비전형적인 임상양상을 보인 칸디다 파라프실로시스 각막염 1예

김훈동,김소영,정문선,Hoon Dong Kim,So Young Kim,Moon Sun Jung 대한안과학회 2010 대한안과학회지 Vol.51 No.1

Purpose: To report a case of Candida parapsilosis keratitis with atypical presentation demonstrated by subepithelial white dot deposits without peripheral inflammatory reaction. Case summary: A 45-year-old woman with Stevens-Johnson syndrome had used topical corticosteroid and bandage contact lens due to recurrent epithelial defect and keratitis. Multiple subepithelial white dot deposits were revealed on the central corneal area without surrounding inflammation. The corneal lesion was improved after epithelial debridement with topical antibiotics and steroid eyedrops. A few months later, however, the corneal lesion recurred. Smear cytology was performed, and yeast-formed fungi and pseudohyphae were found. C. parapsilosis was identified in the culture study. Therefore, the topical steroid was withdrawn and 0.15% topical Amphotericin was applied. The corneal lesion improved and corneal opacity did not progress. Conclusions: The case reported in this study is C. parapsilosis keratitis with multiple subepithelial white dot deposits without typical presentations of fungal kertitis. Although no typical infectious indication was evident, infection should be suspected in patients who show abnormal corneal lesion under immunosuppressive treatment. J Korean Ophthalmol Soc 2010;51(1):136-140

비동맥염성 앞허혈시신경병증에서 동반된 망막하액 축적 1예

조인환,김훈동,최경식.In Hwan Cho. MD. Hoon Dong Kim. MD. Kyung Seek Choi. MD 대한안과학회 2010 대한안과학회지 Vol.51 No.10

Purpose: To report a patient with non-arteritic anterior ischemic optic neuropathy with submacular fluid and peripapillary swelling. Case summary: A 53-year-old patient visited our clinic complaining of acute visual loss in the right eye which began two days previously. The patient had no clinical history of ocular pain on eye movement. A relative afferent pupillary defect was observed in the right eye. Fundoscopic examination showed optic disc edema and an elevated macular lesion (1 disc diameter). Fluorescein angiography (FAG) revealed blocking by serous detachment in the peripapillary area in the early phase and peripapillary leakage in the late phase. Spectral domain optical coherence tomography (SD-OCT) showed submacular fluid and peripapillary swelling. Intravenous steroid injection was administrated. After five days of treatment, visual acuity improved to 0.2; one month later, visual acuity was 0.5. subretinal fluid absorption was observed with remaining lipid deposits. Conclusions: In non-arteritic anterior ischemic optic neuropathy, submacular fluid accumulation can occur due to destruction of retinal glial cells. Accumulation of submacular fluid can induce sudden visual loss and may predict visual prognosis. The macular area requires careful evaluation in non-arteritic anterior ischemic optic neuropathy patients. J Korean Ophthalmol Soc 2010;51(10):1409-1413

가토안에서 전방내 트리암시놀론 주입술이 각막에 미치는 영향

박주연,김훈동,최경식.Joo Youn Park. M.D.. Hoon Dong Kim. M.D.. Kyung Seek Choi. M.D. 대한안과학회 2008 대한안과학회지 Vol.49 No.4

Purpose: To evaluate the safety and effects of intracameral triamcinolone acetonide injection in rabbit corneas. Methods: Triamcinolone acetonide in the amounts of 0.5, 1, and 2 mg was injected into the anterior chamber of rabbit eyes, and intraocular pressure, corneal thickness, and endothelial cell counts were evaluated on days 1, 3, 7, 14, and 28. Twenty-eight days after triamcinolone acetonide injection, the eyes were enucleated and examined after TUNEL staining. Results: No statistically significant differences were found among control, 0.5, and 1 mg triamcinoloneinjected eyes in central corneal thickness, endothelial cell density, pleomorphism, and polymegathism. There was no difference between 2 mg triamcinolone-injected eyes and control eyes for corneal thickness and cell density, but there were statistically significant differences between these two groups for pleomorphism (p<0.05) and polymegathism (p<0.05). Conclusions: The results of this study suggested that intracameral injections of 0.5~1 mg of triamcinolone acetonide are beneficial and cause no toxic effects on corneas.

섬유주절제술 후 발생한 Streptococcus Cristatus 원인의 지연성 안내염 1예

최곤수(Gon Soo Choe),김훈동(Hoon Dong Kim),안병헌(Byung Heon Ahn),정종진(Jong Jin Jung) 대한안과학회 2021 대한안과학회지 Vol.62 No.11

목적: 섬유주절제술 후 발생한 Streptococcus cristatus (S. cristatus) 원인의 여과포 관련 안내염 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 좌안 섬유주절제술 수술을 받은 지 2년 후 발생한 좌안 통증과 시력저하를 주소로 59세 여자 환자가 내원하였다. 좌안 시력은 안전수지였고, 세극등현미경검사에서 상부 결막에 얇아진 백색의 여과포, 심한 결막충혈, 전방 내 염증 소견이 관찰되었으며, 안저는 관찰되지 않았다. 항생제 투여에도 전방 내 염증 소견은 호전되지 않았고, 염증성 막과 전방축농이 동반되었다. 즉시 유리체절제술, 유리체내 항생제주사를 시행하였다. 유리체 검체의 세균배양검사 결과 S. cristatus가 동정되었으며, 수술 7일 후 염증 소견은 점차감소하였다. 수술 후 1개월째 안내염 재발 소견은 없지만, 좌안 최대교정시력은 여전히 안전수지로 유지되고 있다. 결론: 국내에서 아직 보고된 적 없는, 섬유주절제술 후 S. cristatus에 의한 지연성 여과포 관련 안내염을 보고하는 바이며, 섬유주절제술 후 발생한 안내염에서 그람 양성구균이 자랄 경우 S. cristatus에 의한 안내염의 가능성도 고려해야 하겠다. Purpose: To report a case of late-onset bleb-associated endophthalmitis caused by streptococcus cristatus (S. cristatus) after trabeculectomy. Case summary: A 59-year-old woman presented with left ocular pain and visual disturbance. She had undergone trabeculectomy of the left eye 2 years ago. At the initial visit, she was only able to count fingers from the left eye. Whitish thin bleb, conjunctival injection, and inflammation were observed in the left anterior chamber, and the fundus could not be visualized. Despite administering topical and systemic antibiotics, the chamber reaction worsened, and hypopyon and inflammatory membrane were noticed the next day. Vitrectomy with phacoemulsification and intravitreal antibiotic injection was performed, and the intravitreal antibiotic injections were repeated over the next two days. Bacterial culture of vitreous fluid showed a growth of S. cristatus 5 days after the surgery, and inflammation improved after 7 days. One month later, she was still only able to count fingers from the left eye, but there were no signs of endophthalmitis. Conclusions: Postoperative endophthalmitis after glaucoma filtering surgeries caused by S. cristatus has not been reported previously from Korea. To the best of our knowledge, this is the first Korean case of late-onset bleb-associated endophthalmitis caused by S. cristatus. If gram-positive cocci are grown in samples from the patients with endophthalmitis after trabeculectomy, resident oral microflora such as S. cristatus should be considered as the causative pathogen.

당뇨망막병증에 의한 유리체출혈에서 동시에 기록된 명순응 망막전위도와 섬광 시유발전위 검사

김윤경(Yoon Kyung Kim),김훈동(Hoon Dong Kim),박태관(Tae Kwann Park),온영훈(Young Hoon Ohn) 대한안과학회 2017 대한안과학회지 Vol.58 No.3

목적: 증식당뇨망막병증에 의한 심한 유리체출혈에서 동시에 기록된 명순응 망막전위도와 섬광 시유발전위 검사의 임상적 유용성을 알아보고자 하였다. 대상과 방법: 당뇨망막병증으로 인한 Grade IV의 유리체출혈을 진단 받은 23명과 특이 내과적 및 안과적 과거력이 없는 일반인 20명을 대상으로 명순응 망막전위도와 섬광 시유발전위검사를 동시에 시행하였다. 대상 환자 23명은 단안 유리체출혈을 진단 받았으며 반대안은 증식당뇨망막병증을 진단 받았다. 정상안과 증식당뇨망막병증의 파형을 비교하였고, 증식당뇨망막병증을 세분화하여 유리 체출혈안과 출혈이 없는 대조안에서의 명순응 망막전위도와 섬광 시유발전위의 파형을 비교하였다. 유리체출혈을 진단 받은 환자들은 모두 검사 후 유리체 절제술을 시행 받았으며 수술 8주 후 최대교정시력을 확인하여 시력 향상군과 시력 향상이 없는 군으로 분류하였고, 두 군 간 수술 전 파형을 비교하였다. 결과: 정상안과 증식당뇨망막병증의 비교 및 증식당뇨망막병증에서 출혈안과 대조안의 비교에서 명순응 망막전위도의 a-파와 b-파의 진폭, 섬광 시유발전위의 P2의 진폭은 출혈안에서 진폭의 크기가 가장 작았고 정상안의 진폭의 크기가 가장 컸으며 a-파와 b-파의 진폭은 각 군 간 유의한 차이를 보였다(p<0.05). 명순응 망막전위도의 a-파와 b-파의 반응도달시간, 섬광 시유발전위의 P2의 잠복기는 모두 출혈안에서 가장 길었고 정상안에서 가장 짧았으며 각 군 간 유의한 차이를 보였다(p<0.05). 시력 향상이 없는 군과 시력 향상이 있는 군의 수술 전 검사 결과를 비교하였을 때 명순응 망막전위도의 a-파의 진폭이 area under receiver operating characteristic (AUROC) 0.88 (0.74-1.00)로 가장 높았다. 결론: 동시에 기록되는 명순응 망막전위도와 섬광 시유발전위는 망막과 시신경의 기능을 동시에 측정하여 안저 확인이 불가능한 유리 체출혈 환자에서 수술 후 시력 예후를 예측할 수 있는 지표로 이용될 수 있다. Purpose: To determine whether the simultaneous recording of photopic electroretinography (ERG) and flash visual evoked potential (VEP) can predict the postoperative outcome in diabetic cases where massive vitreous hemorrhage precludes fundus observation. Methods: The photopic ERG and flash VEP were recorded simultaneously on 20 eyes of 20 normal subjects, and 23 eyes of 23 patients who were diagnosed with Grade IV vitreous hemorrhage d/t diabetic retinopathy. Of the 23 patients, fellow eyes were diagnosed with proliferative diabetic retinopathy and they underwent pars plana vitrectomy after the test. Three groups were analyzed the responses of photopic ERG and flash VEP. Best corrected visual acuity was also checked before and after the surgery. After the 8 weeks after the vitrectomy, two groups were formed, based on the outcome of surgery and these two groups were analyzed the preoperative response of photopic ERG and flash VEP. Results: When comparing the groups between proliferative diabetic retinopathy and normal eyes, Grade IV vitreous hemorrhage and fellow eyes, there was a statistically significant (p < 0.05) difference in a wave amplitude, a wave implicit time, b wave amplitude, b wave implicit time of photopic ERG and P2 peak time of flash VEP. In addition, a wave amplitude of photopic ERG showed the best predictive ability (area under receiver operating characteristic [AUROC] curve value of 0.88) when comparing improved visual acuity group to the unimproved visual acuity group. Conclusions: Simultaneous recordings of photopic ERG and flash VEP showed the decreased function of retina and optic pathway on eyes with vitreous hemorrhage precluding inspection of the fundus. In addition, preoperative photopic ERG and flash VEP can safely predict the outcome of vitrectomy in dense vitreous hemorrhage of diabetics.

명음성반응(Photopic Negative Response; PhNR)의 원리와 임상

온영훈,김훈동,박주연 순천향대학교 의학연구소 2009 Journal of Soonchunhyang Medical Science Vol.14 No.3

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