과: 대상 환자들은 평균 3.4 ± 1.2회의 유리체내 베바시주맙 주입술을 시행 받았다. 유리체내 트리암시놀론 주입술은 마지막 유리 체내 베바시주맙 주입술 시행 후 평균 4.3 ± 1.7주 뒤 시행되었다. 최대교정시력(logarithm of the minimal angle of resolution, logMAR)은 치료 전 0.61 ± 0.45에서 치료 1개월 후 logMAR 0.52 ± 0.35, 3개월 후 logMAR 0.58 ± 0.37로 좋아지는 경향을 보였으나, 통계학적으로는 유의하지 않았다(p=0.114, 0.412). 그러나 8안(34.8%)에서 3줄 이상의 시력호전을 보였으며, 4안(17.4%)에서는 2 줄 이하의 안정적인 시력 호전을 보였다. OCT 상 중심와두께(central foveal thichness, CFT)는 치료 전 512 ± 166 μm에서 치료 후 한 달째 310 ± 139 μm, 3개월째 324 ± 159 μm로 통계적으로 유의한 호전을 보였다(p=0.014, 0.031). 결론: 분지망막정맥폐쇄에 동반된 황반부종에서 유리체내 트리암시놀론 주입술은 유리체내 베바시주맙 주입술에 반응하지 않는 일부 환자에 있어 최대교정시력과 중심와두께에 호전 소견을 보였으며 하나의 치료적 방법으로 제안될 수 있다. <대한안과학회지 2016;57(11):1731-1737> Purpose: To evaluate the short-term efficacy of intravitreal triamcinolone (IVTA) injection for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO) refractory to intravitreal bevacizumab injections. Methods: This retrospective, observational study included 23 eyes of 23 patients with macular edema secondary to BRVO. The patients with macular edema unresponsive to 2 or more consecutive monthly intravitreal bevacizumab injections were treated with IVTA. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) based on optical coherence tomography were evaluated before IVTA and 1 month and 3 months after IVTA injections. Results: All patients were previously treated with 3.4 ± 1.2 intravitreal bevacizumab injections. The IVTA injection was performed at 4.3 ± 1.7 weeks after the last bevacizumab injection. The logarithm of the minimal angle of resolution (log MAR) BCVA was also decreased from 0.61 ± 0.45 to 0.52 ± 0.35 after 1 month and to 0.58 ± 0.37 after 3 months of IVTA, although without statistical significance (p = 0.114 and 0.412, respectively). Eight eyes (34.8%) showed more than 3 lines improvement of BCVA and 4 eyes (17.4%) showed stable BCVA increasing 2 lines or less. CFT was significantly improved from 512 ± 166 μm to 310 ± 139 μm after 1 month and to 324 ± 159 μm after 3 months of IVTA injections (p = 0.014 and 0.031, respectively). Conclusions: IVTA was beneficial in some patients with macular edema secondary to BRVO refractory to intravitreal bevacizumab therapy. This study indicates that IVTA could be considered as a treatment option for refractory macular edema associated with BRVO. J Korean Ophthalmol Soc 2016;57(11):1731-1737

전신홍반성 루프스와 동반된 맥락망막병증 및 이차성 급성 폐쇄각 발작 1예

안현민(Hyun Min Ahn),최경섭(Kyoung Sub Choi) 대한안과학회 2016 대한안과학회지 Vol.57 No.11

목적: 전신홍반성 루프스(루프스)는 만성 자가면역 질환으로 전신에 침범할 수 있으나 안구, 특히 맥락막을 침범하는 경우는 드문 것으로 알려져 있다. 본 증례에서는 루프스에 의한 양안 맥락망막병증 및 이로 인한 이차적인 급성 폐쇄각 발작이 발생한 1예를 보고 하고자 한다. 증례요약: 우측 음낭 부종(scrotal swelling)으로 비뇨기과 입원 중인 58세 남자가 양안 충혈 및 통증으로 안과 협진의뢰되었다. 안저 소견상 맥락망막염, 맥락막박리가 관찰되었으며, 이차적인 양안 급성 폐쇄각 발작이 세극등검사 및 안압검사를 통하여 확인되었다. 류마티스내과를 통하여 혈액검사를 포함한 전신 감별 검사를 시행하였으며, 전신홍반성 루프스가 진단되었다. 전신성 스테로이드 및 안압하강제치료 시행 후, 양안 맥락망막염 호전과 함께 안압 하강 및 맥락막박리가 소실되었다. 결론: 루프스에서 양안 맥락망막병증과 동반되어 이차적인 급성 폐쇄각 발작이 나타날 수 있으며, 전신적 스테로이드 및 안압하강제 사용이 치료에 도움이 된다. <대한안과학회지 2016;57(11):1801-1805> Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with widespread manifestations that rarely include the eye. We present a case of SLE-associated choroidoretinopathy and secondary angle closure attack in both eyes. Case summary: A 58-year-old male was admitted into the urologic department complaining of right scrotal swelling, and then consulted with the ophthalmology department regarding both ocular pain and eye injection. The patient was diagnosed with acute angle closure attack using a slit lamp test and tonometry secondary to choroidoretinitis with choroidal detachment at fundus examination in both eyes. The rheumatologist performed systemic evaluation, including serologic tests, and then diagnosed the patient with SLE. After systemic steroid therapy, intraocular pressure was decreased and choroidal detachment disappeared with improvements of choroidoretinitis in both eyes. Conclusions: Patients with systemic lupus erythematosus choroidopathy can develop secondary angle closure attack, which can be effectively treated using systemic steroid therapy and antiglaucoma drugs. J Korean Ophthalmol Soc 2016;57(11):1801-1805

망막중심동맥폐쇄에 합병된 망막신생혈관의 유리체강 내 아바스틴 주입술에 의한 치험 1예

최현준(Hyun Joon Choi),최경섭(Kyoung Sub Choi) 대한검안학회 2008 Annals of optometry and contact lens Vol.7 No.1

목적: 중심망막동맥폐쇄에 합병된 망막혈관신생 소견을 보인 환자의 유리체강 내 아바스틴??(Bevacizumab) 주입술 시행 후 망막신생혈관의 퇴행을 경험하였기에 보고하고자 한다. 대상과 방법: 특이 과거력 없는 71세 남자 환자가 양안의 시력저하(안전수지)를 주소로 내원하였다. 안저검사상 양안 후극부에 황반부를 중심으로 망막의 혼탁 및 혈류장애 소견 보였으나, 전형적인 중심와 앵두반점은 보이지 않았다. 형광안저촬영상 양안 동정맥 통과 시간의 지연 및 우안 망막혈관신생 부위의 형광누출이 관찰되었다. 발병 2개월째 우안 안저검사상 유리체출혈 및 악화된 혈관신생 소견 보여, 유리체강 내 아바스틴?? 주입술을 시행하였다. 결과: 주입술 후 3주째, 우안의 유리체 출혈 감소되었고, 형광안저촬영상 혈관신생의 퇴행 소견 보였다. 결론: 유리체강 내 아바스틴?? 주입술은 중심망막동맥폐쇄에 합병된 망막 혈관신생에 있어서 고려할 수 있는 안전하고 효과적인 방법으로 생각한다. Purpose: To report a case of regression of retinal neovascularization following central retinal artery occlusion with a single intravitreal injection of avastin?? (bevacizumab). Methods: A 71-year-old man without significant past medical history visited our clinic because of diminished vision in his both eyes (count-finger vision). Fundus examination showed retinal opacification on the posterior pole around the center of the macula with significant reduction of the retinal circulation, but there is no cherry-red spot at the fovea. Fluorescein angiography revealed marked delay in arteriovenous transit time in both eyes, and leakage from retinal neovascularization in the right eye. Five months after the occlusion, fundus examination of the right eye showed vitreous hemorrhage and increased retinal neovascularization. We performed intravitreal avastin?? injection. Results: After three weeks, there was decreased vitreous hemorrhage and regression of neovascularization on fluorescein angiography in the right eye. Conclusions: Our experience suggests that intravitreal avastin?? injection may be a safe and effective alternative to conventional therapeutic procedures for retinal neovascularization with central retinal artery occlusion.