수정체 유화술에 의한 인공수정체 삽입 수술 후 망막박리의 발생시기

서제현,이진학.Je Hyun Seo. M.D.. Jin Hak Lee. M.D. 대한안과학회 2006 대한안과학회지 Vol.47 No.7

Purpose: To evaluate the onset of retinal detachment (RD) in eyes with phacoemulsification and post chamber lens (PE & PCL) implantation. Methods: We retrospectively analyzed 3023 eyes that had undergone clear cornea incision and PE and PCL implantation and 116 eyes that had undergone scleral incision and PE and PCL implantation. They had been operated from January 1995 to December 2000 by one surgeon and followed up for 4 years or more. Results: Eighteen eyes (0.57%) of the 3139 eyes developed pseudophakic RD within a mean period of 663 days. In the scleral incision group, there were 4 cases of pseudophakic RD (3.4%) of 116 eyes developed in a mean period of 185.2 days. In the clear cornea group, there were 14 pseudophakic RD eyes (0.46%) of the 3023 eyes and the mean period was 799 days. Of these, 3 eyes made up the intraoperative complication group with a mean period 205.6 days. But in the group of cases with no intraoperative complications, the mean period was 962 days. Conclusions: In high myopic eyes, retinal detachment developed in the earlier postoperative period and at a higher rate than those of non-high myopic eyes after PE and PCL implantation.

진균 감염 시 전방 내 암포테리신 주입 치료 성적에 관련된 위험 인자 분석

서제현,위원량,이진학,김미금.Je Hyun Seo. M.D... Won-Ryang Wee. M.D.. Ph.D... Jin Hak Lee. M.D. Ph.D... Mee Kum Kim. M.D. Ph.D.. 대한안과학회 2007 대한안과학회지 Vol.48 No.9

Purpose: To investigate the clinical efficacy of intracameral amphotericin injection and to evaluate risk factors affecting primary treatment success in fungal infection invading the anterior segment of the eye. Methods: Twenty-six eyes of 26 patients diagnosed with fungal infection in the anterior segment were studied. The initial treatment regimen was a topical 0.15% amphotericin application and itraconazole oral administration after culture. Amphotericin (5 ug/0.1 ml, 0.1 cc) was repeatedly injected intracamerally when the infection intensified. Penetrating keratoplasty was conducted for eyes unresponsive to intracameral amphotericin injection. The relative risk ratios of ulcer size, infiltration depth, culture positivity, and hypopyon were compared in each treatment group to evaluate the treatment response. Results: Of patients with fungal infection, 30.7% were cured with intracameral amphotericin injection, while 30.7% needed penetrating keratoplasty. Intracameral amphotericin injection was needed in the presence of large corneal ulcers (>14 mm2), hypopyon, positive fungal culture, use of steroid eye drops, and deep infiltration at initial examination. Large ulcer size (>14 mm2) was the main risk factor for needing penetrating keratoplasty. Of the eyes Candida infection, 66.5% needed evisceration. Conclusions: Large ulcer size and the isolation of Candida were poor prognostic factors related to the efficacy of intracameral amphotericin injection.

도서지역 보건지소 공중보건의사의 응급의료 경험 및 대처능력 고찰

서제현(Je Hyun Seo),이수진(Su Jin Lee),하정훈(Jeong Hoon Ha),김정호(Jung Ho Kim),이재혁(Jae Hyuk Lee),나백주(Baeg Ju Na),강윤화(Yoon Hwa Kang) 한국농촌의학 지역보건학회 2011 농촌의학·지역보건 Vol.36 No.1

본 연구는 도서지역에 있는 47개 보건지소에 근무하는 의과 공중보건의사 79명을 대상으로 응급의료 수행 현황 및 지식수준 등을 파악하고자 하였다. 전체 79명의 대상자 중 35명이 설문에 응답하여 44.30%의 응답률을 보였다. 지난 6개월간 도서지역 보건지소에 근무하는 공중보건의사 중 58.68%가 응급의료 질환을 경험하였고, 평균 1.92건의 응급처치를 수행한 것으로 나타났다. 하지만, 실제 응급처치 능력에 대해서는 일부 생명과 직접 연관된 응급처치 능력에 자신이 없음을 호소하였다. 보건지소 근무 의사 중 20.25% 만이 전문의 자격을 갖춘 의사였는데, 응급의료 관련 질환을 처치하는 데 있어 전문의가 일반의와 비교하면 지식수준이 유의하게 높은 것을 확인할 수 있었다. 또한, 지식수준이 높다 하더라도 장비 및 의료지원 등 부족으로 실제 처치 능력으로 이어 지지 못하는 것을 알 수 있었다. 일부 섬의 경우 1명의 공중보건의사만 배치된 일도 있었으나 일반의 1인, 전문의 1인을 배치하는 것이 타당하다는 의견이 많았고, 공중보건의사 배치 이후 부족한 지식 및 기술을 습득하기 위한 교육 및 지원체계가 필요하다는 의견이 다수 있었다. 도서지역은 지리적으로 고립되어 있고, 이용할 수 있는 보건의료기관에 대한 선택권이 적다는 점에서 보건지소의 역할이 무엇보다 중요하다. 특히 응급질환 발생시 보건지소를 이용하는 주민이 많다는 측면에서도 보건지소 응급의료 기능을 강화하는 방안을 마련하는 것이 필요하겠다. 응급의료기능을 효율적으로 수행하고 질 높은 서비스 제공을 위하여 적절한 인력, 의료장비를 갖추도록 하고, 응급의료에 대한 매뉴얼 개발 및 현장교육 체계를 정비하여 최신의 지식과 기술을 보급하는 방안을 강구하여야 한다. Objectives: To investigate the experience and competence of physicians providing emergency medical services at public health sub-centers on remote Korean islands. Methods: This study enrolled 79 doctors who work at public health sub-centers on remote Korean islands. Data were collected in December 2009 via self-administered e-mail questionnaires. The response rate was 44.3%. Results: Emergent situations occurred at most (58.68%) of the public health sub-centers that were surveyed in December 2009. An average of 1.92 cases required treatment by public health physicians. Only 20.25% of the physicians were specialists in emergency medicine, while the remainder were general practitioners (GPs) without clinical experience as emergency doctors. We also found that the physicians we surveyed had insufficient knowledge of emergency medical care. At some health centers only one doctor was available, and there was no medical team in holiday, although most of the physicians indicated that the ideal number of doctors per center was two or three. In cases of emergency, patients were often sent to the mainland by ship without receiving first-aid treatment. The public health sub-centers lacked the necessary medical equipment to save lives in emergencies and lacked escort systems for emergency patients. Conclusions: The Korean government should address the importance of providing emergency care in remote areas. Health administrators should provide suitable manpower, medical equipment, guidelines for emergency medicine, and education for public health physicians on remote islands.

동공괄약근 마비가 발생한 급성폐쇄각녹내장 환자의 백내장수술 후 고위수차 변화

서수연(Su Youn Suh),이동현(Dong Hyun Lee),조성호(Seong Ho Jo),신종훈(Jonghoon Shin),서제현(Je Hyun Seo) 대한검안학회 2018 Annals of optometry and contact lens Vol.17 No.2

Purpose: To investigate the change of ocular higher-order aberrations (HOA) after cataract surgery in the eyes of acute primary angle closure (PAC) attack with mid-dilated fixed pupil. Methods: This study included eyes of patients with mid-fixed dilated pupil after acute primary angle closure attack. Also, uncomplicated cataract patients were enrolled as control. All the eyes had been underwent cataract surgery with phacoemulsification. Best-corrected visual acuity (BCVA, in logMAR) and HOA (i-Trace, Tracey technologies, Houston, TX) were evaluated preoperatively and postoperatively at 1 month. Paired t-test were used to compare preoperative and postoperative HOA values, and independent t-test for comparison of postoperative HOA in PAC and control groups. Results: BCVA were significantly increased in PAC group (0.64 ± 0.51 vs. 0.43 ± 0.45, p=0.042, respectively), and in control group (0.51 ± 0.25 vs. 0.18 ± 0.15, p<0.001, respectively). Intraocular pressure were significantly decreased in both groups. In control group, coma-like, spherical-like, and high order total (HOT) aberrations were significantly changed (p=0.006, 0.008, 0.006, respectively) in internal optics aberrations. However, HOA values did not show significant changes in PAC group. HOT aberrations of entire eye after cataract surgery in PAC group were higher than those in control group (1.21 ± 1.13 vs. 0.41 ± 0.48, p=0.001). Conclusions: This result suggests that HOAs change after cataract surgery were less profound in the eyes with mid-fixed dilated pupil after acute primary angle closure attack than uncomplicated cataract group.

임신부에서 발생한 포도막염녹내장의 수술적 치료 1예

이종헌(Jong Heon Lee),정재우(Jae Woo Jung),조성호(Seong Ho Jo),서제현(Je Hyun Seo) 대한검안학회 2015 Annals of optometry and contact lens Vol.14 No.4

Purpose: To report a surgical treatment for a case of uveitic glaucoma during pregnancy. Case summary: A glaucoma female to be pregnant with 26 weeks visited for our clinic, who had used anti glaucoma medication. At the initial examination, intraocular pressures (IOP) of right and left eye were 38, 30 mmHg, respectively. We performed selective laser trabeculoplasty of both eyes with no complication, and then IOPs of right and left eyes were decreased to 26, 23 mmHg, respectively. 1 week later, she came to our emergency department due to acute visual impairment. Her IOP was 45 mmHg in right eye with uveitis. We regard that she had uveitic component related to the stress of fetal cardiac abnormality and recent her husband’s car-accident. Afterall she underwent trabeculectomy because of sustained high IOP. After surgery, IOP was decreased to 5 mmHg in right eye with elevated bleb but anterior chamber was shallow. We waited for 3 days because overfilteration would be resolved. After all, we did bleb revision with air injection in anterior chamber. After surgery, that IOP was persisted 10-16 mmHg with cystic bleb. Conclusions: This study showed the course of glaucoma during pregnancy was various, and emotional stress can lead uveitic glaucoma in contrast to the studies showed an association with pregnancy and lower IOP. Also, gentle manipulation is needed for pregnant women, because of thinner and softer sclera in high myopia and pregnancy itself.

뇌하수체샘종 환자의 빛간섭단층촬영소견의 특징

정재우(Jae Woo Jung),조성호(Seong Ho Jo),서제현(Je Hyun Seo),정재호(Jae Ho Jung),성순기(Soon Ki Sung) 대한검안학회 2015 Annals of optometry and contact lens Vol.14 No.4

Purpose: To assess differences in spectral-domain optical coherence tomography (OCT) parameters between who diagnosed pituitary adenoma and glaucoma. Methods: In this study retrospectively evaluated three groups (14 eyes of 7 patients with pituitary adenoma, 14 eyes of 14 patient with glaucoma who has same visual field defect as pituitary adenoma patients, 14 eyes of 14 patients normal controls) were detected visual fiels defect and imaged with spectral-domain OCT (cup to disc ratio, regional retinal nerve fiber layer (RNFL) thickness, ganglion cell complex) between January 2013 and December 2014. In each group regional RNFL thickness. Results: There are statistically significant differences in temporal retinal nerve fiber layer thickness between group of patients with pituitary adenoma and normal controls. And we found that there are statistically significant differences in average cup to disc ratio, vertical cup to disc ratio, cup volume between group of patients with pituitary adenoma and glaucoma (P<0.05). No other parameters in the three groups were significantly different. Conclusions: These results indicate that optical coherence tomography finding is distinguish patients with pituitary adenoma from glaucoma.

광범위 약제내성 폐결핵 약물치료 중 발생한 색소녹내장 1예

정재우(Jae Woo Jung),조성호(Seong Ho Jo),서제현(Je Hyun Seo),김윤성(Yun Seong Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 광범위 약제내성 폐결핵치료를 위해 clofazimine을 복용하던 중 발생한 색소녹내장 1예를 보고하고자 한다. 증례요약: 23세 남자가 광범위 약제내성 결핵으로 약물 치료 중 양안 시야 흐림을 주소로 내원하였다. 환자는 타 병원에서 폐결핵으로 일차항결핵제를 처방 받았으나 불규칙하게 복용 중 광범위 약제내성 결핵으로 진단 후 6개월 전부터 결핵치료를 위해 clofazimine 경구 약을 추가한 후 얼굴피부가 어두운 갈색으로 변하는 소견을 호소하였다. 초진 시 교정시력이 우안 0.15, 좌안 0.5, 안압은 우안 50 mmHg, 좌안 48 mmHg로 측정되었다. 세극등검사상 양안의 각막부종과 각막혼탁이 관찰되었으며, 전방은 흐린 염증소견이 관찰 되었다. 색각검사상 양안 모두 색약의심 소견 및 시야검사상 양안 상비측 시야결손이 관찰되었다. 양안의 전방각경검사상 개방각이었으나 섬유주에 침착된 색소가 관찰되었다. 결핵약에 의한 색소녹내장 진단하에 최대 약물 치료를 시행하였으나 안압 조절이 불량하여 양안 섬유주절제술을 시행하였다. 수술 후 안압은 양안 12 mmHg, 시력은 우안 0.9, 좌안 1.2로 호전되었다. 결론: Clofazimine 복용의 안과합병증으로 기존에 보고되지 않았던 녹내장 발병의 첫 번째 증례이고, 녹내장 발병 기전으로는 clofazimine의 전신적인 색소침착과 관련된 안구 내 전방각의 색소 침착에 의한 녹내장으로 생각된다. 본 증례보고상 녹내장 안약으로는 안압이 조절되지 않아서 섬유주절제술을 시행하여 안압을 성공적으로 조절할 수 있었다. <대한안과학회지 2016;57(6):1026-1030> Purpose: To report a case of secondary pigmentary glaucoma due to clofazimine treatment for extensive drug-resistant tuberculosis. Case summary: A 23-year-old man presented with blurred vision in both eyes. The patient started to take clofazimine for extensive drug-resistant tuberculosis six months prior, after which his facial skin color changed to a dark-brown. Intraocular pressure (IOP) was 50 mm Hg in the right eye and 48 mm Hg in the left eye. Slit lamp examination revealed corneal edema, opacity, and flare in the anterior chamber in both eyes. A color vision test revealed a mild color defect in both eyes. Visual field (VF) test revealed superior temporal VF loss in the left eye. Gonioscopy revealed open angles with high pigmentation in the trabecular meshwork in both eyes. The patient was diagnosed with pigmentary glaucoma, and maximum tolerated medical therapy was performed. However, the IOP was uncontrolled. Trabeculectomy was performed in both eyes. Postoperative IOP was measured to be 12 mm Hg in both eyes without medication, and visual acuity measured 20/22 in the right eye and 20/17 in the left eye. Conclusions: To the best of our knowledge, this report is the first case of clofazimine being a possible cause of pigmentary glaucoma in a patient with extensive drug-resistant tuberculosis. J Korean Ophthalmol Soc 2016;57(6):1026-1030

섬유주절제술 병합 백내장수술 후 고위수차 변화

정재우(Jae Woo Jung),조성호(Seong Ho Jo),서제현(Je Hyun Seo) 대한안과학회 2017 대한안과학회지 Vol.58 No.6

목적: 섬유주 절제술 병합 백내장수술(삼중수술)을 받은 환자에서 수술 전후의 고위수차의 변화를 알아보고, 대조군으로 백내장수술만 받은 환자의 고위수차의 변화를 비교, 분석하고자 하였다. 대상과 방법: 2013년 4월부터 2015년 12월까지 섬유주 절제술 병합 백내장수술을 받은 총 38명 38안을 대상으로 수술 전과 수술후 2주, 4주, 3달 후의 시력, 안압, 고위수차를 측정하였으며, 이들의 변화를 비교하였다. 그리고 대조군으로 같은 기간에 백내장수술을 단독으로 받은 총 34명 34안을 대상으로 수술 전과 수술 후 2주의 고위수차의 변화를 비교하였다. 결과: 섬유주 절제술 병합 백내장수술을 받은 환자군에서, 안압은 유의하게 하강하였으며(p<0.001), 수술 후 안구전체, 각막 및 수정체 고위수차 각각에서 수술 후 2주째 전체고위수차, 코마수차, 구면수차 모두 증가한 이후 3개월까지는 감소하는 경향을 보였으나 통계적 유의성이 없었다. 백내장수술군에서는 수술 후 안구전체 및 수정체 고위수차에서 전체고위수차(각각 p=0.006, p=0.005), 코마수 차(각각 p=0.006, p=0.008), 구면수차(각각 p=0.006, p=0.005) 모두 감소하였다. 결론: 백내장 단독 수술일 경우에는 고위수차가 유의하게 감소하였으나, 섬유주 절제술 병합 백내장수술로 의미있는 고위수차의 변화는 관찰되지 않았다. 이러한 결과는 백내장 단독군의 고위수차가 다소 높았다는 점과 섬유주절제술의 영향과 관련된 것으로 생각된다. <대한안과학회지 2017;58(6):676-684> Purpose: To investigate changes in ocular high-order aberrations (HOAs) resulting from phacotrabeculectomy and phacoemulsification. Methods: We retrospectively reviewed 38 eyes of 38 glaucoma and cataract patients who underwent mitomycin C (MMC) augmented trabeculectomy with phacoemulsification and 34 eyes of 34 cataract patients who underwent phacoemulsifiction. For all patients, we measured the best corrected visual acuity (BCVA), intraocular pressure (IOP), keratometry, and HOAs (iTrace, Tracey Technologies, Houston, TX, USA) both preoperatively and postoperatively. Results: IOP was significantly decreased after surgery in the combined group (p < 0.001). Entire eye, coma-like, and spherical-like high-order aberrations from each entire eye, corneal aberrations, and internal-optics aberration were increased until after 2 weeks, which then decreased until 3 months after phacotrabeculectomy. In the phacoemulsification group, entire eye (each p = 0.006, p =0.006), coma-like (each p = 0.006 and p = 0.005), and spherical-like high-order aberrations (each p = 0.008, p = 0.005) from entire eye and internal-optics aberrations were decreased. Conclusions: After cataract surgery, entire eye, coma-like, and spherical-like high-order aberrations were significantly decreased while aberrations did not change after combined operation. These results suggest that a change in high-order aberrations of internal optics results in a decrease in postoperative HOAs. In addition, the baseline HOAs of the cataract group were higher than those of the combined surgery group, and the effect of trabeculectomy on HOAs may offset the impact of cataract surgery in the combined surgery group.