우측 이마에 필러 주입 후 발생한 시력 소실 1예

조용운,정인영,박종문,유지명,김성재,서성욱,한용섭.Yong Wun Cho. MD. In Young Chung. MD. PhD. Jong Moon Park. MD. PhD. Ji Myong Yoo. MD. PhD. Seong Jae Kim. MD. PhD. Seong Wook Seo. MD. PhD. Yong Seop Han. MD. PhD. 대한안과학회 2014 대한안과학회지 Vol.55 No.8

Purpose: We report a case of visual loss after the injection of poly-L-lactic acid filler into the right forehead area for cosmetic purposes. Case summary: A 46-year-old female patient visited our clinic due to sudden visual disturbance and dysesthesia on the right forehead and cheek. Her best corrected visual acuity was no light perception in the right eye and 20/20 in the left eye. Visual acuity in her right eye was not corrected. An afferent papillary defect in the right eye and paralysis of oculomotor muscles were observed. Fundus exam revealed a pale optic nerve and turbid retina on the posterior pole. The retinal vessels were narrowed. A papule 1 cm to the lateral margin of the right eyebrow due to the needle injection was found and no other visible skin abnormalities were observed. She had a cosmetic poly-L-lactic acid filler injection into the right forehead area immediately before the visual disturbance occurred. Fluorescent angiography showed occlusion of the right retinal artery and blood flow defects on the retina and choroid were present. The patient was followed up for 6 months and visual acuity and dysesthesia in her right forehead and cheek did not improve. Conclusions: Several cases of visual loss have occurred after injection of filler on the glabella and forehead for cosmetic purposes. However, most of the complications were observed after the use of hyaluronic fillers and not due to poly-L-lactic acid filler. This is the first case report of visual loss caused by poly-L-lactic acid filler in South Korea in a normal patient. Hence, consideration of complications when using this type of fillers is important. J Korean Ophthalmol Soc 2014;55(8):1253-1256

Postoperative radiation therapy following the incomplete resection of a non-small cell lung cancer

Jaehyeon Park,MD,Si Yeol Song,MD,PhD,Su Ssan Kim,MD,PhD,Sang-We Kim,MD,PhD,Woo Sung Kim,MD,PhD,Seung-Il Park,MD,PhD,Dong Kwan Kim,MD,PhD,Yong-Hee Kim,MD,PhD,Jongmoo Park,MD,Sang-wook Lee,MD,PhD,Jong H 대한방사선종양학회 2014 Radiation Oncology Journal Vol.32 No.2

Purpose: To review the results of postoperative radiation therapy (PORT) for residual non-small cell lung cancer (NSCLC) following surgical resection and evaluate multiple clinicopathologic prognostic factors. Materials and Methods: A total of 58 patients, who completed scheduled PORT for positive resection margin, among 658 patients treated with PORT from January 2001 to November 2011 were retrospectively analyzed. Radiation therapy was started at 4 to 6 weeks after surgery. Chemotherapy was also administered to 35 patients, either sequentially or concurrently with PORT. Results: The median age of patients was 63 years (range, 40 to 82 years). The postoperative pathological stage I NSCLC was diagnosed in 10 (17.2%), stage II in 18 (31.0%), and stage III in 30 patients (51.7%). Squamous cell carcinoma was identified in 43, adenocarcinoma in 10, large cell in 1, others in 4 patients. Microscopic residual disease (R1) was diagnosed in 55 patients (94.8%), and the remaining three patients were diagnosed with gross residual disease (R2). The median dose of PORT was 59.4 Gy (range, 50.0 to 64.8 Gy). Chemotherapy was administered to 35 patients (60%), and the median follow-up time was 22.0 months (range, 6.0 to 84.0 months). The 3-year locoregional relapse-free survival and distant metastasis-free survival rates were 82.1% and 52.9%, respectively. The median overall survival was 23.8 months (range, 6.0 to 84.1 months), and the 3-year overall survival rate was 58.2%. Chemotherapy did not influence the failure pattern or survival outcome. Conclusion: PORT is an effective modality for improving local tumor control in incompletely resected NSCLC patients. Major failure pattern was distant metastasis despite chemotherapy.

백내장 수술 후 난시교정용 인공수정체를 이용한 난시 교정 효과

차용재(Yong Jae Cha, MD),김미금(Mee Kum Kim, MD, PhD),위원량(Won Ryang Wee, MD, PhD) 대한안과학회 2015 대한안과학회지 Vol.56 No.10

목적: 난시를 동반한 백내장 환자에서 백내장 수술 시 테크니스 토릭 인공수정체 삽입술의 난시교정 효과 및 안정성을 분석하고자 하였다. 대상과 방법: 1D에서 4D의 각막 난시를 동반한 백내장 환자 중 2013년 6월부터 2014년 5월까지 서울대학교병원에서 임상시험 동의하에 백내장 제거술 및 테크니스 토릭 인공수정체 삽입술을 받은 14명 17안을 전향적으로 관찰하여 분석하였다. 수술 전과 후의 시력, 굴절력, 난시, 인공수정체 축, 고위수차의 변화를 술후 3개월까지 관찰하였다. 난시 분석에는 power vector analysis가 사용되었다. 결과: 나안시력(logMAR)은 술 전 평균 0.58 ± 0.34에서 3개월에 0.26 ± 0.43으로 유의하게 향상되었다. 평균 굴절난시는 술 전 -2.67 ± 0.89D였고, 술후 3개월에 -0.59 ± 0.48D로 최종 77.9%의 유의한 감소 효과를 보였다. 난시벡터 분석 시 M, B, J0, J45 모두 술 전과 비교하여 유의하게 감소하였다. 수술 전 의도한 축과 술 후 3개월째 실제 인공수정체 축 간의 평균 차이는 3.26도만큼 시계 방향으로 회전하였지만 통계적으로 유의하지 않았고, 회전은 대부분 술 후 한 달 이내에 발생하였다. 결론: 난시를 동반한 백내장 환자에서 초음파 유화술 및 테크니스 토릭 인공수정체 삽입술은 우수한 난시교정 효과 및 회전 안정성을 보였다. Purpose: To evaluate the efficacy of Tecnis?? toric intraocular lens (IOL) implantation for the correction of astigmatism and rotational stability during cataract surgery in patients with cataract and astigmatism. Methods: We prospectively analyzed 17 eyes of 14 patients with 1 to 4 diopters (D) of corneal astigmatism who underwent phacoemulsification and Tecnis?? toric IOL implantation at Seoul National University Hospital from June 2013 to May 2014. Informed consent was obtained from all participants before the clinical trial. We evaluated the changes in visual acuity, refraction, astigmatism, IOL axis and higher order aberration for 3 months postoperatively. Power vector analysis was used to analyze astigmatism. Results: The mean uncorrected visual acuity (log MAR) significantly improved from 0.58 ± 0.34 to 0.26 ± 0.43 at 3 months postoperatively. The mean refractive astigmatism was significantly decreased by 77.9% from a mean value of -2.67 ± 0.89 D to -0.59 ± 0.48 D at 3 months postoperatively. According to power vector analysis, M, B, J0, and J45 were significantly reduced after the surgery. The mean difference between achieved and intended IOL axis was 3.26 degrees clockwise at postoperative 3 months, which was statistically insignificant. Most of the rotational changes were observed within a month after the surgery. Conclusions: Phacoemulsification and Tecnis?? toric IOL implantation in patients with cataracts and astigmatism showed efficacy for the correction of astigmatism and rotational stability.

신경매독과 연관되어 발생한 안매독의 임상 양상

조용운,김체론,한용섭,정인영,박종문,Yong Wun Cho,MD,Che Ron Kim,MD,Yong Seop Han,MD,PhD,In Young Chung,MD,PhD,Jong Moon Park,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.4

Purpose: To report the manifestation of ocular syphilis combined with neurosyphilis in patients who present with uveitis clinically and are diagnosed initially by an ophthalmologist. Methods: This study is a retrospective, clinical investigation of seven male patients with ocular syphilis from a single tertiary center between 2009 and 2012. Results: The average age of the patients at onset was 44.4 years (range, 33-71 years). Posterior segment involvement was found in all patients. Two patients had papillitis. In serologic testing, all patients had positive responses to Venereal Disease Research Laboratory (VDRL), fluorescent treponemal antibody-absorption test (FTA-ABS) and Treponema pallidum hemagglutination (TPHA). In fluorescein angiography (FAG), retinal vascular and disc leakage was the most common finding. Cerebrospinal fluid (CSF) analysis was performed for six patients and demonstrated positive CSF FTA-ABS and CSF TPHA tests in all patients. CSF VDRL was reactive in 2 patients (33.3%). Conclusions: All patients with ocular syphilis were diagnosed with neurosyphilis based on the analysis of CSF with FTA-ABS and TPHA. Ophthalmologists play an important role in the early diagnosis and treatment of syphilis. J Korean Ophthalmol Soc 2014;55(4):602-607

비접촉경면현미경, 이중샤임플러그 전안부사진기, 초음파각막두께층정계를 이용해 측정한 중심각막두께의 비교

이민지(Min Jee Lee, MD),신용운(Yong Un Shin, MD, PhD),임한웅(Han Woong Lim, MD, PhD),강민호(Min Ho Kang, MD, PhD),조희윤(Hee Yoon Cho, MD, PhD),성민철(Min Cheol Seong, MD, PhD) 대한안과학회 2015 대한안과학회지 Vol.56 No.10

목적: 비접촉경면현미경, 이중샤임플러그전안부 사진기 및 초음파 각막두께측정계를 이용하여 중심각막두께의 측정치를 비교하고자 하였다. 대상과 방법: 정상인 70명 70안을 대상으로 비접촉경면현미경, 이중샤임플러그전안부 사진기 그리고 초음파 각막두께측정계로 측정한 중심각막두께를 비교하고 상관관계를 알아보았다. 결과: 비접촉경면현미경, 이중샤임플러그전안부 사진기 및 초음파 각막두께측정계를 이용하여 측정한 중심각막두께는 각각 567.70 ± 31.21 μm, 557.84 ± 26.29 μm, 553.31 ± 29.69 μm로 비접촉경면현미경이 가장 두껍게 측정되었고 초음파 각막두께측정계가 가장 얇게 측정되었으며, 각 측정치 사이에 통계적으로 유의한 차이를 보였다(p<0.05). 이 중 비접촉경면현미경은 초음파 각막두께측정계보다 유의하게 두껍게 측정되었다(p<0.05). 세 검사는 높은 양의 상관관계를 보였다(r>0.900, p<0.001). 결론: 비접촉경면현미경에 의해 측정된 중심각막두께는 초음파각막두께측정계에 의해 측정된 중심각막두께보다 유의하게 두껍게 측정되어 결과 해석 시 이에 대한 고려가 필요할 것으로 생각된다. 또한 이중샤임플러그전안부 사진기로 측정한 중심각막두께가 초음파 각막두께측정계로 측정한 값에 좀 더 유사한 값을 나타내며 정상안의 중심각막두께 측정에 이중샤임플러그전안부 사진기가 비접촉경면현미경보다 초음파 각막두께측정계를 대체할 수 있는 좀 더 유용한 방법이라 생각된다. Purpose: To compare central corneal thickness (CCT) as measured using noncontact specular microscopy (NCSM), dual rotating Scheimpflug camera (Galilei??), and ultrasound pachymetry (USP). Methods: The measurements of CCT using NCSM, dual rotating Scheimpflug camera and USP in 70 eyes of 70 healthy subjects were compared. Results: The average measurements of CCT using NCSM, dual rotating Scheimpflug camera, and USP were 567.70 ± 31.21 μm, 557.84 ± 26.29 μm, and 553.31 ± 29.69 μm, respectively. The CCT measurement using NCSM was statistically significantly thicker than when measured using USP (p < 0.05). There was no significant difference between the NCSM and dual rotating Scheimpflug camera (p = 0.138). Additionally, there was no significant difference between the dual rotating Scheimpflug camera and USP (p = 0.656). A significant linear correlation was observed among the NCSM, dual rotating Scheimpflug camera, and USP (r > 0.900, p < 0.001). Conclusions: The results of the 3 methods were significantly correlated but the measurement using NCSM was significantly thicker than when using USP. CCT measurements of healthy eyes using dual rotating Scheimpflug camera were more correlated with USP than NCSM. The CCT measurements using dual rotating Scheimpflug camera is a better alternative for USP than NCSM.

Outcome analysis in patients with uterine sarcoma

Tosol Yu,MD,Hak Jae Kim,MD,PhD,Hong-Gyun Wu,MD,PhD,Sung Whan Ha,MD,PhD,Yong-Sang Song,MD,PhD,Noh-Hyun Park,MD,PhD,Jae-Won Kim,MD,PhD 대한방사선종양학회 2015 Radiation Oncology Journal Vol.33 No.1

Purpose: To analyze the prognostic factors for survivals and to evaluate the impact of postoperative whole pelvic radiotherapy (WPRT) on pelvic failure in patients with uterine sarcoma treated with radical surgery. Materials and Methods: We retrospectively analyzed 75 patients with uterine sarcoma who underwent radical surgery with (n = 22) or without (n = 53) radiotherapy between 1990 and 2010. There were 23 and 52 patients with carcinosarcoma and non-carcinosarcoma (leiomyosarcoma, 22; endometrial stromal sarcoma, 25; others, 5), respectively. The median follow-up period was 64 months (range, 17 to 269 months). Results: The 5-year overall survival (OS) and pelvic failure-free survival (PFFS) of total patients was 64.2% and 83.4%, respectively. Multivariate analysis revealed that mitotic count (p = 0.006) was a significant predictor of OS. However, factors were not found to be associated with PFFS. On analyzing each of the histologic subtypes separately, postoperative WPRT significantly reduced pelvic failure in patients with carcinosarcoma (10.0% vs. 53.7%; p = 0.046), but not in patients with non-carcinosarcoma (12.5% vs. 9.9%; p = 0.866). Among the patients with carcinosarcoma, 4 patients (17%) had recurrence within the pelvis and 3 patients (13%) had recurrence in other sites as an initial failure, whereas among the patients with non-carcinosarcoma, 3 patients (6%) experienced pelvic failure and 13 patients (25%) experienced distant failure. Conclusion: The most significant predictor of OS was mitotic count. Based on the improved PFFS after postoperative WPRT only in patients with carcinosarcoma and the difference in patterns of failure between histologic subtypes, optimal adjuvant treatment options should be offered to patients based on the risk of recurrence patterns.

부분결합간섭계에 내장된 인공수정체 도수측정 공식들의 정확성 비교

김동윤,김명준,김재용,차흥원,Dong Yoon Kim,MD,Myoung Joon Kim,MD,PhD,Jae Yong Kim,MD,PhD,Hungwon Tchah,MD,PhD 대한안과학회 2009 대한안과학회지 Vol.50 No.4

Purpose: To evaluate the accuracy of various formulas installed in IOLMaster software which uses partial coherence interferometry for axial length measurement. Methods: This retrospective comparative study included 81 eyes of consecutive patients who had uneventful cataract surgery with implantation of Acrysof single piece (SA60AT) IOL. Axial length was measured with IOLMaster and IOL power was calculated using various formulas, including SRK II, SRK/T, Holladay 1, Haigis, and Hoffer Q. Subjects were stratified by axial length into Groups A (axial length < 23.50 mm), B (23.50 mm ≤ axial length < 25.00 mm), and C (axial length ≥ 25.00 mm). Target refractions of the five formulas were compared to the postoperative manifest refraction at 1 month. Results: The five formulas showed no difference in predicting postoperative refractive errors among all of the groups. Conclusions: Five formulas installed in IOLMaster software provided equivalent predictions of postoperative refractive error regardless of axial length. J Korean Ophthalmol Soc 2009;50(4):523-528

Clinical outcomes after sentinel lymph node biopsy in clinically node-negative breast cancer patients

Hee Ji Han,MD,Ju Ree Kim,MD,PhD,Hee Rim Nam,MD,PhD,Ki Chang Keum,MD,PhD,Chang Ok Suh,MD,PhD,Yong Bae Kim,MD,PhD 대한방사선종양학회 2014 Radiation Oncology Journal Vol.32 No.3

Purpose: To evaluate non-sentinel lymph node (LN) status after sentinel lymph node biopsy (SNB) in patients with breast cancer and to identify the predictive factors for disease failure. Materials and Methods: From January 2006 to December 2007, axillary lymph node (ALN) dissection after SNB was performed for patients with primary invasive breast cancer who had no clinical evidence of LN metastasis. A total of 320 patients were treated with breast-conserving surgery and radiotherapy. Results: The median age of patients was 48 years, and the median follow-up time was 72.8 months. Close resection margin (RM) was observed in 13 patients. The median number of dissected SNB was two, and that of total retrieved ALNs was 11. Sentinel node accuracy was 94.7%, and the overall false negative rate (FNR) was 5.3%. Eleven patients experienced treatment failure. Local recurrence, regional LN recurrence, and distant metastasis were identified in 0.9%, 1.9%, and 2.8% of these patients, respectively. Sentinel LN status were not associated with locoregional recurrence (p > 0.05). Close RM was the only significant factor for disease-free survival (DFS) in univariate and multivariate analysis. The 5-year overall survival, DFS, and locoregional DFS were 100%, 96.8%, and 98.1%, respectively. Conclusion: In this study, SNB was performed with high accuracy and low FNR and high locoregional control was achieved.

Drechslera 균종에 의한 진균각막염 1예

김체론,서성욱,박종문,유지명,한용섭,김선주,김성재,Che Ron Kim,MD,Seong Wook Seo,MD,PhD,Jong Moon Park,MD,PhD,Ji Myung Yoo,MD,PhD,Yong Seop Han,MD,Sunjoo Kim,MD,PhD,Seong Jae Kim,MD 대한안과학회 2011 대한안과학회지 Vol.52 No.11

Purpose: To report a case of fungal keratitis caused by Drechslera species. Case summary: A 77-year-old man visited our clinic complaining of left ocular pain and decrease of visual acuity for 1 week On slit-lamp examination, epithelial defect and stromal infiltration on the corneal center with numerous inflammatory cells in the anterior chamber were found. There was no improvement after routine antibiotic treatment. A corneal biopsy and culture were performed on the corneal lesion. The KOH smear study reported hyphae, thus the patient was treated with 0.25% amphotericin B, 0.2% fluconazole and 5% natamycin eye drops. A clinical improvement was observed on the corneal lesion and Drechslera species was identified by the culture study. Conclusions: The authors report an experience of fungal keratitis caused by Drechslera species. J Korean Ophthalmol Soc 2011;52(11):1366-1369

외편위 환자에서 3D TV 시청이 사시각 및 굴절이상에 미치는 영향

서혜진,김승현,서영우,최용민,유은주,한지윤,남기태,조윤애,Hye Jin Seo,MD,Seung Hyun Kim,MD,PhD,Young Woo Suh,MD,PhD,Yong Min Choi,MD,Eun Joo Yoo,MD,Ji Yun Han,MD,Ki Tae Nam,MD,Yoon Ae Cho,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.10

Purpose: To investigate the effects of watching three-dimensional (3D) television (TV) on the angle of deviation and refractive error in children with exodeviation. Methods: Twenty-three volunteers with exodeviation, aged 6 to 12 years, without any ocular abnormalities other than refractive error and exodeviation were recruited for this study. The subjects watched 3D TV for 50 minutes at a viewing distance of 2.8 meters. The image disparity of 3D contents was -1 to 1 degree. Refractive errors were measured before and immediately after watching TV and after a 10-minute rest. The changes in angle of deviation were also obtained. Refractive errors and angle of deviation before and after watching 3D TV were compared. Results: The mean age of the subjects was 9.30 ± 1.58 years. The mean baseline angle of deviation was 13.04 ± 5.25 (6-30) prism diopters (PD), which did not change significantly immediately after watching 3D TV and after a 10-minute rest (<EM>p</EM> = 0.452). The mean refractive errors were -2.15 ± 1.55 D in the right eye and -2.06 ± 1.55 D in the left eye before and changed to -2.14 ± 1.57 D and -2.11 ± 1.45 D, respectively, immediately after watching 3D TV. After a 10 minute rest, the mean refractive errors were 2.14 ± 1.53 D in the right eye and -2.07 ± 1.53 D in the left eye. All changes in refractive errors were not statistically significant (<EM>p </EM>= 0.991 in right eye, 0.495 in left eye). The amount of myopic shift in both eyes immediately after watching 3D TV was correlated with the angle of exodeviation (r = 0.468, p = 0.024). However, the correlation disappeared after a 10-minute rest (r = 0.345, <EM>p </EM>= 0.107). Conclusions: Watching properly made 3D contents on 3D TV for 50 minutes at more than 2.8 meters of viewing distance did not affect the refractive error in children with exodeviation. Further studies on the relationship between the amount of myopic shift and the angle of exodeviation are necessary. J Korean Ophthalmol Soc 2014;55(10):1525-1529