양안에 발생한 코우츠병 1예

마대중,최진,장지웅,김정훈,김성준,유영석.Dae Joong Ma. MD. Jin Choi. MD. Ji Woong Jang. MD. Jeong Hun Kim. MD.. Seong Joon Kim. MD.. Young Suk Yu. MD. PhD. 대한안과학회 2011 대한안과학회지 Vol.52 No.1

Purpose: To report a case of bilateral Coats' disease. Case summary: A 19-month-old boy presented with esodeviation of his eyes, which started 5 months prior. A fundus exam showed total bullous exudative retinal detachment with retinal vascular telangiectasia in the right eye and localized exudative retinal detachment with vascular telangiectasia at the inferior periphery in the right eye. Fluorescein angiogram of the left eye showed retinal telangiectatic vessels, avascular area and fluorescein leakeage from telangiectatic vessels. The patient received external drainage of subretinal fluid and intravitreal air injection of the right eye and Argon LASER photocoagulation and cryotheraphy of the left eye. A cytologic exam of the subretinal fluid drained from the right eye showed no malignant cells. Forty-four months after the operation, his best corrected visual acuity was no light perception in the right eye and 0.4 in the left eye. Both fundi were flat and stable. No complications, such as glaucoma, recurred retinal detachment, or pain, occurred. Conclusions: Coats' disease rarely occurs bilaterally and can be involved asymmetrically. The disease presents more severely when bilateral and can progress after long-term observation. Proper treatment and long-term follow-up of both eyes are necessary to prevent visual loss and preserve eyes. J Korean Ophthalmol Soc 2011;52(1):112-116

Window to Heart; Ocular Manifestations of Hypertension

마대중,유형곤 한양대학교 의과대학 2016 Hanyang Medical Reviews Vol.36 No.3

Systemic hypertension affects not only the heart, kidneys, brain, and large arteries but also the eyes. High blood pressure (BP) causes a series of pathophysiological changes in the retinal vasculature, including focal and diffuse narrowing of the retinal arteriole, opacification of the arteriolar wall, and compression of the venules by arterioles. In severe cases, hemorrhage, nerve fiber layer infraction, and disc swelling can occur. Systemic hypertension results in various retinal vascular diseases, such as hypertensive retinopathy, retinal vein or artery occlusion, retinal arterial macroaneurysm, and nonarteritic ischemic optic neuropathy. High BP also increases the risk of development and progression of diabetic retinopathy. Signs of hypertensive retinopathy are predictive of target-organ damages, including cardiovascular and cerebrovascular diseases. While managing patients with hypertensive retinopathy, physicians should be aware of the management of cardiovascular and cerebrovascular risk factors.

중도 시각장애인의 신체활동 참여 소외현상 탐색

조가람 ( Ga-ram Jo ) , 김준식 ( Joon-sik Kim ) , 김연수 ( Yeon-soo Kim ) , 유형곤 ( Hyeong-gon Yu ) , 조인환 ( In-hwan Cho ) , 마대중 ( Dae-joong Ma ) , 김운형 ( Woon-hyung Ghim ) , 홍인환 ( In-hwan Hong ) 한국스포츠정책과학원(구 한국스포츠개발원) 2020 체육과학연구 Vol.31 No.1

[목적] 본 연구는 중도시각장애인의 신체활동 참여 소외와 극복과정과 이에 영향을 미치는 요인을 탐색하는 것이다. [방법] 연구목적을 달성하기 위해 성인 중도시각장애인 21명을 연구참여자로 선정하였으며, 반구조화된 면접방법으로 1:1 면담을 진행하여 자료를 수집하였다, 자료의 분석은 Strauss와 Corbin이 제시한 근거이론 분석방법에 따라 개방코딩, 축 코딩, 선택코딩의 순서를 따라 이루어졌다. [결과] 연구결과 총 203개의 개념이 도출되었고, 이를 21개의 하위범주로 구성하였으며 하위범주들의 공통되는 주제를 다시 9개의 주제로 상위범주화할 수 있었다. 구체적인 연구결과는 다음과 같다. 첫째, 중도시각장애인의 신체활동 소외현상에 직접적인 영향을 미치는 요인은 체육시설과 체육프로그램 관련 정보 그리고 전문 지도자의 부재 등과 같은 열악한 제반환경인 것으로 나타났다. 이러한 인과적 조건은 중도시각장애인의 ‘분주한 일상’과 ‘위축된 심리상태’라는 맥락 조건 속에서 ‘여가경험의 상실’이라는 중심현상으로 귀결되었다. 둘째, 건강관리 필요성의 인식 정도와 주변인의 긍정적인 관여 정도에 따라 중도시각장애인들은 운동 효과에 대한 기대를 품게 되었으며 운동 효과에 대한 기대가 크면 클수록 자신을 둘러싼 제약 속에서 제한적으로 신체활동에 다시 참여하게 되었다. 셋째, 이때 참여하게 되는 신체활동의 성격은 건강개선이라는 목적을 달성하기 위한 도구적 의미가 강했다. 이러한 신체활동의 유형은 단순히 심신의 회복을 목적으로만 진행되는 신체활동의 형태이다 보니 이들의 자율성과 흥미를 내재하고 있지 못했다. 그래서 이들은 지속적인 신체활동의 참여를 유지하는데 어려움을 겪었다. [결론] 중도시각장애인의 신체활동 보장을 위한 제반 환경에 대한 개선과 정비가 필요하며 시력과 시야를 상실해가는 초기단기에 있는 중도시각장애인에게 집중적인 신체활동 지원서비스가 제공되어야 할 것이다. 또한, 중도시각장애인 당사자와 보호자를 대상으로 운동의 효과와 가치에 대한 교육과 홍보가 수행되어야 하며 지속적인 신체활동 참여를 위해 운동프로그램을 다양화 및 개발하는 한편 장애 진단을 받기 전 참여했던 운동 종목에 지속적으로 참여할 수 있도록 돕는 방향으로 재정적·정책적 지원이 뒷받침되어야 할 것이다. [Purpose] The purpose of this study is to investigate the alienation and the overcoming process of the physical activity participation of people with Adventitious Visual Impairment(AVI) [Methods] 21 Adults with AVI were recruited and one on one semi-structured interview was conducted. Ground theory was used to analyze the data. Member check, peer debriefing was conducted to enhance the trustworthiness of this study. [Results] As a result, a total of 203 concepts were derived. This consisted of 21 subcategories and the common themes of the subcategories were categorized into nine categories. Specific results are as follows. First, the physical activity of people with AVI was directly affected by the sports facilities, physical activity programs, and professional instructor. This causal condition resulted in the loss of leisure experience in the context of the busy daily life and the depressed psychological state. Second, due to the perceived need of health care and the positive involvement of others, people with AVI came to expect the effect of exercise. Third, people with AVI participated in physical activity again as a tool to achieve the purpose of health improvement. This type of physical activity has a limitation that it can not guarantee the continuity of physical activity due to the limitation that it does not contain autonomy and interest of people with AVI. [Conclusion] Based on these results, the following suggestions were made. First, it is necessary to improve the environment for ensuring participation in physical activity of people with AVI. Moreover education and promotion of the effects and values of the exercise should be carried out for people with AVI and their guardians. Second, it is necessary to diversify physical activity types and reconstruct existing exercise programs.

자가면역 연관 주변부각막궤양의 임상양상 및 예후인자 분석

마대중,최혁진,김미금,위원량,Dae Joong Ma,Hyuk Jin Choi,Mee Kum Kim,Won Ryang Wee 대한안과학회 2011 대한안과학회지 Vol.52 No.8

Purpose: To investigate clinical manifestations and prognostic factors of autoimmune-related peripheral corneal ulcers. Methods: Nineteen eyes in 18 patients who were diagnosed with autoimmune-related peripheral corneal ulcer from November 1999 to August 2010 were enrolled in the present study. Clinical manifestations and treatment results were investigated retrospectively. Results: The average age at presentation was 64.6 years with female (66.7%) and unilateral (94.4%) dominance. The main etiologies were Mooren’s ulcer (53.6%) and rheumatoid arthritis (26.3%). The ulcer depth was greater than 75% of the corneal thickness in more than half of the cases (57.9%) and the mean extent of the ulcer was 69.5°. There were no significant improvements in visual acuity after treatment (p = 0.789) and no significant differences in treatment outcomes among etiologies or treatment modalities. The patients who underwent ulcer recurrence (p = 0.048) or treatment failure (p = 0.005) had poorer final visual acuity than those patients who did not. The ulcer depth correlated with treatment failure (p = 0.037). The final visual acuity showed positive correlations with visual acuity at presentation (p = 0.031) and negative correlations with the number of recurrences (p = 0.042). Conclusions: The visual acuity at presentation and ulcer depths were significant prognostic factors. These factors appeared to be helpful in the treatment of marginal keratitis depending on the depth of the ulcer. J Korean Ophthalmol Soc 2011;52(8):936-942

무봉합 후방인공수정체 공막고정술의 단기 임상결과 다섯 예 분석

마대중,김미금,위원량.Dae Joong Ma. MD. Mee Kum Kim. MD. PhD.. Won Ryang Wee. MD. PhD. 대한안과학회 2012 대한안과학회지 Vol.53 No.11

terior chamber intraocular lens transscleral fixation when a scleral flap cannot be made. Methods: Five patients underwent the knotless technique for posterior chamber intraocular lens transscleral fixation when a scleral flap could not be made. Partial thickness scleral anchoring sutures were repeated three times near the transscleral penetration site in both ends. The end of the anchoring suture was passed under the exposed part of the partial thickness scleral anchoring suture and pulled to adjust the position of the intraocular lens. Then, anchoring sutures were covered with a conjunctival flap. Complications and change of intraocular lens astigmatism were evaluated. Results: During the 8-month postoperative follow-up period, one case of ciliary body hemorrhage due to intraoperative transscleral penetration and one case of mild intraocular lens tilting owing to the improper tension of the string were observed. Except for one case with a concurrent penetrating keratoplasty, intraocular lens astigmatism showed no significant change during the postoperative follow-up period and no significant difference compared to transscleral fixation with a scleral flap. Conclusions: Knotless technique for external fixation of posterior chamber intraocular lens transscleral fixation is a safe and easy technique and may be a good alternative for the scleral flap-making technique in posterior chamber intraocular lens transscleral fixation when a scleral flap cannot be made.

Outcomes of Venovenous Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome in Adults

마대성,김준범,정성호,주석중,정철현,이재원 대한흉부외과학회 2012 Journal of Chest Surgery (J Chest Surg) Vol.45 No.2

Background: Despite improved managements for acute respiratory distress syndrome (ARDS), its mortality remains high. Extracorporeal membrane oxygenation (ECMO) has emerged as the final option for the treatment of ARDS unresponsive to conventional measures. This study describes our experiences of venovenous ECMO support for the treatment of ARDS. Materials and Methods: Between 2007 and 2010, 56 patients (aged 56.6±13.4 years, 43 males) received venovenous ECMO for the treatment of ARDS. The detailed clinical records were retrospectively reviewed. Results: Before the institution of ECMO support, 35 patients (55.4%) required nitric oxide inhalation, 35 patients (55.4%) received continuous renal replacement therapy, and 20 patients (35.7%) were in shock status. The median duration of ECMO support was 164 hours (range, 5 to 1,413 hours). 27 (48%) patients could be successfully weaned from ECMO. Of them, 7 (13%) survived to discharge. On logistic regression analysis, a requirement for higher inspiratory pressure before ECMO support was the only significant factor that could predict ECMO weaning failure. Conclusion: The outcome of venovenous ECMO support for the treatment of ARDS was suboptimal. Further improvements in outcomes should be made through the accumulation of experience and establishment of a standardized protocol for the management of ECMO.

나이관련황반변성에서 영양보충제의 역할

유형곤,마대중 대한의사협회 2016 대한의사협회지 Vol.59 No.12

Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness in the elderly in developed countries but therapeutic options are limited. Many observational studies have shown that a high dietary intake of antioxidants, fish oil, and carotenoids is associated with a lower risk of prevalent and incident AMD. The Age-Related Eye Disease Study 1 demonstrated that routine supplementation with a certain formulation of vitamins C, E, β-carotene, and zinc with copper reduces the risk of worsening AMD and severe vision loss by 25% over a 6-year period in patients with intermediate or advanced AMD in 1 eye or intermediate AMD in both eyes. The recent Age- Related Eye Disease Study 2 demonstrated that a certain combination of lutein and zeaxanthin is a safe and effective alternative to β-carotene, which is known to be associated with lung cancer in smokers. The aim of this review focuses on the role of supplements in the treatment and prevention of AMD and sums up the recent findings about the micronutrients most frequently used for AMD.

치료 경험이 없는 중심망막정맥폐쇄안과 나이 및 성별 매칭 정상안의 맥락막혈관지수 비교

주혜준,김하경,마대중,문용석 대한안과학회 2023 대한안과학회지 Vol.64 No.1

Purpose: To compare the subfoveal choroidal vascularity indices (CVIs) of treatment-naïve patients with central retinal vein occlusion (CRVO) with controls. Methods: Twenty-one eyes of 21 treatment-naïve CRVO patients and 42 age- and sex-matched control eyes (of 42 subjects) lacking any retinal disease were included. The subfoveal CVIs were measured using ImageJ software. Results: The mean subfoveal CVI in eyes with treatment-naïve CRVO at the initial visit was significantly higher than that of control eyes (0.6464 ± 0.0326 vs. 0.6209 ± 0.0434 respectively; p = 0.024). In contrast, no significant difference in the mean subfoveal CVI was found between CRVO eyes 6 months after initial diagnosis and control eyes (0.6311 ± 0.0600 vs. 0.6209 ± 0.0434 respectively; p = 0.238). Of the 21 eyes with CRVO, 18 (85.7%) received intravitreal injections (bevacizumab, ranibizumab, aflibercept, or triamcinolone) and four (19.0%) underwent panretinal photocoagulation. Conclusions: The subfoveal CVI of eyes with treatment-naïve CRVO at the initial visit was significantly higher than that of control eyes, but decreased by 6 months. Further studies are needed to determine whether CRVO treatments such as intravitreal injection or panretinal photocoagulation affect choroid hemodynamics. 목적: 치료 경험이 없는(treatment naïve) 중심망막정맥폐쇄안과 정상안의 맥락막혈관지수(choroidal vascularity index)를 비교하고자 하였다. 대상과 방법: 21명의 치료 경험이 없는 중심망막정맥폐쇄 환자 21명의 21안과 나이 및 성별을 매칭한 정상 대조군 42명의 42안이 분석에 포함되었다. 맥락막혈관지수는 ImageJ 소프트웨어를 통해 측정하였다. 결과: 치료 경험이 없는 중심망막정맥폐쇄안의 평균 중심오목하 맥락막혈관지수는 0.6464 ± 0.0326, 정상 대조군의 중심오목하 맥락막혈관지수는 0.6209 ± 0.0434였으며 통계적으로 유의한 차이를 보였다(p=0.024). 6개월 경과 후, 중심망막정맥폐쇄안의 평균중심오목하 맥락막혈관지수는 0.6311 ± 0.0600이었으며, 정상 대조군과 유의한 차이를 보이지 않았다(p=0.238). 중심망막정맥폐쇄안 21안 중 18안(85.7%)은 유리체강내 bevacizumab, ranibizumab, aflibercept 또는 triamcinolone을 주입받았으며, 4안(19.0%)은 범망막레이저광응고술을 시행받았다. 결론: 치료 경험이 없는 중심망막정맥폐쇄안의 평균 중심오목하 맥락막혈관지수는 정상안에 비해 유의하게 높았으나, 6개월 후 감소하여 정상안과 차이를 보이지 않았다. 유리체강내 주사 또는 범망막광응고술 등의 중심망막정맥폐쇄에서의 치료가 맥락막의 혈역학적 변화에 영향을 주었는지에 대해서는 후속 연구가 필요하다.

파장가변 빛간섭단층촬영을 이용한 안구생체계측과 백내장수술 후 굴절력 예측의 비교

장미리내,이혜진,이상윤,김진영,마대중,정진호 대한안과학회 2020 대한안과학회지 Vol.61 No.8

Purpose: To compare the ocular biometry and postoperative refractive outcomes using two devices; the swept-source optical coherence tomography biometer (Argos) versus the partial coherence interferometer (IOL Master® 500, Carl Zeiss Meditec AG, Jena, Germany). Methods: The axial length (AL), anterior chamber depth (ACD) and keratometry (K) in 221 cataract eyes were measured with Argos and IOL Master® 500. One month after surgery, refraction of the respective eyes was conducted and the mean absolute error (MAE) calculated for analysis of the refractive outcomes. Results: Measurement was not possible in 13 eyes with the IOL Master® 500 but was possible with Argos. Measurement was not possible in one eye with either biometer. Agreement in measured ocular biometry between the two devices by intraclass correlation coefficient (ICC) and Bland-Altman plot (ICC AXL = 0.999, ACD = 0.975, K = 0.978) was excellent. The AL and ACD measured with Argos were significantly longer than measured with IOL Master® 500 (p = 0.005, p = 0.000). The MAE showed no significant difference between the Argos and IOL Master® 500 (p = 0.087). Conclusions: The measurement of ocular biometry was better in Argos than in IOL Master® 500. The accuracy of the intraocular lens power calculations of Argos was clinically acceptable and compatible with a conventional device. 목적: 백내장안에서 파장가변 빛간섭단층촬영기계인 Argos와 부분결합간섭기계인 IOL Master® 500의 생체계측치를 비교하고, 백내장수술 후 굴절력 예측의 정확성을 비교해보고자 한다. 대상과 방법: 백내장수술을 위한 검사를 받은 221안을 대상으로 Argos와 IOL Master® 500을 이용하여 안축장길이(axial length), 전방깊이(anterior chamber depth, ACD), 각막굴절률(K)을 측정하여 비교하였다. 수술 한 달 후 실제 굴절력과 예측굴절력을 이용한 절대굴절오차를 구하여 술 후 굴절예측의 정확도를 비교하였다. 결과: 221안 중 13안은 IOL Master® 500으로 측정이 되지 않았으나, Argos로는 생체계측이 가능하였으며, 두 장비 모두에서 측정이 불가한 경우는 1안이었다. 측정이 불가했던 14안을 제외한 207안에서 두 장비로 측정한 생체계측값들은 급내상관계수(intraclass correlation coefficient, ICC) 및 Bland-Altman plot에서 높은 일치도를 보였다(ICC AXL=0.999, ACD=0.975, K=0.978). 안축장길이 및 전방깊이는 Argos로 측정한 경우가 IOL Master® 500으로 측정한 경우보다 유의하게 길었으나(p=0.005, p=0.000) 각막굴절률은 유의한 차이가 없었다(p=0.647). 두 장비의 수술 후 굴절력 예측에 대한 절대굴절오차는 통계적으로 유의한 차이가 없었다(p=0.087). 결론: Argos는 IOL Master® 500과 생체계측값의 높은 일치도를 보이면서도 계측값의 획득률이 더 높았다. 또한 통계적으로 동등하며 우수한 수술 후 굴절예측력을 보여주었다.

안과 전공의가 시행한 유리체내 주입술의 단기간 안전성 고찰

배영환(Young Hwan Bae),김하경(Ha Kyoung Kim),배소현(So Hyun Bae),윤창기(Chang Ki Yoon),마대중(Dae Joong Ma) 대한안과학회 2021 대한안과학회지 Vol.62 No.11

목적: 안과 전공의가 시행한 유리체내 주입술의 단기 안정성을 확인해보고자 한다. 대상과 방법: 2018년 1월부터 2020년 10월까지 본원에서 안과 전공의 및 망막 전문의에게 베바시주맙, 라니비주맙, 애플리버셉트 및 트리암시놀론 아세토나이드 유리체내 주입술을 처음으로 시행 받은 503명의 503안의 의무기록을 후향적으로 분석하였다. 결과: 총 503안 중 안과 전공의가 211안(전공의군), 망막 전문의가 292안(망막 전문의군)에 유리체내 주입술을 시행하였다. 두 군 간의 주사 전 임상양상의 차이는 원인 질환의 빈도를 제외하고 관찰되지 않았다. 안압상승은 전공의군에서 2안(0.95%), 망막 전문의군에서 5안(1.71%) 발생하였으나, 두 군 간의 유의한 차이는 없었다. 결막하 출혈은 전공의군에서 29안(13.74%), 망막 전문의군에서 32안(10.96%) 발생하였으나, 두 군 간의 유의한 차이는 없었다. 비감염성 안내염은 전공의군에서는 발생하지 않았고, 망막 전문의군에서 2안(0.68%) 발생하였으나, 두 군 간의 유의한 차이는 없었다. 감염성 안내염은 전공의군에서 2안(0.95%), 망막 전문의군에서 1안(0.34%) 발생하였으나, 두 군 간의 유의한 차이는 없었다. 두 군 모두에서 각막미란, 외상성 수정체 손상, 유리체출혈, 망막열공 및망막박리는 발생하지 않았다. 결론: 단기간의 안구 합병증의 발생 빈도를 평가하였을 때, 안과 전공의가 유리체내 주입술을 시행하여도 안전할 것으로 생각된다. Purpose: This study evaluated the short-term safety of resident-performed intravitreal injections. Methods: We retrospectively reviewed the medical records of 503 patients (503 eyes) treated for the first time in our hospital from January 2018 to October 2020 via intravitreal bevacizumab, ranibizumab, aflibercept, or triamcinolone acetonide injections by residents or retina specialists. In terms of short-term ophthalmic complications, patients were followed-up 1 day, 1 week, and 1 month after injection. Results: A total of 503 eyes of 503 patients were included. Intravitreal injections were given to 211 and 292 eyes by residents (the resident group) and retina specialists (the retina specialist group), respectively. There were no between-group differences in baseline characteristics except in terms of the indications for injection. Intraocular pressure elevation >5 mmHg occurred in two eyes (0.95%) in the resident group and five (1.71%) in the retina specialist group, but the difference was not statistically significant. Subconjunctival hemorrhage occurred in 29 eyes (13.74%) of the resident group and 32 eyes (10.96%) of the retina specialist group; again, the difference was not statistically significant. No case of noninfectious endophthalmitis occurred in the resident group but two (0.68%) cases occurred in the retina specialist group; again, the difference was not significant. There were two (0.95%) cases of infectious endophthalmitis in the resident group and one (0.34%) case in the retina specialist group; again, the difference was not significant. No corneal erosion, traumatic lens damage, vitreous hemorrhage, or retinal tearing or detachment were noted in either group. Conclusions: Resident-performed intravitreal injections appear to be safe.