원추각막에서 각막내 링(KeraRing#174;) 삽입술의 임상성적

최성욱,최우석,허준,Sung Wook Choi,MD,Woo Seok Choae,MD,Jun Her,MD 대한안과학회 2011 대한안과학회지 Vol.52 No.3

Purpose: To report the outcomes after the implantation of intrastromal corneal ring segments (KeraRing<sup>®) by manual tunnel creation for the correction of keratoconus. Methods: The present retrospective case series was comprised of 12 eyes of 11 consecutive keratoconic patients. Intrastromal corneal ring segments (KeraRing<sup>®) were implanted for keratoconus correction after manual tunnel creation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refractive outcome, and complete ophthalmologic examinations were performed before and after surgery at 1 day, 1 week, 3 months, and 6 months. Corneal topography was measured before surgery, 6 months after surgery and during any necessary follow-up visits. Results: Intrastromal corneal ring segments (KeraRing<sup>®) implantation significantly increased BCVA from logMAR 0.47 ± 0.19 to logMAR 0.28 ± 0.17 (p < 0.05) and decreased the spherical equivalent from -6.03 ± 3.24 D to -2.24 ± 1.96 D. The simulated keratometric value in the Orbscan IIz significantly decreased in K maximum from 50.7 ± 2.93D to 47.65 ± 3.15 D and in K minimum from 47.65 ± 3.15 D to 44.92 ± 2.80 D. Conclusions: Intrastromal corneal ring segments implantation (KeraRing<sup>®) by manual tunnel creation appears to be effective in improving BCVA and reducing corneal astigmatism and keratometric value in keratoconic patients. KeraRing<sup>® may delay or prevent the need for a corneal graft, and reduce the contact lens intolerance. J Korean Ophthalmol Soc 2011;52(3):277-284

연령관련황반변성에서 유리체강내 혈관내피성장인자억제제 주입술 후 망막색소상피파열의 위험인자

최우석,박재홍,이우석,김상원,윤희성,Woo Seok Choae,Jae Hong Park,Woo Seok Lee,Sang Won Kim,Hee Seong Yoon 대한안과학회 2013 대한안과학회지 Vol.54 No.10

Purpose: Intravitreal anti-vascular endothelial growth factor (VEGF) treatment has become an important part in the treatment of neovascular age-related macular degeneration (AMD). In the present study we describe the clinical feature of retinal pigment epithelium (RPE) tears after intravitreal injection of anti-VEGF agent and compared the tear group to the control group. Methods: In this retrospective case series, data of 11 patients with eyes that developed RPE tears after intravitreal anti- VEGF injection (8 ranibizumab and 3 bevacizumab) were collected and analyzed. The tear group included 11 patients with eyes that developed RPE tears and the control group included 22 patients with no RPE tears after treatment. We investigated age, gender, bilaterality, duration from injection to tear, pigment epithelial detachment (PED) height and diameter, along with central retinal thickness (CMT) using optical coherence tomography (OCT), fluorescein angiography (FAG), and visual acuities before and after treatment. Results: The mean age of the tear group was 81.36 ± 5.55 years which was significantly different from the control group’s mean age of 74.82 ± 5.28 years (p = 0.003). OCT findings showed PED greatest linear dimension (GLD) was 2978.45 ± 947.69 μm in the tear group and 2250.23 ± 988.49 μm in the control group (p = 0.027). PED height was 507.09 ± 153.97 μm in the tear group and 353.23 ± 199.42 μm in the control group (p = 0.010). CMT was 431.64 ± 200.33 μm in the tear group and 289.95 ± 61.27 μm in the control group (p = 0.005). There was no significant difference between groups according to gender, bilaterality, visual acuities, and subretinal fluid based on OCT and FAG findings. In the tear group, visual acuities before and after the tear were not significantly different. Conclusions: Old age and eyes with high and wide PED appear to be more vulnerable to RPE tear. Further investigation with a larger number of patients is needed to further confirm these results.

연령관련황반변성의 혈관내피성장인자억제제 주사치료 후 발생한 망막색소상피파열의 장기 경과관찰

박재홍,최우석,윤희성,Jae Hong Park,Woo Seok Choae,Hee Seong Yoon 대한안과학회 2014 대한안과학회지 Vol.55 No.9

Purpose: To evaluate the long-term clinical outcomes of retinal pigment epithelium (RPE) tears after intravitreal injection of anti- vascular endothelial growth factor (VEGF) agent for the treatment of neovascular age-related macular degeneration (AMD). Methods: The authors performed a retrospective chart review of 13 eyes of 13 patients who developed RPE tears after intravitreal anti-VEGF injection between February 2009 and June 2013. We investigated continuation of the treatment after tear, visual acuity, presence of cystoid macular edema, and central macular thickness (CMT) using optical coherence tomography (OCT) before and after treatment and visual outcomes depending on foveal sparing. Results: After RPE tear, 12 of 13 patients continued injection of an anti-VEGF agent. The average number of injections was 6.08 ± 5.18. Mean visual acuity immediately after tear was 1.65 ± 0.8 log MAR, and that at the last visit was 1.82 ± 0.88 log MAR. Nine eyes with macular edema in OCT continued receiving injection, and improvement of macular edema was observed in four eyes at the final visit. The final visual acuity of patients with foveal involvement was 2.17 ± 0.49 log MAR, which was worse than the 1.51 ± 1.06 log MAR in patients without foveal involvement, although the difference was not significant (<em>p</em> = 0.295). Conclusions: When anti-VEGF injections were continued after RPE tear, no improvement in visual acuity was observed, although better anatomical outcomes did result. Patients with foveal involvement had worse visual acuity than patients without foveal involvement, but the difference was not significant. J Korean Ophthalmol Soc 2014;55(9):1340-1346

결절맥락막혈관병증에서 유리체강내 애플리버셉트 주입술의 단기 효과

양 헌(Heon Yang),전혜민(Hye Min Jeon),김상원(Sang Won Kim),윤희성(Hee Seong Yoon),최우석(Woo Seok Choae) 대한안과학회 2015 대한안과학회지 Vol.56 No.11

목적: 이전에 치료한 적 없는 결절맥락막혈관병증(polypoidal choroidal vasculopathy, PCV) 환자에 유리체강내 aflibercept (Eylea??;Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA and Bayer, Basel, Switzerland)를 주입한 후 단기간 시력 및 망막의 해부학 적 구조에 미치는 변화를 확인하고자 하였다. 대상과 방법: 2014년 5월부터 9월 사이에 본원에서 PCV로 진단 받고 aflibercept 주입술을 받은 환자 중 과거 치료 받은 적 없었던 16명 16안에 대해 의무기록을 후향적으로 분석하였다. Aflibercept 주입술 전과 후 1, 2, 3개월째 최대교정시력 및 빛간섭단층촬영 (optical coherence tomography, OCT) 상 소견과 3개월째 인도시아닌그린혈관조영술(indocyanine green angiography, ICGA) 상 변화를 관찰하였다. 결과: 최대교정시력(logarithm of the minimum angle of resolution, logMAR)은 치료 전 0.75 ± 0.60에서 치료 후 1, 2, 3개월에 0.74 ± 0.64, 0.71 ± 0.63, 0.57 ± 0.53으로 점차 호전되는 양상을 보였고, 3개월째에 유의한 시력 상승을 보였다( p<0.05). OCT 상 중심와두께는 치료 전 379 ± 130 μm에서 치료 후 281 ± 92, 247 ± 54, 232 ± 51 μm로 유의하게 감소되었다 (p<0.05). OCT 상 망막색소상피박리 완전 관해율은 치료 후 43, 55, 50%, 망막하액은 67, 83, 92%, 망막내액은 33, 60, 60%였다. ICGA상 결절은 치료 후 3개월에 86%에서 감소되었다. 결론: PCV에서 aflibercept 주입술은 단기간 형태학적 개선을 유도하는 효과적이고 안전한 방법으로 보인다. 최대교정시력은 해부학 적 지표들의 호전소견에 비하여 술 후 2개월까지 의의 있는 차이가 보이지 않았으나, 3개월째에는 유의한 상승을 보였다. Purpose: To evaluate the short-term effect of intravitreal aflibercept (Eylea ?? ; Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA and Bayer, Basel, Switzerland) on the visual outcomes and retinal anatomic changes of patients with polypoidal choroidal vasculopathy (PCV). Methods: Intravitreal Eylea ?? was injected into 16 eyes of 16 patients with PCV in this retrospective case study. After therapy, the patients were followed up for over 3 months. Changes in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) using optical coherence tomography (OCT) and abnormal vasculature on indocyanine green angiography (ICGA) were evaluated. Results: The mean log MAR BCVA was 0.75 ± 0.60 at baseline, 0.74 ± 0.60 and 0.71 ± 0.63 at 1 and 2 months, respectively (p > 0.05) and 0.57 ± 0.53 at 3 months (p < 0.05) after treatment. The mean CFT was 379 ± 130 μm at baseline, 281 ± 92 μm, 247 ± 54 μm, and 231 ± 51 μm at 1, 2, and 3 months, respectively, after treatment (p < 0.05). Complete resolution was 43%, 55%, and 50% at 1, 2, and 3 months, respectively in pigment epithelial detachment (PED), 67%, 83%, and 92% at 1, 2, and 3 months, re-spectively in subretinal fluid (SRF) and 33%, 60%, and 60% at 1, 2, and 3 months, respectively in intraretinal fluid (IRF) using OCT. The polypoidal lesions in ICGA decreased in 12 of 14 eyes (86%). Conclusions: Intravitreal injection of Eylea ?? with PCV reduced CFT due to decreased retinal PED, SRF, IRF and occluded effec-