순수소안구증에 동반된 급성폐쇄각녹내장 1예

황제형,염동주,김재석,이주화,Je Hyung Hwang,MD,Dong Ju Yeom,MD,Jae Suk Kim,MD,Joo Hwa Lee,MD 대한안과학회 2010 대한안과학회지 Vol.51 No.2

Purpose: To present a case of acute angle-closure glaucoma in a nanophthalmos patient. Case summary: A 28-year-old woman visited the hospital for a sudden pain in the left eye, she had a small orbital bone and narrow palpebral fissurea in both eyes. Her intraocular pressure (IOP) was 58 mmHg in the left eye. The slit lamp examination showed shallow anterior chambers in both eyes, and the gonioscopic examination showed a closed angle in the left eye. The diameters of the corneas were 11 mm , and the axial lengths were 19.7 mm in the right eye and 19.6 mm in the left eye. The depths of the anterior chambers were 1.51 mm in the right eye and 1.82 mm in the left eye. The disease was diagnosed as acute angle-closure glaucoma in the left eye of the patient with nanophthalmos, and thus the IOP of the left eye was lowered using ophthalmic drugs and medications. Laser iridotomy was performed on both eyes. Conclusions: For around a year of follow-up after laser iridotomy, complications such as the rise of intraocular pressure and choroidal effusion were not observed. This suggests that laser iridotomy can be an effective treatment for acute angle-closure glaucoma accompanying nanophthalmos. J Korean Ophthalmol Soc 2010;51(2):303-306

정상안압녹내장환자의 중심각막두께와 망막신경섬유층의 상관관계

황제형,김재석,이주화,Je Hyung Hwang,MD,Jae Suk Kim,MD,Joo Hwa Lee,MD 대한안과학회 2010 대한안과학회지 Vol.51 No.1

Purpose: To investigate the correlation between central corneal thickness (CCT) and peripapillary retinal nerve fiber layer (RNFL) thickness in the eyes of patients with normal tension glaucoma (NTG) at the initial examination and to examine the difference in the degrees of damage of RNFL thickness depending on the CCT. Methods: Fifty-one eyes of 36 patients with NTG were included in the study, and 51 eyes of 30 people without the disease were used as a control group. CCT and peripapillary RNFL thickness were measured in each eye by ultrasonic pachymetry and optical coherence tomography(OCT), respectively. Patients from the normal NTG group who underwent OCT more than three times inthree years were identically assigned to two groups based on CCT: thin (< 553.6 μm) and thick (≥ 553.6 μm). Thus, a comparison of the changes in the thickness of retinal nerve fiber layer was performed between the two groups. Results: Patients with NTG showed a significant positive correlation between CCT and the mean peripapillary RNFL thickness at the initial examination (R=0.68, p<0.01). There were no significant differences in the changes in thickness of RNFL between the groups based on CCT (p>0.05) Conclusions: At the time of initial diagnosis of NTG, there was a significant correlation between the thickness of CCT and RNFL. Howeverthere was no significant correlation between the thickness of CCT and the progression of the damage of RNFL. J Korean Ophthalmol Soc 2010;51(1):63-69

덱사메타손 삽입물의 수정체 내로의 주입 후 수술적 처치

황제형(Jae Hyung Hwang),이정헌(Jeong Hyun Lee),김재석(Jae Suk Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.4

목적: 덱사메타손 삽입물의 수정체 내 주입 후 발생한 백내장 2예의 수술적 처치를 보고하고자 한다. 증례요약: (증례 1) 73세 남자 환자가 개인의원에서 우안 망막분지정맥폐쇄로 덱사메타손 삽입물 주사 중 수정체 내로 주입되어 본원으로 의뢰되었다. 경과관찰 중 후낭혼탁이 진행되어 수정체 내 주사 후 10일째 수정체유화술과 인공수정체삽입술을 시행하였고 덱사메타손 삽입물을 유리체강으로 위치시키려 했으나 삽입물이 부스러져 삽입물을 제거하고 덱사메타손 삽입물 유리체강내 주입술을 다시 시행하였다. (증례 2) 69세 여자 환자가 본원에서 좌안 망막분지정맥폐쇄로 덱사메타손 삽입물 주사 중 수정체 내로 주입되었다. 주사 후 1일째 수정체유화술과 인공수정체삽입술을 시행하였고 덱사메타손 삽입물을 유리체강으로 밀어 넣었다. 결론: 수정체 내 덱사메타손 삽입물이 주입되어 발생한 백내장의 제거 시 수정체유화술로 제거하는 데 무리가 없었으며, 수정체 내 삽입된 삽입물을 유리체강내로 밀어 넣는 경우 주사 후 약 10일 뒤에는 삽입물이 부스러져 유리체강내로 재위치시킬 수 없었고 주사 후 1일 뒤에는 삽입물의 경도가 유지되고 있어 후낭 파열부의 확장 없이 유리체강내로 재위치시킬 수 있었다. Purpose: To report two cases of phacoemulsification and intraocular lens implantation after inadvertent intralenticular injection of a dexamethasone implant. Case summary: (Case 1) A 73-year-old male was referred to our hospital after an accidental intralenticular injection of a dexamethasone implant in a local clinic for treatment of branch retinal vein occlusion in his right eye. During the follow-up period, posterior capsular opacity progressed and phacoemulsification and intraocular lens implantation were performed 10 days later. During the surgery, the dexamethasone implant shattered and could not be repositioned into the vitreous cavity. The remnants of that implant were removed and a second dexamethasone implant was successfully injected into the vitreous cavity. (Case 2) A 69-year-old female was being treated for branch retinal vein occlusion in her left eye in our hospital. A dexamethasone implant was accidentally injected into her lens, thus phacoemulsification and intraocular lens implantation were performed the following day. During the procedure, we were able to successfully reposition the dexamethasone implant into the vitreous cavity. Conclusions: Cataract formation after intralenticular injection of a dexamethasone implant can be easily managed with phacoemulsification. However, the dexamethasone implant shattered 10 days after the injection and could not be repositioned. The implant kept its hardness for at least one day and we were able to reposition it into the vitreous cavity without extending the rupture site of the posterior capsule.

소아 굴절력 측정 및 사시 유무 평가에서의 휴대용 시력검사기의 임상적 효용성

정규호,황제형,최진 대한안과학회 2020 대한안과학회지 Vol.61 No.4

Purpose: To investigate the clinical efficacy of the Spot Vision Screener in measuring refractive power and detecting strabismus in pediatric patients. Methods: We retrospectively analyzed the spherical equivalent, cylinder, and strabismus using the Spot Vision Screener before cycloplegic refraction for pediatric patients <10 years of age. We compared the spherical equivalent and cylinder using the Spot Vision Screener with the results of cycloplegic refraction, and we measured the accuracy of the Spot Vision Screener in detecting strabismus compared with the alternate prism cover test. Results: A total of 38 eyes of 19 patients were included in this study. There was no significant difference in spherical equivalent between the Spot Vision Screener before cycloplegic refraction and cycloplegic refraction (paired t-test: -0.25 ± 1.12 diopters [D] vs. 0.04 ± 1.86 D; p = 0.12). There was a significant difference in cylinder between the Spot Vision Screener before cycloplegic refraction and cycloplegic refraction, but the difference was only -0.25 D (paired t-test: -1.41 ± 1.16 D vs. -1.16 ± 1.25 D; p = 0.01). The sensitivity of the Spot Vision Screener was 42.86%, and the specificity was 66.67% for detecting strabismus. Conclusions: The Spot Vision Screener was a useful instrument to measure the refractive power in pediatric patients before cycloplegic refraction, but it had poor sensitivity and specificity for detecting strabismus. 목적: 소아 환자들을 대상으로 휴대용 시력검사기를 이용하여 굴절력 및 사시 유무를 평가하여 휴대용 시력검사기의 임상적 효용성을 확인하고자 하였다. 대상과 방법: 만 10세 이하의 소아를 대상으로 조절마비굴절검사 전 Spot Vision Screener를 이용하여 측정한 구면렌즈대응치와 난시 정도, 사시 유무를 후향적으로 분석하였다. Spot Vision Screener로 측정한 구면렌즈대응치 및 난시 정도를 조절마비굴절검사를 통해 측정한 구면렌즈대응치 및 난시 정도와 비교하였다. 교대프리즘가림검사로 확인한 사시 여부와 비교하여 Spot Vision Screener의 사시 평가 정확도를 평가하였다. 결과: 총 19명 38안이 본 연구에 포함되었다. 조절마비제 점안 전 Spot Vision Screener를 이용하여 측정한 값과 조절마비굴절검사를 통해 측정한 값을 비교한 경우 구면렌즈대응치에서는 유의한 차이가 없었다(대응표본 t-검정, -0.25 ± 1.12 diopters [D] vs. 0.04 ± 1.86D; p=0.12). 난시에서는 유의한 차이가 있었지만 그 차이가 평균 -0.25D였다(대응표본 t-검정, -1.41 ± 1.16D vs. -1.16 ± 1.25D; p=0.01). 사시 유무를 평가하는 데에 있어 Spot Vision Screener의 민감도는 42.86%, 특이도는 66.67%였다. 결론: Spot Vision Screener는 소아에서 굴절력을 확인하는 데에 있어 효용성이 있으나 사시 유무를 확인하는 데 있어서는 민감도와 특이도가 낮아 효용성이 낮은 것으로 보인다.

M-plus 다초점 인공수정체의 임상성적

정영권,박창원,황제형,주천기.Young Kwon Chung. Chang Won Park. Je Hyung Hwang. Choun-Ki Joo. 대한안과학회 2014 대한안과학회지 Vol.55 No.4

Purpose: To evaluate the clinical outcomes of eyes implanted with a zonal refractive multifocal intraocular lens (IOL) with an inferior segmental near add (M-plus), and to compare the outcomes between M-plus and a diffractive-type multifocal IOL, AT LISA (366D, bifocal). Methods: We reviewed 19 eyes from 10 patients who were implanted with M-plus and 52 eyes of 26 patients who were implanted with AT LISA. The clinical outcomes of these 2 intraocular lenses were evaluated at 1 day and 2 months postoperatively, and consisted of distant, intermediate, and near visual acuity, contrast sensitivity, degree of tilt, and decentration using anterior segment photography, depth of focus, and patient satisfaction. Results: There were no statistical differences between the 2 groups with respect to distant vision, near vision, refractive error, contrast sensitivity, degree of tilt, decentration, or satisfaction score. The M-plus group demonstrated significantly better intermediate visual acuity. In the defocus curve, the M-plus group also demonstrated significantly better visual acuities for intermediate unfocused vision levels. Conclusions: The M-plus multifocal IOLs are able to provide satisfactory distant and near visual acuity and visual function. The M-plus multifocal IOLs provide better intermediate vision than the AT LISA. J Korean Ophthalmol Soc 2014;55(4):519-526

전층각막이식 환자에서 발병한 Paecilomyces lilacinus 진균 각막염 1예

원재연,신지영,황제형,주천기,Jae Yon Won,Ji Young Shin,Je Hyung Hwang,Choun-Ki Joo 대한안과학회 2014 대한안과학회지 Vol.55 No.9

Purpose: To report a case of corneal ulcer caused by <em>Paecilomyces lilacinus</em> after penetrating keratoplasty. Case summary: A 67-year-old male with a history of penetrating keratoplasty in the left eye 7 years prior and re-penetrating keratoplasty in the left eye due to graft failure in June 2013, visited our clinic for ocular pain and conjunctival injection in the left eye 3 days in duration. Corneal scrapings were performed for Gram and fungal stains and cultures. The patient was admitted to the hospital for hourly topical fortified ceftazidime and amphotericin B. Despite intensive topical therapy, no improvement was observed. Three days later, fungal culture confirmed<em> Paecilomyces lilacinus</em> and topical voriconazole was prepared from the intravenous formulation and was administered topically and intravenously. Despite medical therapy with voriconazole, perforation occurred requiring a tectonic keratoplasty. Conclusions: Keratitis caused by <em>Paecilomyces lilacinus</em> is difficult to eradicate and refractory to amphotericin B. We suggest early use of topical eyedrops, intracameral, and intravitreal injections of voriconazole may be an appropriate treatment for patients with Paecilomyces lilacinus keratitis. J Korean Ophthalmol Soc 2014;55(9):1384-1387

Introduction of Lens-angle Reconstruction Surgery in Rabbit Eyes

김민희,황호식,박경진,황제형,주천기 대한안과학회 2014 Korean Journal of Ophthalmology Vol.28 No.6

Purpose: In this study, we examined the stability of the lens-angle supporter (LAS) for accommodation restorationby comparing intraocular lens (IOL) location, after-cataract and ciliary body damage after cataract surgeryin rabbits. Methods: Eight rabbits were divided into experimental and control groups of four rabbits each. Phacoemulsificationand irrigation and aspiration were performed in all rabbits. This was followed by an LAS and IOL insertionin the four experimental rabbits. In the four control rabbits, only an IOL insertion was performed. Six monthsafter the surgery, the location of the IOL, the conditions of the lens capsule and ciliary body were evaluatedusing a slitl-amp examination and Miyake-Apple view. Results: For the experimental group, the ultrasound biomicroscope results showed normal LAS and IOL positioningin all four cases. According to the slitlamp examination and Miyake-Apple view, the IOL was positionedat the center, with less after-cataract and damage to the ciliary body. For the control group, ultrasound biomicroscoperesults indicated a higher IOL position than normal, as well as a single case of IOL decentering. According to the slit-lamp examination and Miyake-Apple view, the IOL was decentered with more severe after-cataract and ciliary body damage. Conclusions: The LAS has the potential to maintain a stable IOL position while producing less after-cataractwhen used in lens-angle reconstruction for correction of presbyopia. Moreover, LAS implantation incurs lessdamage to the ciliary body.

수정체 혼탁유형에 따른 객관적 검안기기의 결과

박창원,김근영,김효진,황제형,주천기,Chang Won Park,MS,Geun Yeong Kim,MD,Hyo Jin Kim,PhD,Je Hyung Hwang,MD,Choun-Ki Joo,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.1

Purpose: To investigate the results using the OQAS and the Pentacam in cataract patients classified according to the type of lens opacity. Methods: The present study included 124 eyes of 92 patients who had cataract surgery at Seoul St. Mary’s Hospital from December 2011 to January 2012 and were classified into nuclear, cortical, and posterior subcapsular cataract patients. The lens opacity was determined with OSI, MTF, Strehl ratio, width 10%, width 50% and the opacity of Scheimpflug image by the OQAS and the Pentacam. Additionally, the correlation between subjective cataract classification and objective opacity value was analyzed. Results: The nuclear cataract group showed a 6.40 ± 2.41 OSI value and had high opacity. The cortical cataract group showed the highest MTF cut-off value (12.02 ± 6.19 C/deg). When evaluating Pentacam results, the posterior subcapsular cataract group had the lowest average level of lens opacity (9.12 ± 1.08) followed by in increasing order, the cortical cataract group (9.79 ± 1.67) and the nuclear cataract group (11.08 ± 1.84). The results were statistically significant (p < 0.001). The OSI value of the OQAS was significantly correlated with nuclear and posterior opacity (p = 0.049, p = 0.039, respectively) except cortical opacity (p = 0.781). MTF and nuclear opacity showed statistically significant correlation and the lens opacity of Pentacam was correlated with nuclear and posterior opacities. In cortical cataract with severe peripheral opacity, the cortical opacity showed significant correlation with Maximum. Conclusions: The OQAS and Pentacam results showed high correlation with the nuclear and posterior opacities which can be useful for cataract surgery. J Korean Ophthalmol Soc 2014;55(1):79-84

각막이식 후 발생한 수여 잔류막에 대한 야그레이저 치료 효과

김용찬(Yong Chan Kim),황제형(Jae Hyung Hwang),김만수(Man Soo Kim) 대한안과학회 2015 대한안과학회지 Vol.56 No.5

목적: 각막이식 후 전방에 의도하지 않게 발생된 수여 각막의 잔류막을 빛간섭단층촬영으로 분석하고, Nd-YAG 레이저로 치료 효과를 알아보고자 했다. 대상과 방법: 본원에서 2007년 1월부터 2013년 5월까지 전층각막이식 및 심층부분각막이식을 시행 받은 742명 중, 전방에 잔류막이 관찰되고, 교정시력이 저하되어, Nd-YAG 레이저 치료 후 1년 이상 추적관찰이 가능했던 10명의 환자의 의무기록을 후향적으로 분석하였다. 기저질환으로 수포성각막병증 2안, 홍채각막내피증후군 2안, 각막이상증 1안, 기타 원인에 의한 각막혼탁 5안을 대상으로 하였다. Nd-YAG 레이저를 이용한 잔류막 제거술은 이식 후 평균 4.9개월에 시행하여, 시행 전후 시력의 변화, 내피세포 수의 변화, 각막두께의 변화, 내피세포부터 전방 내 잔류막까지의 거리와 내피세포 감소와 상관 관계를 조사하였다. 결과: 대상자는 10명 10안, 남자 5명 5안, 여자 5명 5안이었으며, 평균 나이는 56.9세였다. Nd-YAG 레이저를 이용한 전방 잔류막 제거술 12개월 뒤에 측정한 교정시력은 통계학적으로 유의한 시력호전을 보였다(p=0.039). Nd-YAG 레이저 1달 후 측정한 공여각막 내피세포 수는 통계학적으로 유의하게 감소한 결과를 보였다(p=0.01). 공여각막 내피세포부터 전방 내 잔류막까지의 거리는 평균712.0 ± 217.5 μm였으며, 이 거리와 공여각막 내피세포 손실과의 통계적인 연관성은 없었다(R2=0.39, p=0.072). 결론: 각막이식 후 전방에 의도치 않게 발생된 잔류막은 공여각막 내피세포로부터 가까운 거리에서 형성됨을 빛간섭단층촬영으로 확인하였다. Nd-YAG 레이저를 이용한 제거술은 시력개선에 효과적이나, 내피세포로부터 가까이 형성됨에 따라 유의한 내피세포의 감소를 보였다. <대한안과학회지 2015;56(5):664-671> Purpose: To evaluate the clinical efficacy and shortcomings of neodymium-doped yttrium aluminum garnet (Nd-YAG) laser membranotomy in inadvertently retained host membrane. Methods: Among 742 patients who underwent penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) surgery at Seoul St. Mary's Hospital between January 2007 and May 2013 by a single surgeon, 10 patients had a thin, opaque membrane in the anterior chamber observed under slit lamp examination and both a subjective decrease in visual acuity and de-crease i best corrected visual acuity. A single surgeon performed membranotomy using the Nd-YAG laser at 4.9 months after graft surgery. In this study we compared the differences in visual acuity, endothelial cell count and correlations between distance from donor endothelium and retained host membrane and endothelial loss before and after the graft surgery. Results: Patients who had Nd-YAG laser membranotomy performed on the retained host membrane showed significant im-provements in visual acuity (p = 0.039). Donor endothelial cell count was significantly reduced 1 month after Nd-YAG laser. The average distance between donor endothelium and retained host membrane was 712.0 ± 217.5 µm. The distance and the de-creased donor endothelial cell count were not statistically correlated (R2 = 0.39, p = 0.072). There were no significant complica-tions after the laser membranotomy. Conclusions: Inadvertently retained host membrane forms close to the donor endothelium as identified on optical coherence to-mography (OCT) images. Nd-YAG laser membranotomy significantly affected clear vision but endothelial cell count loss was al-so observed. J Korean Ophthalmol Soc 2015;56(5):664-671

전안부 빛간섭단층촬영계를 이용한 연성콘택트렌즈의 산소투과율에 따른 중심각막두께 변화 비교

송미령(Miryoung Song),채민병(Minbyung Chae),황제형(Je-hyung Hwang),김태진(Tae Jin Kim) 대한검안학회 2013 Annals of optometry and contact lens Vol.13 No.2

목적: 전안부 빛간섭단층촬영계를 이용하여 산소투과율이 다른 연성콘택트렌즈를 착용하였을 때 각막의 저산소 상태에서 산소투과율에 따른 중심각막두께의 변화를 비교하여 알아보고자 하였다. 대상과 방법: 건강한 성인 30명을 대상으로 렌즈를 착용하지 않은 눈을 대조군으로 하고 산소투과율이 낮은 렌즈와 산소투과율이 높은 렌즈를 각각 착용하여 눈을 감은 상태를 유지하면서 120분 동안 30분 간격으로 전안부 빛간섭단층촬영계를 이용하여 중심각막 두께를 측정하였다. 결과: 상피층의 두께 변화는 세 그룹 간에 유의한 차이는 없었지만, 기질층 두께의 변화에서는 산소투과율이 낮은 그룹이 다른 두 그룹에 비해 증가하였으며 30분마다 약 1%씩 통계적으로 유의한 증가를 보였다(p<0.05, ANOVA). 전체 각막 두께의 변화에서도 산소투과율이 낮은 그룹이 다른 두 그룹에 비해 유의하게 증가하였고 산소투과율이 높은 그룹과 대조군은 두 그룹 간에 유의한 차이가 없었다. 중심각막두께의 최종변화는 산소투과율이 낮은 그룹은 27.69 ± 9.36 um, 산소투과율이 높은 그룹은 15.07 ± 11.49 um로 산소투과율이 낮은 그룹이 산소투과율이 높은 그룹에 비해 유의하게 증가하였다. 결론: 전안부 빛간섭단층촬영계를 이용하여 저산소 상태에서 산소투과율이 낮은 렌즈가 산소투과율이 높은 렌즈에 비해 기질층의 부종을 통하여 중심각막두께를 증가시키는 것을 알 수 있었다. Purpose: With anterior segment optical coherence tomography(OCT), changes of central corneal thickness should be compared by contact lens oxygen transmissibility when wearing different soft contact lens under the corneal hypoxic and closed-eye condition. Methods: Control group is eyes which don t wear lens for 30 healthy adults. They wore lens with low oxygen transmissibility (Lens A) and lens with high oxygen transmissibility (Lens B). Central corneal thickness was measured by anterior segment OCT every 30 minutes maintained closed-eye during 120 minutes. Results: There was no significant change among the three groups for the changes of epithelial thickness. But, in the changes of stromal thickness, Lens A group was increased in comparison with other two groups and showed statistically significant increase of about 1% every 30 minutes (p < 0.05). In changes of the whole corneal thickness, Lens A group showed significant increase in comparison with other two groups and there was no significant difference between Lens B group and control group. In the final changing rate of the central corneal thickness, Lens A group was 5.07 ± 3.06% and Lens B group was 2.68 ± 1.67%. Lens A group showed more significant increased than Lens B group. Conclusions: Under the hypoxic condition, when wearing lens with low oxygen transmissibility for 120 minutes, central corneal thickness showed significant increase. And, usages of anterior segment OCT should be gradually increased for several diseases of various purposes because it can grasp with the whole anterior video under the condition wearing lens.