안와내 농양을 동반한 양측 해면정맥굴혈전증 1예

구남균,김진희,이세엽.Nam-Kyun Koo. M.D.. Jin-Hee Kim. M.D.. Se-Youp Lee. M.D. 대한안과학회 2005 대한안과학회지 Vol.46 No.4

Purpose: We report a case of bilateral cavernous sinus thrombosis and unilateral intraorbital abscess in a patient suffering proptosis, a limitation of ocular movement, and visual disturbance. Methods: After several days of febrile and chilling sensation, a 49-year-old man suffered from vision loss, a limitation of ocular movement in all directions, proptosis in the right eye and mild abduction limitation in the left eye. Brain MRI, indicated inflammation in the bilateral cavernous sinuses and intraorbital abscess in the right eye, leading to a diagnosis of cavernous sinus thrombosis. Systemically, the patient was treated with antibiotics and steroid injection. For intraorbital abscess, aspiration and antibiotics injection were administered locally. The patient improved overall and the abscess size decreased. Blood culture showed α-hemolytic Streptococcus. The Gram stain of the specimen from the intraorbital abscess revealed Gram-positive cocci but no specific strain was cultured. Results: We believe that proptosis in the right eye, intraorbital abscess, limitation of ocular movement, retinal hemorrhage, and optic atrophy were due to α-hemolytic Streptococcus, which had spread to the cavernous sinus and right orbit through the vascular system. Conclusions: We report a case of bilateral cavernous sinus thrombosis and intraorbital abscess in the right eye in a patient who suffered from sepsis caused by α-hemolytic Streptococcus.

염증성 각막내피반의 수술적 제거로 치유한 안내염 1예

구남균,김광수,김유철.Nam Kyun Koo. MD. Kwang Soo Kim. MD. Yu Cheol Kim. MD 대한안과학회 2011 대한안과학회지 Vol.52 No.8

Purpose: To report a case of endophthalmitis treated with surgical removal of the inflammatory endothelial plaque. Case summary: A 61-year-old male was transferred to our clinic due to corneal laceration of the left eye. An emergency operation for the lacerated cornea was performed. After the operation, the patient had no specific symptoms for 8 months but then visited our clinic with sudden decreased visual acuity. On slit lamp examination, the patient had some chamber reactions. Anterior chamber reactions exacerbated after 2 months and the best corrected visual acuity was decreased from 1.0 to 0.08. An inflammatory corneal endothelial plaque and endothelial precipitates had developed. The posterior segment was not visualized due to the severe anterior chamber inflammatory reaction. No growth was observed on bacterial or fungal cultures. However, administration of eye drops and oral voriconazole were initiated based on a clinical impression suspicious of fungal infection. Despite the treatment, the infection did not respond. Voriconazole was then directly injected into the vitreous and anterior chamber. Although the patient’s best corrected visual acuity slightly improved, the inflammatory reactions of the anterior chamber and vitreous did not. The inflammatory endothelial plaque on the patient’s cornea was then surgically removed and the best corrected visual acuity improved to 1.0. Mycelium was detected on the KOH smear of the endothelial plaque. There were no further inflammatory reactions in the anterior chamber or vitreous after surgical removal of the endothelial plaque. J Korean Ophthalmol Soc 2011;52(8):990-993

A Case of Paclitaxel-induced Maculopathy Treated with Methazolamide

구남균,김유철 대한안과학회 2012 Korean Journal of Ophthalmology Vol.26 No.5

54-year-old female patient who had been undergoing anti-cancer chemotherapy and radiotherapy for seven years after surgery for left breast cancer visited our clinic for visual disturbance in the right eye at nine months after paclitaxel administration. The best-corrected visual acuity was 0.5 in the right eye and 1.0 in the left eye. The patient was diagnosed with maculopathy due to paclitaxel administration based on the finding of cystoid macular edema in the right eyeon fundus examination and optical coherence tomography; however, no leakage was detected on fluorescein angiography. Thus, drug replacement was planned. On the other hand, no abnormal finding was observed in the left eye. However, as the anti-cancer effect of paclitaxel is significant, replacing paclitaxel with another agent was not warranted; therefore, maintenance therapy with methazolamide was performed before and after administering the anti-cancer agent. Aggravation of cystoid macular edema was prevented, and vision improvement was achieved by oral maintenance therapy with methazolamide. In addition, the same fundus findings as shown in the right eye were detected in the left eye at 16 months after paclitaxel administration. After administering methazolamide, macular thickness was reduced, and vision was improved in the left eye. Paclitaxel administration was discontinued due to cutaneous metastasis from the breast cancer, and another anti-cancer agent was then administered. No subsequent cystoid macular edema has occurred.

콜라겐 함유 피부주입물 주사 후 발생한 결막하 이물 침착 1예

구남균,김유철,김광수,Nam Kyun Koo,MD,Yu Cheol Kim,MD,Kwang Soo Kim,MD 대한안과학회 2012 대한안과학회지 Vol.53 No.4

Purpose: To report a case of subconjunctival foreign body migration in both eyes after collagen-containing filler injection. Case summary: A 51-year-old female, who had been treated with collagen-containing filler in her eyelid, nose, and forehead for cosmetic complaints four months earlier, presented to our clinic with decreased visual acuity and foreign body sensation in both eyes. Slit lamp examination revealed moderate nucleosclerosis and subcapsular opacity in her crystalline lens, in addition to scattered subconjunctival foreign body infiltration in both eyes. Cataract extraction with posterior chamber lens implantation was performed, and the subconjunctival foreign body was also partially removed. Biopsy of the remaining foreign body was performed, and examination revealed foreign material and multivacuolated cells in the conjunctiva. Conclusions: Clinicians and patients should be aware of the risk of migration of collagen-containing filler inject at or near the eyelid, to the eyeball, including the conjunctiva. J Korean Ophthalmol Soc 2012;53(4):588-591

Relationship between the Morphology of Diabetic Macular Edema and Renal Dysfunction in Diabetes

구남균,진현철,김광수,김유철 대한안과학회 2013 Korean Journal of Ophthalmology Vol.27 No.2

Purpose: To determine the correlation between renal dysfunction and the morphologic changes of macular edema in diabetes. Methods: The current study included 93 patients with diabetic macular edema based on optical coherence tomography (OCT) who completed systemic condition testing one month before or after the OCT. Based on the OCT findings, patients were divided into the following five groups: group A (diffuse), group B (cystoid), group C (serous), group D (vitreomacular tractional), and group E (a mixed presence of cystoid and serous types). In each group, we performed a retrospective analysis of serum albumin, urine albumin, and serum creatinine. We also analyzed the patients in whom serum albumin was <3.0 mg/dL and serum creatinine was >1.6 mg/dL. Urine albumin was measured in all five groups. In each group, a comparative analysis was performed using Fisher’s exact test. Results: The number of patients who were assigned to groups A to E was 15, 46, 6, 3, and 23, respectively. According to a comparison of the patients in whom the serum albumin and serum creatinine were abnormal, there was no significant difference among the five groups. The proportion of patients in whom the urine albumin was abnormal was significantly greater in group C (67%) than in groups A (7%), B (20%), or E (22%). Conclusions: Serous-type macular edema occurred more frequently than other types of macular edema in patients with albuminuria.

급성 망막중심동맥폐쇄에서의 스펙트럼 영역 빛간섭단층촬영상의 소견

박재영,구남균,서원문.Jae Yeong Park. MD. Nam Kyun Koo. MD. Won Moon Seo. MD 대한안과학회 2012 대한안과학회지 Vol.53 No.8

Purpose: To evaluate spectral-domain optical coherence tomography (SD-OCT) images of acute central retinal artery occlusion (CRAO). Methods: Six eyes of 6 patients who were diagnosed with acute CRAO were enrolled in the present study. The main SD-OCT measurements included macular thickness in the macular cube map and retinal thickness in the 5-line raster map. Results: In acute CRAO, macular thickness increased more than that in the normal fellow eye in all cases. SD-OCT images demonstrated increased reflectivity and thickness in the inner retinal layer, especially in the nerve fiber layer and ganglion cell layer. However, in the outer retinal layer, SD-OCT images disclosed decreased reflectivity and increased thickness. The central subfield thickness area image showed normal reflectivity and thickness. The horizontal cross-sectional image showed relatively the same edema ratio between the inner retinal layer and outer retinal layer thickness. There was no cystoid or serous foveal detachment-type edema. Conclusions: SD-OCT images of CRAO showed increased outer retinal layer thickness and decreased reflectance as well as increased inner retinal layer thickness and reflectance. However, inner segment and outer segment junctions of the photoreceptor and retinal pigment epithelial signal were intact. J Korean Ophthalmol Soc 2012;53(8):1099-1103

압박시신경병증으로 발현된 내경동맥의 미파열성 거대동맥류

박재영,구남균,Jae Yeong Park,Nam Kyun Koo 대한안과학회 2012 대한안과학회지 Vol.53 No.9

Purpose: To report a case of compressive optic neuropathy due to a giant unruptured aneurysm of a distal internal carotid artery. Case summary: A 68-year-old female presented with a one-week history of visual disturbance in her left eye. The patient had no underlying disease except hypertension. Best corrected visual acuity was 20/20 in the right eye and 8/20 in the left eye. The color perception test showed abnormal findings in the left eye. Slit lamp examination showed no abnormal finding except incipient cataract in both eyes. Additionally, fundus examination showed no abnormal finding. Brain MRI and MRA revealed a 2.4 × 2.2 × 3.0-cm-sized unruptured giant aneurysm on the left internal carotid artery. Conclusions: A giant aneurysm should be considered as a cause for acute or subacute optic neuropathy in a patient with hypertension. J Korean Ophthalmol Soc 2012;53(9):1368-1371