알코올성 간경화에서 발생한 망막출혈 2예

온영훈(Young Hoon Ohn),박태관(Tae Kwann Park),한정우(Jung Woo Han),서두리(Du Ri Seo),김영신(Young Shin Kim) 대한안과학회 2015 대한안과학회지 Vol.56 No.8

목적: 알코올성 간경화에서 발생한 빈혈과 혈소판감소증으로 망막출혈 2예를 경험하였기에 이를 보고하고자 한다. 증례요약: (증례 1) 알코올성 간경화로 소화기내과에 입원 치료 중 양안의 시력저하가 발생한 45세 여자로, 안저검사상 양안의 황반부를 포함하는 다수의 망막전출혈 및 망막하출혈이 관찰되었다. 혈액학적 검사상 심한 빈혈과 혈소판감소증이 관찰되었다. 수혈로 혈액학적 이상을 교정하였고, 증상 발생 후 1개월째 시력은 호전되고, 망막출혈은 감소되었다. (증례 2) 알코올성 간경화로 간 이식을 시행받은 후 3일 뒤 호소한 좌안 시력저하로 의뢰된 47세 남자 환자로, 안저검사상 좌안 황반부를 포함하는 다수의 망막전출혈이 양안에서 관찰되었다. 간 이식 당시 심한 빈혈과 혈소판감소증이 관찰되어 수혈로 이를 교정하였다. 증상 발생 후 3개월째 좌안 시력이 호전되었고, 망막출혈은 대부분 흡수되었다. 결론: 알코올성 간경화로 인해 발생하는 혈액학적 이상으로 망막출혈이 발생할 수 있다. 정기적인 경과관찰로 망막출혈의 감소와 시력의 회복을 확인하였다. Purpose: To report 2 cases of retinal hemorrhage due to anemia and thrombocytopenia in patients with alcoholic cirrhosis. Case summary: (Case 1) A 45-year-old female with alcoholic cirrhosis who was treated in the gastroenterology department pre-sented with reduced vision in both eyes. Fundus examination showed multiple preretinal and subretinal hemorrhages with mac-ular involvement in both eyes. Hematological findings revealed severe anemia and thrombocytopenia. One month after the transfusion treatment her visual acuity was improved and retinal hemorrhages resolved. (Case 2) A 47-year-old male presented with painless loss of vision in the left eye 3 days after orthotopic liver transplantation for the treatment of alcoholic cirrhosis. Fundus examination showed preretinal hemorrhages in both eyes with macular involvement in the left eye. During the trans-plantation, hematological findings revealed severe anemia and thrombocytopenia. Three months after the transfusion treatment his visual acuity was improved and retinal hemorrhages nearly completely resolved. Conclusions: Hematological abnormalities due to alcoholic cirrhosis can cause retinal hemorrhage. In the present cases the reti-nal hemorrhages were resorbed and the visual acuity recovered.

다국소 망막전위도검사의 임상적 응용

온영훈 ( Young Hoon Ohn ),안용석 ( Yong Suk Ahn ) 대한안과학회 2002 대한안과학회지 Vol.43 No.10

한가족에 발생한 가족성 삼출성 초자체망막증

온영훈(Young Hoon Ohn),신환호(Han Ho Shin),최병수(Byung Su Choi),박성희(Song Hee Park) 대한안과학회 1995 대한안과학회지 Vol.36 No.4

근시의 정도에 따른 안압, 뇌척수압 및 사상판경유압력차의 관계

나승관(Seung Kwan Nah),온영훈(Young Hoon Ohn),김찬윤(Chan Yun Kim),이시형(Si Hyung Lee) 대한안과학회 2018 대한안과학회지 Vol.59 No.6

목적: 한국인에서 근시와 안압, 뇌척수압, 사상판경유압력차 간의 관계를 알아보고자 하였다. 대상과 방법: 본 연구는 2008년부터 2012년까지 시행한 국민건강영양조사자료를 바탕으로 19세 이상의 성인 6,933안을 대상으로 젊은 연령군(19-49세, Group 1)과 고령군(≥50세, Group 2)으로 분류하였다. 추정뇌척수압은 ‘cerebrospinal fluid pressure(mmHg)=0.44×신체비만지수(kg/m2)+0.16×이완기혈압(mmHg)-0.18×나이(years)-1.91’ 공식을 사용하였다. 사상판경유압력차는 안압에서 추정뇌척수압수치를 제하여 구하였다. 결과: 전체 환자군에서, 평균추정뇌척수압은 13.7 ± 0.1 mmHg (Group 1: 14.2 ± 0.1 mmHg, Group 2: 11.5 ± 0.1, p<0.01)였고 평균 안압은 14.0 ± 0.1 mmHg (Group 1: 14.0 ± 0.1 mmHg, Group 2: 14.1 ± 0.1, p=0.724)였으며, 평균사상판경유압력차는 0.7 ± 0.1mmHg (Group 1: 0.3 ± 0.1 mmHg, Group 2: 3.0 ± 0.2, p<0.001)였다. 혼란변수를 보정한 후 시행한 다중선형회귀분석에서 근시의 정도와 추정뇌척수압 간의 양의 상관관계를 가졌으며(p<0.001; β: 0.12, spherical equivalent [SE]: 0.03), 이는 안압에서도 마찬가지였다(p<0.001; β: 0.29, SE: 0.05). 결과적으로 근시가 심할수록 높은 사상판경유압력차와 연관이 있었다(p=0.002; β: 0.18, SE: 0.06). Group 1과 Group 2로 나눠 시행한 분석에서 Group 1은 비슷한 연관성을 보였으나(추정뇌척수압: p<0.001; β: 0.12, SE: 0.03; 안압: p<0.001; β: 0.28, SE: 0.05; 사상판경유압력차: p=0.005; β: 0.17, SE: 0.06), Group 2에서는 사상판경유압력차와 근시의 정도와의 관계가 통계적으로 유의하지 않았다(p=0.274; β: 0.18, SE: 0.16). 결론: 한국인에서 공식으로 계산한 사상판경유압력차는 근시의 정도와 연관이 있으며, 이는 근시가 녹내장의 발병과 진행에 영향을 미치는 병리기전에 사상판경유압력차 증가가 기여할 수 있음을 나타낸다. Purpose: To investigate the relationships between myopia and the three parameters of intraocular pressure (IOP), estimated cerebrospinal fluid pressure (CSFP), and the trans-lamina cribrosa pressure difference (TLCPD). Methods: A total of 6,933 adults (≥19 years of age) who participated in the Korea National Health and Nutrition Examination Survey (2008–2012). These subjects were divided into two groups: young age group (19–49 years of age) and old age group (≥50 years of age). The estimated CSFP was calculated as CSFP (mmHg) = 0.44 body mass index (kg/m2) + 0.16 diastolic blood pressure (mmHg) - 0.18 age (years) - 1.91. The TLCPD was calculated by subtracting the CSFP from the IOP. Results: The mean estimated CSFP in the total population was 13.7 ± 0.1 mmHg (young, 14.2 ± 0.1 mmHg; old, 11.5 ± 0.1; p <0.01), the mean IOP in the total population was 14.0 ± 0.1 mmHg (young, 14.0 ± 0.1 mmHg; old, 14.1 ± 0.1; p = 0.724), and the mean TLCPD in the total population was 0.7 ± 0.1 mmHg (young, 0.3 ± 0.1 mmHg; old, 3.0 ± 0.2; p < 0.001). After adjusting for confounding factors, multivariate linear regression analyses revealed significant positive associations between the degree of myopia and the estimated CSFP (p < 0.001; β, 0.12; spherical equivalent [SE], 0.03), as well as IOP (p < 0.001; β, 0.29; SE, 0.05). As a result, a higher TLCPD also showed a significant association with more myopic refractive error (p=0.002; β, 0.18; SE, 0.06). In subgroup analyses, a similar association was shown only in the young age group (estimated CSFP, p < 0.001; β, 0.12; SE, 0.03; IOP, p < 0.001; β, 0.28; SE, 0.05; TLCPD, p = 0.005; β, 0.17; SE: 0.06), while the old age group did not show a significant association between TLCPD and the degree of myopia (p = 0.274; β, 0.18; SE, 0.16). Conclusions: The calculated TLCPD showed an association with high myopia. It was consistent with the potential role of high myopia in the pathogenesis of open-angle glaucoma.

약물 유도 망막변성 생쥐 모델에서 안구내 면역세포에서의 F4/80와 nestin 발현 양상

안상일,온영훈,박태관,Sang Il Ahn,MD,Young Hoon Ohn,MD,PhD,Tae Kwann Park,MD,PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.6

Purpose: To evaluate the expression patterns of F4/80 and nestin in the ciliary body and the optic nerve following N-methyl- N-nitrosourea (NMU)-induced retinal degeneration in adult mice. Methods: After intraperitoneal injection of MNU (60 mg/kg) in adult mice, the eyes were enucleated at 2, 4, 7 and 30 days. Hematoxylin and eosin (H&E) stain, terminal deoxyribonucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) stain and immunohistochemical stains of F/80 and nestin were performed. Results: After MNU treatment, the photoreceptors were destroyed by cell apoptosis. According to immunohistochemistry, F4/80 and nestin were not co-expressed in the control group, but F4/80 was expressed within the ciliary body and optic nerve in the MNU-treated group; the expression of nestin also increased. In the outer nuclear layer, F4/80 and nestin co-expressing cells were observed. Conclusions: In response to retinal damage, the F4/80 and nestin co-expressing cells migrated to the retina from the ciliary body and optic nerve and were activated.

당뇨망막병증의 진행에 따른 망막전위도의 변화

한영근(Young Keun Han),온영훈(Young Hoon Ohn) 대한안과학회 2000 대한안과학회지 Vol.41 No.1

선천비진행야맹증의 분류와 다국소망막전위도 소견

성미선,박태관,온영훈,Mi-Sun Sung,Tae-Kwann Park,Young-Hoon Ohn 대한안과학회 2005 대한안과학회지 Vol.46 No.11

Purpose: To report on the classification of congenital stationary night blindness (CSNB) and multifocal ERG findings. Methods: We studied three patients (case 1-3) with night blindness but normal fundus and one patient (case 4) with decreased vision after trauma with respect to the patients` medical history, familial history, refraction, slit lamp examination, fundus examination, FAG, ERG, and multifocal ERG. Results: The ERG in case 1 showed a decreased rod response, and this patient was diagnosed with Riggs-type CSNB. The typical “negative ERG” was found in all three cases of ERG (except case 1), and these cases were diagnosed with Schubert-Bornschein-type CSNB. Based on Miyake`s classification, case 2 was incomplete, and cases 3 and 4 were complete. The mfERG of the cases with complete Schubert-Bornschein type had delayed implicit times of the first-order kernel and decreased amplitudes of the second-order kernel. The delayed implicit times and the decreased amplitudes of the first- and second-order kernels were found in the cases of Riggs- type and incomplete Schubert-Bornschein-type.

망막중심정맥폐쇄에서 유리체강내 베바시주맙 주사 전 후에 망막전위도를 통한 망막기능의 평가

조인환,박태관,온영훈,In Hwan Cho,Tae Kwann Park,Young-Hoon Ohn 대한안과학회 2011 대한안과학회지 Vol.52 No.9

Purpose: To investigate the changes of electroretinogram (ERG) at baseline and during the first 3 injections of intravitreal bevacizumab in central retinal vein occlusion (CRVO) patients. Methods: Thirteen eyes of 13 CRVO patients who received 3 injections of intravitreal bevacizumab at 6-week intervals and who could be examined for visual acuity, optical coherence tomography and ERG at 4 weeks after each injection were included in the present study. In addition, the ERG results of the unaffected fellow eyes group at 4 weeks after each injection were compared with the CRVO eyes group. Results: Amplitudes of rod b wave, a and b waves of maximal combined response and cone response, oscillatory potentials and 30-Hz flicker significantly decreased in the CRVO eyes group than the fellow eyes group at 4 weeks after each injection (<em>p</em> < 0.001). After injection, amplitudes of all the above-mentioned ERG parameters gradually increased during the 1st and the 2nd injection (<em>p</em> < 0.001). However, there was no significant difference at 4 weeks after the 2nd and 3rd injections (<em>p</em> > 0.05). Conclusions: After intravitreal bevacizumab injection, macular functions significantly improved and amplitudes of all ERG parameters gradually increased in CRVO patients. J Korean Ophthalmol Soc 2011;52(9):1055-1062

증식당뇨망막병증에서 수정체초음파유화술 및 인공수정체삽입술을 병행한 유리체절제술의 임상분석

성미선,박태관,온영훈,Mi-Sun Sung M,D,Tae-Kwann Park,M,D,Young-Hoon Ohn,M,D 대한안과학회 2005 대한안과학회지 Vol.46 No.8

Purpose: To describe the results and complications of combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in patients with proliferative diabetic retinopathy, and to analysis the factors to be associated with visual outcome. Methods: Retrospective study was performed on 70 eyes of 58 patients who had undergone combined pars plana vitrecotmy and phacoemulsification with intraocular lens implantation because of proliferative diabetic retinopathy. Preoperative, intraoperative, and postoperative complicated factors to be associated with visual outcome were analyzed. Results: The changes of visual acuity were classified into “improved” 57eyes (81%), “stationary” 7eyes (10%), and “decreased” 6eyes (9%). Posterior capsule rupture during operation was occurred in 2 eyes (2.9%). After cataract, macular edema and neovascular glaucoma were developed in order of incidence of postoperative complications. The factors to be associated with visual outcome were diabetic nephropathy, posterior capsule rupture, macular edema, neovascular glaucoma, and retinal detachment. (P<0.05) Conclusions: Combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation may be relatively safe for the patients with proliferative diabetic retinopathy.

약물로 유도된 망막변성 흰 쥐에서 발생한 망막전위도의 초기 가역적 변화

노규화,박태관,온영훈.Kyu Hwa Roh. M.D.. Tae Kwann Park. M.D.. Young Hoon Ohn. M.D.. Ph.D. 대한안과학회 2006 대한안과학회지 Vol.47 No.7

Purpose: To evaluate the early ERG (electroretinogram) changes in N-methyl-N-nitrosourea (MNU)-induced retinal degeneration in rats. Methods: Thirty-six 6-week-old male rats were injected intraperitoneally with 60mg/kg MNU and divided into 6 groups. Histology and ERG were recorded for the rats of each group before treatment and at 3, 6, 12, 18, and 24 hours after MNU injection. Promptly after the ERG recording, rats were sacrificed and the eyeballs prepared for histologic sectioning. The Tdt-mediated dUTP-digoxigenin nick end labeling (TUNEL) method was used to detect photoreceptor cell death. Results: The first decreases of ERG responses were noticed maximally at 3 hours after the treatment. Thereafter, the amplitude of the responses was partially recovered at 12 hours post-treatment. The second decrease of ERG amplitudes was observed in the 18-hour recordings, and those changes progressed to 24 hours after the treatment. In the histologic findings, TUNEL (+) cells in the Outer Nuclear Layer (ONL) were not detected at 3 hours after MNU injection, but were initially noticed at 6 hours post-injection. Conclusions: The first decreases of ERG amplitudes proceeded the appearance of TUNEL (+) cells in ONL, and these electrophysiological changes seemed to not be related to photoreceptor cell death. We propose that electrophysiological changes observed might be related to the MNU-induced activity enhancement of guanylate cyclase in the phototransduction pathway. We also show that photoreceptor cell death in the MNU-induced retinal degeneration model occurs at 6 hours after the treatment, which is earlier than the results of previous reports.