비구면 일체형 인공수정체 삽입 후 동공 크기가 시력에 미치는 영향

한진우,한경은,안지민,정세환,이형근,서경률,김응권,김태임,Jinu Han,Kyung Eun Han,Ji Min Ahn,Se Hwan Jeong,Hyung Keun Lee,Kyoung Yul Seo,Eung Kweon Kim,Tae Im Kim 대한안과학회 2012 대한안과학회지 Vol.53 No.11

Purpose: To evaluate the influence of pupil size on uncorrected visual acuity and spherical aberration of the TECNIS 1-piece intraocular lens (IOL). Methods: In this study 61 eyes were implanted with a TECNIS 1-piece IOL. Pupil size was checked by standard pupil card with cobalt blue light postoperatively. Best corrected visual acuity (BCVA) and uncorrected visual acuity (UCVA) were assessed postoperatively. Total spherical aberration and high-order aberration for mesopic pupil size zone were measured. Results: There were no significant differences of spherical equivalent, age, preoperative astigmatism, BCVA between two groups, but small pupil group revealed better UCVA (p = 0.02) and lower ocular aberration than large pupil group. Conclusions: After cataract surgery, pupil size greater than 5.0 mm increases total aberration. Thus, visual acuity with small pupil after aspheric TECNIS 1-piece IOL implantation show better clinical result on uncorrected visual acuity.

안과 영역에서의 차세대 염기서열 분석

한진우(Jinu Han) 대한검안학회 2018 Annals of optometry and contact lens Vol.17 No.4

Next-generation sequencing is widely used in inherited diseases and cancer genetics fields. Next-generation sequencing technology provides accurate diagnosis in genetically heterogeneous disorders such as retinitis pigmentosa, Leber congenital amaurosis, or cone-rod dystrophy. However, the precise interpretation of variants produced by massively parallel sequencing is somewhat difficult to most of ophthalmologists, and misinterpretation of these variants lead to unwanted devastating consequences to the patients and their family. The molecular genetic findings need to be carefully evaluated in the context of the clinical findings to avoid misdiagnosis. Gene therapy trials are already in the market for specific forms of Leber congenital amaurosis. We are in the middle of exiting era of effective treatment for patients with inherited eye diseases, which was considered as incurable in the past. To success such a treatment, molecular diagnosis will become essential.

편측 상사근마비에서 상사시 각도에 따른 단일 하사근절제술의 치료 효과 및 유용성

이수경(Sukyung Lee),한진우(Jinu Han)한승한(Seung-han Han),신우범(Woo Beom Shin) 대한안과학회 2021 대한안과학회지 Vol.62 No.11

목적: 편측 상사근마비 환자에서 수술 전 상사시각에 따른 단일 하사근절제술의 유용성을 살펴본다. 대상과 방법: 편측 상사근마비 진단 하 일차적으로 단일 하사근절제술을 시행 받은 환자 99명을 수술 전 상사시각에 따라 15 prism diopters (PD) 이하(그룹 1), 16 PD 이상 20 PD 이하(그룹 2), 20 PD 초과(그룹 3)로 분류하여 수술 전후 상사시각 및 머리기울임 호전 여부를 분석하였다. 수술 성공은 잔여 상사시각이 5 PD 이하이고 과교정되지 않았을 때로 정의하였으며, 수술 전 상사시각이 5 PD 이하였을 경우 수술 후 잔여 상사시각과 머리기울임 호전이 있으며 과교정되지 않았을 때로 정의하였다. 결과: 전체 99명 중 그룹 1, 2, 3은 각각 65명, 22명, 12명이었으며, 모든 그룹에서 수술 후 상사시각의 유의한 호전을 보였다. 그룹 1에서 그룹 3으로 갈수록 상사시 교정 효과가 의미 있게 증가하였다. 머리기울임은 각 그룹의 80.3%, 95.0%, 90.9%에서 호전되었다. 각 그룹의 수술 성공률은 각각 87.7%, 77.3%, 50.0%였고, 그룹 1과 2 간에는 유의한 차이가 없었고 그룹 1과 3 사이에만 유의한 차이가 있었다. 결론: 수술 성공률과 머리기울임 호전, 과교정 등을 고려하였을 때, 수술 전 상사시각이 20 PD 이하인 편측 상사근마비 환자에서 단일 하사근절제술이 1차 수술로서 유용하다. 반면 수술 전 상사시각이 20 PD보다 큰 환자에서는 50%의 성공률을 보였으므로, 두 외안근의 동시 수술 혹은 단일 하사근절제술 시행 후 2차 수술의 필요성을 고려해야 한다. Purpose: To evaluate surgical outcome and effectiveness of inferior oblique (IO) myectomy on unilateral superior oblique palsy (SOP) as a primary treatment. Methods: This study is a retrospective review of the medical records of 99 patients who had undergone IO myectomy due to SOP as a first-line treatment. Sixty-five patients with hyperdeviation of 15 prism diopters (PD) or less were categorized into group 1, 22 patients with hyperdeviation between 16 PD to 20 PD into group 2, and 12 patients with hyperdeviation higher than 20 PD into group 3. Preoperative hyperdeviation, postoperative hyperdeviation, and improvement of head tilting were then compared between the 3 groups. Surgery was determined to be successful when the post-op residual hyperdeviation is less than 5 PD, or when the improvement of hyperdeviation and head tilting was noted, for the patients who had preoperative deviation less than 5 PD, and without hypercorrection. Results: All groups showed significant improvement of hyperdeviation, and the amount of correction was larger in group with larger preoperative hyperdeviation. 80.3%, 95.0%, and 90.9% of patients showed improvement of head tiling and success rate was 87.7%, 77.3%, and 50.0% in group 1, 2, and 3 respectively. Group 1 and 2, group 2 and 3 had no significant difference in success rate but only group 1 and 3 had significant difference. Conclusions: Considering success rate with improvement of head position, self-titrating and possibility of overcorrection, IO myectomy could be an effective option as a first-line surgical treatment for unilateral SOP with hyperdeviation of 20 PD or less. However, due to a 50% success rate in patients with hyperdeviation larger than 20 PD, a secondary operation must be considered following IO myectomy, or a two-muscle procedure must be considered as a primary treatment.

긴장 및 조절 눈모음과다 내사시 환자들에서의 사시 수술 후 결과

이민우(Minwoo Lee),한승한(Sueng-Han Han),한진우(Jinu Han) 대한안과학회 2018 대한안과학회지 Vol.59 No.5

목적: 높은 조절눈모음비(accommodative convergence per accommodation, AC/A) 눈모음과다 내사시 환자들과 낮은 조절눈모음 비를 가진 긴장 눈모음과다 내사시 환자들에서 양안 내직근 후전술(bilateral medial rectus recession)의 수술 결과를 비교하였다. 대상과 방법: 근거리 사시각이 원거리 사시각보다 10 prism diopter (PD) 이상 큰 환자들 중에서 양안 내직근 후전술을 시행한 환자들의 의무기록을 후향적으로 분석하였다. 눈모음과다 내사시 환자들 중 사시 수술을 경험한 모든 환자들의 의무 기록을 확인하였고, 긴장 눈모음과다 내사시 환자 6명과 높은 조절눈모음비(AC/A) 눈모음과다 내사시 환자 10명을 대상으로 하였다. 마지막 추적 관찰 기록에서 원거리와 근거리 주시 시 각도 편차가 10 PD 이하이며, 원거리와 근거리의 사시각이 8 PD 이하인 경우를 성공적인 수술 결과로 정의하였다. 결과: 수술 당시의 평균 연령은 긴장 눈모음과다 내사시군에서 5.9 ± 1.6세였고, 높은 조절눈모음비 눈모음과다 내사시군에서는 7.3 ± 2.9세로 관찰되었다(p=0.301). 수술 후 추적관찰기간은 긴장 눈모음과다 내사시군에서 2.7 ± 2.9년, 높은 조절눈모음비 눈모음과다 내사시군에서 4.0 ± 3.3년으로 유의미한 차이가 없었다(p=0.426). 근거리와 원거리 사시각의 차이는 모든 긴장 눈모음과다 내사시 환자(100%)에서 10 PD 이내로 줄어들었으나, 높은 조절눈모음비 눈모음과다 내사시군의 경우 10명 중 오직 6명(60%)만이 10 PD 이내로 줄어들었다. 수술의 성공률은 긴장 눈모음과다 내사시군에서 5명(83.3%), 높은 조절눈모음비 눈모음과다 내사시 환자군에서 5명(50%)으로 긴장 눈모음과다 내사시군에서 수술의 성공률이 더 높은 것을 확인하였으나, 숫자가 작아 통계적으로 유의미한 차이가 확인되지는 않았다(p=0.307, Fisher’s exact test). 긴장 눈모음과다 내사시 환자 5명에서는 증량 양안 내직근 후전술을 시행하였고 5명(100%) 모두에서 성공적인 수술 결과를 확인하였다. 결론: 긴장 눈모음과다 내사시 환자에서 양안 내직근 후전술을 시행하였을 때 6명 중 5명(83%)에서 성공적인 수술 결과를 확인하였으 며, 이는 높은 조절눈모음비 눈모음과다 내사시군에서 확인한 수술 성공률(50%)에 비해 높았다. 또한 높은 조절눈모음비 눈모음과다 내사시 환자군에서 증량 내직근 후전술을 시행할 때에 비하여 긴장 눈모음과다 내사시 환자군에서 증량 내직근 후전술을 시행할 때더욱 높은 성공률을 기대할 수 있을 것이다. <대한안과학회지 2018;59(5):465-470> Purpose: To investigate the surgical outcomes of augmented bilateral medial rectus (BMR) recession in patients with low accommodative convergence/accommodation (AC/A) ratio tonic convergence excess esotropia (ET) compared to high AC/A ratio convergence excess ET. Methods: This study included patients with esodeviation ≥10 prism diopter at near than at distance fixation who underwent BMR recession. The medical records of all esotropic patients with convergence excess who underwent strabismus surgery were reviewed. Six patients with tonic convergence excess and 10 patients with a high AC/A ratio met the study inclusion criteria. A successful outcome was defined as a near or distance angle of deviation ≤8 prism diopter and a ≤10 prism diopter difference between the two at the final recorded visit. Results: The mean age at surgery was 5.9 ± 1.6 years in the tonic convergence excess ET group and 7.3 ± 2.9 years in the high AC/A ET group (p = 0.301). The average length of the postoperative follow-up was 2.7 years (range, 0.6–8.4 years) in the tonic convergence excess ET group and 4.0 years (range, 0.6–8.4 years) in the high AC/A ET group (p = 0.426). Near-distance disparities were reduced in all patients with tonic convergence excess ET within 10 prism diopter postoperatively, but in only 6 of 10 patients in the high AC/A ET group. Five of 6 patients (83.3%) had successful outcomes in tonic convergence excess ET group; 5 of 10 patients (50%) had successful outcomes in the high AC/A ET group. Conclusions: In our series, five patients (83%) obtained successful results in the tonic convergence excess ET group compared with 50% in the high AC/A ET group. Augmented BMR recession can be safely performed in esotropic patients with tonic convergence excess. J Korean Ophthalmol Soc 2018;59(5):465-470

밀러-피셔증후군과 비커스태프 뇌줄기염의 임상적 특징

김민하(Min Ha Kim),서유리(Yuri Seo),한승한(Sueng-Han Han),한진우(Jinu Han) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.4

Purpose: To investigate the clinical characteristics of patients clinically diagnosed with anti-GQ1b antibody syndrome. Methods: From November 2005 to July 2019, we retrospectively reviewed the medical records of 52 patients diagnosed with Miller-Fisher syndrome, Bickerstaff brainstem encephalitis or anti-GQ1b antibody syndrome. Symptom including acute ophthalmoplegia, ataxia, hyporeflexia and other neurologic features were reviewed. Laboratory results including cerebrospinal fluid (CSF) analysis and anti-ganglioside antibodies were also analyzed. Results: Among 52 patients, 40 were diagnosed with classic Miller-Fisher syndrome, 3 patients were Guillain-Barré syndrome with ophthalmoparesis, 1 patient was acute ophthalmoparesis without ataxia, 2 patients were acute ataxic neuropathy, and 6 patients were diagnosis with Bickerstaff brainstem encephalitis. Thirty five patients were male (67.3%), the mean age of onset was 39.3 ± 16.7 years, and average follow-up duration was 9.6 ± 15.9 months. Forty-four patients (84.6%) showed preceding infection, and upper respiratory infection was more common than gastrointestinal infection. Forty-nine patients (94.2%) showed ophthalmoplegia, 48 patients (92.3%) showed ataxia and hyporeflexia was presented in 43/51 patients (84.3%). Other than classic symptoms, dysarthria (21/52, 40.4%), dizziness (27/52, 51.9%), and paresthesia (23/52, 44.2%) was observed. Among 48 patients who underwent CSF analysis, 11 patients (22.9%) showed albumino-cytologic dissociation. Only 12 patients (23.1%) had positive anti-ganglioside antibodies. Conclusions: Anti-GQ1b antibody syndrome is not easy to differentiate from other diseases, careful physical examination and history taking is necessary to make correct diagnosis. The recognition of accompanying symptoms and signs could facilitate early and exact diagnosis of anti-GQ1b antibody syndrome.