경도 눈꺼풀처짐 환자에서 결막뮬러근 절제술의 결과

배준성,하명숙,이지영,김성주,장재우 대한안과학회 2008 대한안과학회지 Vol.49 No.9

Purpose: To assess surgical outcomes after adjusting the amount of resection of the conjunctiva and the Müller muscle according to 10% phenylephrine test results. Methods: The charts of 32 patients (32 eyes) with mild upper eyelid ptosis were reviewed retrospectively. They all had conjunctiva-Müller muscle resections. A preoperative 10% phenylephrine test was performed to determine the resection amount of the Müller muscle and conjunctiva. An 8 mm resection was performed when phenylephrine raised the ptotic lid to the same level as that of the contralateral lid. A 7 mm resection was performed when the ptotic lid was raised to a level higher than that of the contralateral lid. A 9 mm resection was performed when the ptotic lid was raised to a level not quite to the level of the contralateral lid. Results: Of the 32 patients, 28 were female and 4 were male. The mean age of the patients was 30.8±10.2 years. Patients were followed up for an average of 40.2±36.8 days, postoperatively. Postoperative upper lid positions were exactly symmetrical in 26 of the 32 patients. Five patients showed undercorrection, and 1 patient showed overcorrection. Conclusions: Excellent results were obtained by resecting the conjunctiva and Müller muscle according to the phenylephrine reaction of a ptotic eyelid. J Korean Ophthalmol Soc 2008;49(9):1365-1370

Posterior approach technique in mild ptosis repair

Seontae Kim,Longyu Jin,Jiyoung Suh,Heebae Ahn 대한미용의학회 2018 대한미용의학회지 Vol.2 No.1

Background: The success rates of conjunctiva-Müller muscle resection vary in reports of previous studies, with 81% to 88.6% success rates having been reported in other countries. Few studies have reported on the surgical success rates of conjunctiva-Müller muscle resection in Korea compared to the number of reports on other methods of blepharoptosis repair. We therefore sought to determine the clinical efficacy and success rate of conjunctiva-Müller muscle resection in patients with mild blepharoptosis and identify the factors that affect the surgical success rate. Objective: This study was performed to evaluate of the clinical efficacy and success rate of conjunctiva-Müller muscle resection (posterior approach technique) in patients with mild blepharoptosis and to identify the factors that affect its surgical success rate. Methods: Surgeries were performed by one surgeon in 30 patients (35 eyes) and only when the marginal reflex distance 1 (MRD1) increased over 1 mm at 5 minutes after the administration of 0.25% phenylephrine eye drops. The MRD1, MRD2, Brow-pupil distance (BPD), and interpalpebral fissure (IPF) were measured pre-operatively, 1 month post-operatively, and at the final follow-up visit. Results: The mean MRD1 increased significantly from 0.83±0.96 mm pre-operatively to 2.45±0.77 mm post-operatively (p=0.012). The mean IPF also increased significantly from 5.54±2.04 mm pre-operatively to 7.62±1.85 mm post-operatively (p=0.003). The mean BPD, however, did not change significantly (22.94±4.96 mm pre-operatively and 23.19±5.72 mm post-operatively, p=0.863). The post-operative MRD1 for the eye with blepharoptosis was less than 1 mm compared to that for the opposite eye. Conclusion: Conjunctiva-Müller muscle resection is a safe and effective surgical method in patients with mild or moderate blepharoptosis with good levator palpebrae muscle function in which the post-operative results can be predicted on the basis of the amount of muscle resection.

결막에서 발생한 평활근육종 1예

윤상철,이종혁,백혜정,Sang Chul Yoon,Jong Hyeok Lee,Hye Jung Paik 대한안과학회 2006 대한안과학회지 Vol.47 No.7

Purpose: We describe a very rare the leiomyosarcoma that developed in the conjunctiva. Methods: A 59-year-old man was treated at another hospital two months before presenting to our institution. He had not gotten any better and so was admitted to our hospital. He had normal visual acuity and intraocular pressure. However, we found a geographic, highly vascularized mass involving the corneal limbus in the medial bulbar conjunctiva, from which a pterygium had been removed a year previously. An excision of the mass was carried out to detect a suspected conjunctival intraepithelial neoplasm. Results: Tissue obtained from operation had cells with thin nuclei, spindle cells with pleomorphic cigar-shaped nuclei and eosinophilic cytoplasm, atypical cells, and from four to five mitotic figures under ten high power field. In immunohistochemical staining, Vimentin, Smooth muscle actin (SMA), Desmin, CD68 stained positively and cytokeratin, Cam5.2, S-100, HMB-45, CD 34 stained negatively. We found no clues of other origins from the general physical examination. Considering these factors, we conclude that this was a Stage I, G2T1aN0M0 leiomyosarcoma with moderate differentiation. Conclusions: Analysis by immunohistochemical staining is necessary to detect leiomyosarcoma in the conjunctiva, as it is very rare and hard to diagnose by the histologic method alone. We report a leiomyosarcoma of the conjunctiva after pterygium excision, and suggest that it be considered a differential diagnosis of conjunctival masses, even though it is very rare.

결막 뮬러근 절제술의 임상 결과와 수술 성공에 미치는 요인

박대일,하성우,유혜린,Dae Il Park,Sung Woo Ha,Helen Lew 대한안과학회 2011 대한안과학회지 Vol.52 No.11

Purpose: To investigate clinical outcomes and to analyze the factors of successful treatment of conjunctiva-Müller muscle resection (CMMR) in patients with mild to moderate ptosis. Methods: The medical records of 22 patients (30 eyes) with upper lid ptosis were retrospectively reviewed. All patients underwent conjunctiva-Müller muscle resections, and four patients (seven eyes) underwent concurrent upper lid blepharoplasty. The mean follow-up period was 81.62 ± 21 days. Pre- and post-operative MRD1, IPF and pupil to brow distance were measured using the Image J program. A preoperative phenylephrine test and a pathologic examination were performed to analyze the presence of Müller’s muscle and the tear secreting glands from the CMMR specimens. Results: The overall success rate of the procedure was 93%. Postoperatively, the MRD1 increased on average by 1.47 mm (p = 0.00) and increased by an average of 1.72 mm when the phenylephrine test response was greater than 2 mm and by 0.99 mm when the response less than 2 mm. The Müller muscle was observed in every specimen. Conclusions: Conjunctiva-Müller muscle resection is an effective and safe method for treating mild to moderate ptosis, for which the preoperative phenylephrine test result is the most important factor for surgical success. J Korean Ophthalmol Soc 2011;52(11):1263-1268

眼瞼結膜 刺絡療法(棘鍼療法)을 시술한 中風 환자의 眼昏 치험 4例

옥민근,임웅경,윤형선,선영재,문장혁,김창환,Ock, Min-keun,Lim, Woong-kyoung,Yoon, Hyoung-seon,Sun, Young-jae,Moon, Jang-hyuk,Kim, Chang-hwan 대한한방안이비인후피부과학회 2004 한방안이비인후피부과학회지 Vol.17 No.3

Objective: This study was performed to evaluate the effects of venesection on palpebral conjunctiva, on the stoke patients complaint of defective vision. Methods: We studied four selected stroke patients with defective vision which start with stroke. Venesection was performed with syringe needleonce or several times on upper or lower palpebral conjunctiva. After every venesection we washed the eye(s) with normal saline. We evaluated the effects by VAS. Results & conclusion: Venesection on palpebral conjunctiva was efficacious against defective vision occured on the stoke patients. But more clinical & scienific trials are expected to follow this study.

젊은 남성에서 단안 눈꺼풀 부종을 동반한 일차 국소아밀로이드증

신혜은,서유정,정지원 대한안과학회 2023 대한안과학회지 Vol.64 No.9

Purpose: We report a young patient with unilateral eyelid swelling secondary to local, palpebral conjunctival amyloidosis. Case summary: A 31-year-old male was referred with a 6-month history of mild, right upper eyelid swelling but without redness or tenderness. Slit-lamp examination revealed a diffuse hemorrhagic papilliform lesion on the right upper palpebral conjunctiva, this raised a suspicion of giant papillary conjunctivitis. As the lesion was unilateral, there was no history of allergic disease or contact lens use, and the lesion was refractory to topical anti-inflammatory treatment so, excisional biopsy of the right upper palpebral conjunctiva was performed. During the operation, the papilliform lesion was removed, it peeled off on the blade. After surgery, the eyelid swelling improved. Histopathological examination revealed an eosinophilic amorphous deposit consistent with amyloidosis. Further evaluation ruled out systemic amyloidosis; there were no abnormal findings. Thus, we diagnosed primary localized amyloidosis of the palpebral conjunctiva. At the 1-year follow-up, no recurrence was detected. Conclusions: Although primary localized amyloidosis of the palpebral conjunctiva is rare, this should be considered if chronic eyelid swelling accompanied by another conjunctival lesion such as giant papillary conjunctivitis is encountered.

최루가스(o-Chlorobenzylidene Malononitrile)가 흰쥐의 각막과 결막에 미치는 영향

이군자 서울보건대학 1995 서울보건대학 부설 한국보건과학연구소 논문집 Vol.2 No.1

Two groups of rats were exposed to the o-chlorobenzylidine malononitrile(CS) being used in the control of riots, and sacrificed to examine histological and histochemical changes of the cornea and conjunctiva. 1. In animals exposed to the CS gas (50mg/min./㎥) for 20min., reversible histological changes were observed in the cornea. Epithelial and endothelial Na,^(+) K^(+) -ATPase activity were reduced, wing cells of the epithelium were transformed to the squamous shape and mitotic activity occurred actively in the basal layer. 2. In animals exposed repeatedly to the CS gas (50mg/min./㎥) for 20min. once a day for 10 days, Na^(+), K^(+)-ATPase, Mg^(2+)-ATPase and alkaline phosphatase activities of the corneal epithelium and endothelium were reduced. And there was epithelial shrinkage, irregular basement membrane and irregularly arranged collagen fibers were also observed in the stroma. 3. In animals exposed to the CS gas (50mg/min./㎥) for 20min., reversible histological changes were observed in the conjunctiva. Mucin secreting activity of the goblet cells was reduced and lymphocytes, eosinophils were infiltrated. 4. In animals exposed repeatedly to the CS gas (50mg/min./㎥) for 20min. once a day for 10 days, irreversible changes were observed. Desquamation with oedema and shrinkage of the epithelial cells, and loss of some basement membrane were observed. Mucin secreting activity of the goblet cells was reduced and lymphocytes, eosinophils were infiltrated significantly. As a result when eyes are temporally exposed to the CS gas reversible degenerative changes, desquamation with oedema of the epithelium and infiltration are produced. And when eyes are repeatedly exposed to the CS gas histopathologic changes such as desquamation with oedema of the epithelium, infiltration, and reduced mucin secreting activity are occurred.

Distribution of Interleukin-22–secreting Immune Cells in Conjunctival Associated Lymphoid Tissue

윤창호,이대승,정현정,류진석,김미금 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.2

Interleukin (IL)-22 is a cytokine involved in epithelial cell regeneration. Currently, no research studieshave analyzed the distribution of the three distinct IL-22–secreting cell populations in human or mouse conjunctiva. This study investigated the distribution of the three main populations of IL-22–secreting immune cells, αβ Thcells, γδ T cells, or innate cells (innate lymphoid cells [ILCs] or natural killer cells), in conjunctival associated lymphoidtissues (CALTs) in human and mouse models. Methods: We collected discarded cadaveric bulbar conjunctival tissue specimens after preservation of the corneo-limbal tissue for keratoplasty from four enucleated eyes of the domestic donor. The bulbar conjunctivatissue, including the cornea from normal (n = 27) or abraded (n = 4) B6 mice, were excised and pooled in RPMI1640 media. After the lymphoid cells were gated in forward and side scattering, the αβ Th cells, γδ T cells, orinnate lymphoid cells were positively or negatively gated using anti-CD3, anti-γδ TCR, and anti–IL-22 antibodies,with a FACSCanto flow cytometer. Results: In normal human conjunctiva, the percentage and number of cells were highest in αβ Th cells, followed byγδ T cells and CD3– γδ TCR – IL-22+ innate cells (presumed ILCs, pILCs) (Kruskal-Wallis test, p = 0.012). In normalmice keratoconjunctiva, the percentage and total number were highest in γδ T cells, followed by αβ Th cellsand pILCs (Kruskal-Wallis test, p = 0.0004); in corneal abraded mice, the population of αβ Th cells and pILCstended to increase. Conclusions: This study suggests that three distinctive populations of IL-22–secreting immune cells are presentin CALTs of both humans and mice, and the proportions of IL-22+αβ Th cells, γδ T cells, and pILCs in CALTs inhumans might be differently distributed from those in normal mice.

결막에 국한된 점막연관 림프조직형 림프종에서 냉동요법을 이용한 치료 2예

장우석,박재복,김숙영,김근해,Woo-Seok Chang,Jae-Bok Park,Sook-Young Kim,Keun-Hae Kim 대한안과학회 2008 대한안과학회지 Vol.49 No.7

Purpose: To report two cases of conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas treated with cryotherapy. Case summary: Two patients with MALT lymphoma of the conjunctiva were treated by carbon dioxide cryotherapy under topical anesthesia using 0.5% proparacaine hydrochloride (Alcaine®, Alcon). Cryotherapy was repeated in recurrent lesions up to three times. One patient was free of the tumor for 18 months of follow-up after the third cryotherapy was performed. The second patient had complete disease arrest for 9 months after the third cryotherapy. Neither patient experienced complications during the follow-up period. Conclusions: Cryotherapy is a comparatively easy treatment tool with fewer complications for patients, making it preferable from a patient’s perspective as well. Cryotherapy may be a useful treatment modality in patients with MALT lymphomas localized to the conjunctiva. J Korean Ophthalmol Soc 49(7):1165-1172, 2008

결막에 발생한 원발성 비호지킨 림프종 1례

문규,김동민,김현리,이기주,이봉규,이만재,김태원,이영미,정춘해 朝鮮大學校 附設 醫學硏究所 1997 The Medical Journal of Chosun University Vol.22 No.1

Primary conjunctival Non-Hodgkin's lymphoma is a very rare lymphoma. A 36-yera-old woman presented with an indolent salmon-colored tumor of the left lower eyelid conjunctiva. Histologically, we found a small lymphocytic infiltrate in the subepithelium consist of uniform component. An immunohistological study demonstrated B cell lineage. A comprehensive investigation, in particulary an orbital CT scan did not demonstrate any other localization of this lymphoma. She was treated with chemotherapy (CHOP) and Radiotherapy. Here in we report a case of primary Non-Hodgkin's lymphoma on the conjuctinva with literature review.