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Yuri Kim(Yuri Kim),Helen Lew(Helen Lew) 대한안과학회 2022 Korean Journal of Ophthalmology Vol.36 No.6
Purpose: To compare the diagnosis and treatment outcome of lacrimal drainage obstruction of patients who underwent systemic chemotherapy (CTx) or radioactive iodine treatment (RAI) by using dacryoendoscopy and at the same time performing dacryoendoscopy-guided silicone tube insertion (STI) to treat epiphora. Methods: From July 2017 to December 2020, the medical records of 11 patients (16 eyes) were diagnosed with lacrimal drainage obstruction after CTx or RAI and underwent dacryoendoscopy-guided STI were reviewed retrospectively. We tried to count the number of obstructive sites in total patients using slit-lamp examination and dacryoendoscopic findings. Results: A total of 11 patients, 16 eyes, were enrolled in this study. The onset of epiphora in the CTx group (3.0 ± 4.0 months) was significantly shorter than that in the RAI group (52.6 ± 36.5 months, p = 0.001). There were total 32 obstructive sites including 28 obstructive sites of dacryoendoscopic findings and four sites of punctual stenosis in total 16 cases. Using dacryoendoscopy, granulation findings was dominant in RAI patients (p = 0.038) and mucus finding was frequent mostly in lacrimal sac and canaliculus. In the CTx group, mucosal edema finding was dominant (p = 0.038) and fibrotic membrane finding was frequent in all levels of lacrimal drainage system. Regarding the obstructive location, lacrimal sac was the most frequently obstructed site in the two groups (p = 0.038). Conclusions: The onset of epiphora in the CTx group was significantly earlier than in the RAI group. In the CTx group, mucosal edema finding was frequent in all levels of lacrimal drainage system. In the RAI group, granulation finding was frequent mostly in lacrimal sac and canaliculus. Since the clinical outcome was satisfactory, intervention with dacryoendoscopy-guided STI could be a treatment of choice in patients with epiphora after CTx or RAI.
Clinical Implication of Dacryoendoscopy in the Patients with Tearing: A Systematic Review
Yuri Kim(Yuri Kim),Jeong Yoon Park(Jeong Yoon Park),Helen Lew(Helen Lew) 대한안과학회 2023 Korean Journal of Ophthalmology Vol.37 No.3
Purpose: A systematic review of the literature on diagnostic and therapeutic indications, techniques, and complications of dacryoendoscopy (DE) was performed. Methods: The authors performed a PubMed search of articles published in English on DE. Data were collected and classified according to the categories of the disease. The clinical outcomes and limitations were particularly analyzed. Results: The lacrimal drainage system from the canaliculus to the inferior meatus could be examined based on the specific anatomical features by DE. The canalicular mucosa is smooth and brightly colored, the lacrimal sac shows covering mucosa with good vascularization and the nasolacrimal duct is lined with bright tubular mucosal folds. DE allows direct visualization of the detailed internal condition of the lacrimal disorders, to directly diagnose the site of obstruction with accuracy and address the causes and recanalize the lacrimal drainage system using assisted micro lacrimal surgical instruments in the tearing patients. Conclusions: Better visualization of the lacrimal canal with DE improves the understanding of physiology and precise identification of the obstructing lesions, both of which are the key to a comprehensive management for the tearing patients.
Binocular Visual Rehabilitation in Paralytic Strabismus by Botulinum A Toxin Chemodenervation
Myungjin Kim,Helen Lew 대한안과학회 2022 Korean Journal of Ophthalmology Vol.36 No.1
Purpose: To investigate the effect of botulinum A toxin (BTXA) chemodenervation in paralytic strabismus patients withoutsurgical correction. Methods: A retrospective chart review of 51 patients who were diagnosed as paralytic strabismus and underwent BTXA chemodenervationwas performed. The patients were divided into four groups according to the cause of paralytic strabismus ofvasculopathy, neoplasm, trauma, and idiopathic. They were also divided into two groups of early and late treatment accordingto the initiation time of BTXA chemodenervation after the onset of strabismus (3 months), and of the initial strabismustype of exotropia and esotropia. We investigated the changes of angle of deviation and diplopia after BTXA chemodenervation. Results: The average deviation of angles decreased by 25.2 prism diopter (PD) (35.1 to 9.9 PD) in total patients, and the overallsuccess rate was 64.7% (33 by 51), and the there was no statistically significant difference in success rate between eachgroup divided by the cause of paralytic strabismus. According to the treatment timing, the deviation of the angle decreasedby 28.0 PD (36.8 to 8.8 PD) in the early treatment group, and 21.3 PD (33.5 to 12.2 PD) in late treatment group at the time ofthe last postinjective follow-up. According to the initial strabismus type, the average angle of deviation decreased by 20.3 PD(35.6 to 15.3 PD) in exotropia group by cranial nerve 3 palsy, and 24.4 PD (32.5 to 8.1 PD) in esotropia by cranial nerve 6 palsy. Conclusions: BTXA chemodenervation reduced the angle of deviation and the number of patients with diplopia regardless ofthe cause of paralytic strabismus. Early BTXA chemodenervation can be considered as the first treatment of choice in paralyticstrabismus, especially in esotropia patients.
안쪽 눈꺼풀테 종양과 눈물점 주위 종양의 임상양상 비교
이승현(Seunghyun Lee),유혜린(Helen Lew) 대한검안학회 2019 Annals of optometry and contact lens Vol.18 No.2
Purpose: To compare the clinical features and biopsy results of patients with the tumor on the lid margin at medial side versus those with the tumor around the punctum. Methods: A retrospective medical record review was conducted on 58 patients, each having tumor on the eyelid from March 2001 to June 2018 in CHA Bundang Medical Center. Results: Thirty seven cases with the tumors on the lid margin at medial side and 21 cases with the tumors around the punctum were reviewed. There were increase in size for 18.9% of the tumors on the lin margin and 23.8% of the tumors around the punctum and epiphora for 19.0% of the tumors around the punctum. Histology revealed 70.3% for epidermal tumors, 21.6% for inflammatory and infection lesions, 4.0% for stromal tumors and 2.7% of adnexal tumors in the tumors on the lid margin at medial side. There were 76.2% for epidermal tumors and 23.9% for adnexal tumors in the tumors around the punctum. The tumors occurred more commonly on the upper lid (75.7%) for the tumors on the lid margin, whereas more often on lower lid (81.0%) for the tumors around the punctum. Conclusions: The incidence of adnexal tumors was relatively high and stromal, inflammatory and infectious tumors was low in the tumor around the punctum compared to on the lid margin. And the tumors occur more often at lower lid. There would be a difference in the location, pathology and etiopathogenesis of tumors between on the eyelid margin and around the punctum.
A Case of Optic Neuropathy Treated by Percutaneous Trans-coronary Angiography
Young Kwang Chu,Helen Lew,Sang Yeul Lee 대한안과학회 1999 Korean Journal of Ophthalmology Vol.13 No.2
There are many risk factors involved in the development of ischemic optic neuropathy such as diabetes mellitus, hypertension, arteriosclerosis, and vascular incompetence. Therefore, the treatment of ischemic optic neuropathy should not be solely based on proper diagnosis but should also involve a thorough and systemic investigation to identify those multifactorial possibilities, which may contribute to the pathogenesis of the disease. We report upon a patient who developed non-arteritic ischemic optic neuropathy following treatment of a sphenoethmoid mucocele, which lead to recovered vision and a satisfactory improvement of visual field defects, after percutaneous trans-coronary angiography with stent insertion of the coronary arteries.
김창호,유혜린,윤영수,김민영,Chang Ho Kim,Helen Lew,Young Soo Yun,Min Young Kim 대한안과학회 2006 대한안과학회지 Vol.47 No.4
Purpose: Nystagmus is a rare involuntary eye movement which has no known, specific, underlying diseases. Schizencephaly is also a rare disease. A child with generalized developmental delay came to the pediatric clinic. He showed schizencephaly on MRI, and was referred to department of rehabilitation. During rehabilitative evaluation, the patient was referred to the department of ophthalmology due to esotropia. We found that the patient had little esotropia, but did have nystagmus. Therefore, we report a case of congenital nystagmus associated with schizencephaly. Methods: A one-year-old boy showing schizencephaly on MRI and esotropia underwent examination. Results: The patient did not have a remarkable past or familial history, and didn`t show any other anomaly. There were no abnormal findings on slit lamp examination, and according to strabismus studies, he showed very little esotropia. He did show nystagmus. We couldn`t find any significant refractive error or ocular dysfunction on cycloplegic refraction and fundus examination, respectively. Visual evoked potential showed normal findings. On MRI, ordered by the pediatrician, open-lip type schizencephaly on the right frontal lobe and absence of septum pellucidum were seen. There was no endocrinologic abnormality. Conclusions: We report the case of a child with congenital nystagmus accompanied by schizencephaly, and present a literature review.