유리체절제술 후 발생한 황반원공: 예방이 가능한가?

김리브가,김유철,김광수,Rebecca Kim,MD,Yu Cheol Kim,MD,Kwang Soo Kim,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.2

Purpose: To evaluate the causes of secondary macular hole after vitrectomy and the possibility of their prevention. Methods: 27 patients (28 eyes) who experienced macular hole formation after vitrectomy were reviewed retrospectively. Age, sex, operation methods, duration between the vitrectomy and the secondary macular hole surgery and causes of the primary vitrectomy were recorded. Best-corrected visual acuity (BCVA) before and after primary vitrectomy; preoperative and postoperative macular findings with optical coherence tomography and fundus examination; and BCVA before and after macular hole surgery were analyzed. Results: Of the 2945 eyes that had undergone vitrectomy, 28 eyes (0.96%) experienced macular hole formation. As causes of primary vitrectomy, 12 eyes had proliferative diabetic retinopathy, 6 eyes had rhegmatogenous retinal detachment, 2 eyes had branch retinal vein occlusion, 3 eyes had age-related macular degeneration and 5 eyes had trauma such as eyeball rupture or intraocular foreign body. The mean duration between primary vitrectomy and macular hole formation was 20.4 months (4 days-115 months). The estimated causes of macular hole formation included cystoid macular edema (CME) (n = 13), thinning of the macula (n = 6), thickening of internal limiting membrane or recurrence of preretinal membrane (PRM) (n = 7), recurrence of subretinal hemorrhage (n = 1) and macular damage during vitrectomy (n = 2). Final BCVA after macular hole surgery decreased in most cases compared to BCVA before macular hole formation except in 7 eyes (25%). Conclusions: Close observation of the macula after primary vitrectomy especially in eyes with continuous CME, and recurrent PRM and proper management on them including timely removal of the tangential traction force are necessary for preventing macular hole formation. In addition, surgeons should make efforts not to exert excessive tractional force on the macula to avoid iatrogenic damage during removal of the preretinal membrane. J Korean Ophthalmol Soc 2014;55(2):230-236

비굴절조절내사시 환자의 조절눈모음비

김리브가,이세엽,Rebecca Kim,Se Youp Lee 대한안과학회 2014 대한안과학회지 Vol.55 No.2

Purpose: To measure the ratio of accommodative-convergence to accommodation (AC/A ratio) in patients with nonrefractive accommodative esotropia in comparison to refractive accommodative esotropia and normal groups. Methods: A total of 43 subjects were divided into 3 groups: the nonrefractive accommodative esotropia group (group 1), the refractive accommodative esotropia group (group 2) and the normal group (group 3). Age, sex, age of onset, and refractive errors were recorded. The deviation angle was measured near and at distance by using a prism cover test. The AC/A ratio was calculated using a gradient method. Results: Refractive errors were 2.3 ± 1.7 D (OD) and 2.4 ± 2.1 D (OS) in group 1, 4.8 ± 0.9 D (OD) and 4.6 ± 1.1 D (OS) in group 2, and -0.3 ± 1.5 D (OD) and -0.5 ± 1.5 D (OS) in group 3. Group 2 had higher mean refractive errors than groups 1 and 3, while the difference in refractive error between group 1 and group 3 was not statistically significant. The AC/A ratio was 5.5 in group 1, 2.1 in group 2 and 2.2 in group 3; there was no significant difference between groups 2 and 3, while group 1 had a significantly higher AC/A ratio than both of these groups. Conclusions: AC/A ratio in patients with nonrefractive accommodative esotropia is higher than that of refractive accommodative esotropia or normal children. It could be used for bifocal lens as non-surgical treatment. J Korean Ophthalmol Soc 2014;55(2):267-270

압축공기에 의한 수상으로 안와기종과 뇌기종이 발생한 1예

김리브가 대한안과학회 2020 대한안과학회지 Vol.61 No.6

Purpose: To report a case of orbital emphysema and pneumocephalus after exposure to compressed air. Case summary: A 49-year-old male visited our medical center after his left eye was damaged by a compressed air gun in an industrial setting. During the anterior segment examination, swelling of the left periorbital area, crepitation, and tenderness were observed in the upper and lower eyelids. On slit-lamp examination, there was a 12 mm conjunctival laceration in the temporal area, subconjunctival hemorrhage, multiple subconjunctival air bubbles, and microhyphema in the anterior chamber. A computed tomography scan of the head and orbit showed subcutaneous and intraorbital emphysema and pneumocephalus. Primary closure of the lacerated conjunctiva was performed. The patient was prescribed systemic and topical antibiotics with bed rest. Four days after the trauma, microhyphema and swelling of the eyelids were decreased significantly. Six days after the trauma, there were improvements of orbital emphysema and pneumocephalus without any complications. In summary, we report a rare case of orbital emphysema and pneumocephalus caused by compressed air. Conclusions: Orbital emphysema and pneumocephalus can occur due to compressed air injury in the absence of orbital wall fracture. 목적: 압축공기에 수상 후 안와기종, 뇌기종이 발생한 환자 1예를 보고하고자 한다. 증례요약: 49세 남자가 작업 중 에어건에서 송출되는 압축공기에 좌안을 수상하여 내원하였다. 좌측 안와주위부종, 상하안검의 염발음, 압통이 있었다. 세극등현미경검사에서 12 mm의 외측 결막열상, 결막하출혈, 결막하 공기방울이 관찰되었고 전방출혈 소견이 있었다. 안와와 두부 전산화단층촬영에서 피하 및 안와기종이 관찰되었으며, 뇌기종이 관찰되었다. 결막열상에 대한 일차봉합술을 시행하였고, 입원 후 정맥 내 항생제 투여와 절대 안정을 취하고 항생제 안약을 점안하였다. 외상 4일 후 안검부종 및 전방출혈은 감소하였고, 외상 후 6일째 시행한 전산화단층촬영에서 뇌기종과 안와기종은 현저히 감소하였다. 압축공기에 의한 수상으로 안와골절 없이 안와기종과 뇌기종이 발생한 경우는 매우 드물게 보고되고 있으며 이에 본 증례를 보고하는 바이다. 결론: 압축공기에 안와수상 시 안와골절의 발생 없이 안와기종, 뇌기종이 발생할 수 있다.

신생혈관녹내장 환자에서 섬유주절제술 전 유리체강내 베바시주맙 주입술의 효과

이유현,김리브가,장성동 대한안과학회 2015 대한안과학회지 Vol.56 No.6

목적: 신생혈관녹내장 환자에서 섬유주절제술 전 시행한 유리체강내 베바시주맙 주입술의 효과와 수술 성공에 영향을 미치는 인자에대해 알아보았다. 대상과 방법: 2003년부터 2013년까지 신생혈관녹내장으로 섬유주절제술을 시행한 환자는 총 58명(58안)이었다. 2003년부터 2006년까지는 마이토마이신 C를 이용한 섬유주절제술만 시행하였고 2007년부터 2013년까지는 위의 술식에 술 전 유리체강내 베바시주맙을 추가하였다. 의무기록을 후향적으로 조사하여 술 전 유리체강내 베바시주맙 주입술의 효과를 알기 위하여 시행한 군과 하지 않은군으로 나누어 섬유주절제술 전부터 수술 후 12개월까지의 최대교정시력과 안압을 조사하여 비교하였다. 섬유주절제술 후 수술 성공률과 관련된 인자들을 알기 위해 연령, 수정체 상태, 유리체강내 베바시주맙 주입술 여부 및 섬유주절제술과의 기간, 이전 유리체절제술 여부와 술 후 발생한 합병증으로 구분하였다. 결과: 마이토마이신 C를 이용한 섬유주절제술만 시행한 안은 26안이며 술 전 유리체강내 베바시주맙 주입술을 시행한 안은 32안이었다. 수술 후 성공률은 6개월에서 유리체강내 베바시주맙 주입술을 시행한 경우 81.3%로 섬유주절제술만 시행한 경우인 57.7%보다 높았으며(p=0.012) 1년의 경과관찰에서도 각각 78.1%와 50.0%로 관찰되었다(p=0.021). 또한 유리체강내 베바시주맙 주입술을 시행한 경우에서 유의한 안압 하강을 관찰할 수 있었으며(p=0.048) 1년 후 안압 유지를 위해 사용해야 하는 점안 안압하강제의 개수가 0.4개로 섬유주절제술만 시행한 경우인 0.8개에 비해 유의하게 적었다(p=0.040). 수술 실패의 위험인자로 단변량 연구에서는 술 후 전방출혈(hazard ratio [HR]=2.872, p=0.044)과 술 전 유리체강내 베바시주맙 주입술(HR=0.280, p=0.030)이었지만 다변량 회귀분석에서는 유일하게 술 전 유리체강내 베바시주맙 주입술만이 유의한 인자였다(p=0.046). 결론: 신생혈관녹내장 환자에서 섬유주절제술 전 유리체강내 베바시주맙주입술은 수술 성공을 높이는 인자이며 술 후 1년에서 섬유주절제술만 시행한 경우에 비해 유의한 안압 하강과 수술 후 사용해야 하는 점안 안압하강제의 개수가 적음을 보여주었다. Purpose: To evaluate the efficacy of preoperative intravitreal bevacizumab injection (IVBI) and prognostic factors of surgical success in neovascular glaucoma patients, who underwent trabeculectomy. Methods: A total of 58 patients (58 eyes) diagnosed with neovascular glaucoma who underwent trabeculectomy between 2003 and 2013 were enrolled in this retrospective study. Trabeculectomy with mitomycin C was performed between 2003 and 2006 and additional preoperative IVBI with the above mentioned technique was performed between 2007 and 2013. To evaluate the efficacy of preoperative IVBI, the patients were divided into the preoperative IVBI group and control group. Best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured from preoperative to postoperative 12 months. To evaluate the prognostic factors related to surgical success, the following was investigated: age, lens status, preoperative IVBI, time interval between preoperative IVBI and trabeculectomy, previous vitrectomy and, postoperative complications. Results: Trabeculectomy with mitomycin C only was performed in 26 eyes and additional preoperative IVBI was performed in 32 eyes. Surgical success was 81.3% in the IVBI group and 57.7% in the control group at postoperative 6 months (p = 0.012), and 78.1% in the IVBI group and 50.0% in the control group at postoperative 12 months (p = 0.021). Statistically significant IOP reduction effect was observed in the IVBI group (p = 0.048), and reduced anti-glaucoma eye drop usage was observed in the IVBI group (0.4) compared with 0.8 in the control group (p = 0.040). Postoperative hyphema (hazard ratio [HR] = 2.872, p = 0.044) and preoperative IVBI (HR = 0.280, p = 0.030) were considered risk factors for surgical failure in univariate analysis, however, only preoperative IVBI was statistically significant in multivariate analysis (p = 0.046). Conclusions: In neovascular glaucoma patients, preoperative IVBI before trabeculectomy is a good prognostic factor of surgical success and shows benefit in lowering the IOP and reducing anti-glaucoma eye drop usage at postoperative 1 year.