EMLA cream induced bilateral corneal de-epithelization

Hong Nien Lee,Fazliana Ismail,Visvaraja Subrayan 대한미용의학회 2020 대한미용의학회지 Vol.4 No.2

EMLA cream is widely used in dermatological procedures and is frequently applied prior to cosmetic procedures. Limited restriction of use among the personnel who handle the patients or customers. The exposure of EMLA cream to the cornea can have profound effects; it poses the risks of eye infections, reduced vision, discomfort, and pain. The aim of this study was to increase the awareness of the side effects of EMLA cream application near the eyes. EMLA, being an alkaline cream, causes corneal injury rapidly; hence, precautions should be taken during its use. EMLA cream is easily accessible and widely used in the cosmetic industry. Its use near the eye region requires extra caution. Patients experiencing difficulty in opening the eyes and discomfort after application of EMLA cream near the eyes should not be ignored. It is important to avoid EMLA cream entering into the eyes during its applications on the eyelids. De-epithelized cornea is more prone to infection, subsequently resulting in scarring and permanent reduction in vision.

감염공막염의 임상양상과 치료 결과

박미화,유웅선,김현아,정인영,서성욱,김성재 대한안과학회 2019 대한안과학회지 Vol.60 No.6

목적: 감염공막염의 위험인자, 임상양상, 원인균 및 치료 경과와 시력 예후에 대해서 보고하고자 한다. 대상과 방법: 2011년 1월부터 2018년 12월까지 본원 안과에서 입원 치료를 받은 감염공막염환자 중에서 3개월 이상 경과관찰이 가능하였던 20명을 대상으로 의무기록을 후향적으로 분석하였다. 감염공막염의 위험인자, 임상양상, 동정된 원인균, 치료 경과와 예후 등을 조사하였다. 결과: 환자들의 평균 나이는 69.2 ± 8.4세였고, 평균 입원 기간은 11.3 ± 5.8일이었으며, 증상이 나타나고 입원하기까지의 시간은 16.8 ± 13.9일, 그리고 평균 경과관찰기간은 23.3 ± 25.4개월이었다. 모든 환자들은 익상편수술의 과거력이 있었으며, 배양검사 결과 양성이 나온 환자는 18명(90%)이었고, Pseudomonas aeruginosa가 12명에서 동정되었다. 입원 당시에 수술을 시행한 경우는 18명(90%)이었고, 입원에서 수술을 시행하기까지의 시간은 평균 4.1 ± 4.4일이 걸렸다. 결론: 감염공막염의 위험인자로는 익상편수술의 과거력이 있었으며, 대개가 녹농균의 감염에 의해 발생하였다. 정확한 원인균을 파악하고 그에 따른 적절한 항생제 치료와 수술적 치료를 병행하는 것이 시력 예후를 향상시킬 수 있는 방법으로 생각된다. Purpose: To investigate risk factors, clinical features, pathogenic organisms, and outcomes in patients with infectious scleritis. Methods: This study was a retrospective review of 20 patients with infectious scleritis who were admitted from January 2011 to December 2018 in a single tertiary hospital, with at least 3 months of follow-up. We analyzed age, risk factors, clinical manifestations, pathogenic organisms, treatment, and outcomes of infectious scleritis. Results: The mean patient age was 69.2 ± 8.4 years and the mean duration of hospitalization was 11.3 ± 5.8 days. Furthermore, the mean duration of symptoms before presentation was 16.8 ± 13.9 days; patients were followed for a mean duration of 23.3 ± 25.4 months. All patients had prior pterygium surgery. Eighteen patients (90%) were culture-positive and Pseudomonas aeruginosa (P. aeruginosa) was identified in 12 eyes. In the acute stages, adjuvant surgical intervention was performed for 18 patients (90%) for these patients, the mean duration of hospitalization before surgery was 4.1 ± 4.4 days. Conclusions: The most common risk factor and pathogenic organism for infectious scleritis were prior pterygium surgery and P. aeruginosa, respectively. Identification of specific causative organisms and corresponding antibiotic treatment with adjuvant surgical intervention may improve visual prognosis in patients with infectious scleritis.

안과진료에서 COVID-19의 감염 위험과 예방

김재영 대한의사협회 2021 대한의사협회지 Vol.64 No.1

The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in China in December 2019. Recent reports have confirmed that SARS-CoV-2 is primarily transmitted through secretions of the respiratory tract; however, it remains controversial whether or not COVID-19 affects the eye. This study presents a review of current evidence related to ocular transmission of SARS-CoV-2 for gaining a better understanding of the ocular manifestations of patients with COVID-19. The study also summarizes appropriate measures to be taken to protect healthcare providers in the ophthalmology department from being exposed to infected tears or conjunctival secretions. Some studies reported that SARS-CoV-2 can be transmitted through infected tears and conjunctival secretions of patients with COVID-19. Ocular manifestations such as injection, increased discharge, or epiphora, which are consistent with those of viral conjunctivitis, are more commonly reported. Therefore, during the ongoing COVID-19 pandemic, personnel working in the ophthalmology department should be provided with adequate and appropriate personal protection equipment. The exact mechanism and pathophysiology of ocular transmission of SARS-CoV-2 remain unclear, thus warranting further studies.

Long-term Outcomes of Surgeries for Retinal Detachment Secondary to Parasitic or Viral Infectious Retinitis

Hyunjean Jung,Junwon Lee,Christopher Seungkyu Lee,Min Kim,Sung Soo Kim,Suk Ho Byeon,Jay Jiyong Kwak 대한안과학회 2024 Korean Journal of Ophthalmology Vol.38 No.3

or parasitic infectious retinitis. Methods: A total of 47 eyes that received pars plana vitrectomy with or without scleral buckling due to RD secondary to polymerase chain reaction-proven viral (cytomegalovirus, varicella zoster virus, and herpes zoster virus) or parasitic (toxoplasma and toxocara) retinitis from October 1, 2006, to June 30, 2023, in a single medical center were retrospectively enrolled. Results: Mean follow-up period was 59.03 ± 55.24 months in viral retinitis and 34.80 ± 33.78 months in parasitic retinitis after primary reattachment surgery. During follow-up, nine eyes (24.3%) with viral retinitis and five eyes (50.0%) with parasitic retinitis developed retinal redetachment. Visual acuity success at final follow-up was achieved in 19 eyes (51.4%) with viral retinitis and six eyes (60.0%) with parasitic retinitis (p = 0.64). The incidence of retinal redetachment during the 1st postoperative year was significantly higher in parasitic retinitis compared with viral retinitis (crude incidence, 0.21 vs. 0.85; p = 0.02). Hazard ratio analysis adjusted for age and sex showed 4.58-fold (95% confidence interval, 1.22–17.27; p = 0.03) increased risk of retinal redetachment in parasitic retinitis compared with viral retinitis during the 1st postoperative year. Tamponade with silicone oil and preoperative diagnostic vitrectomy were associated with significantly decreased risk of retinal redetachment in patients with parasitic retinitis. Conclusions: Compared with RD secondary to viral retinitis, RD secondary to parasitic retinitis showed higher incidence of retinal redetachment during the 1st postoperative year. Tamponade with silicone oil and preoperative diagnostic vitrectomy were associated with significantly decreased risk of retinal redetachment in patients with parasitic retinitis.

Delayed intraorbital infection after craniofacial bone surgery

Jung, Joo Sung,Lim, Nam Kyu,Kang, Dong Hee Korean Cleft Palate-Craniofacial Association 2019 Archives of Craniofacial Surgery Vol.20 No.5

Intraorbital infection shows a low incidence, but it might cause blindness or even death. This case is unusual in that its origin from a craniofacial bone fracture prior to infection of the maxillary sinus. A 33-year-old female patient was referred for right cheek swelling. When she visited the emergency room, we removed right cheek hematoma and bacterial examination was done. In the past, she had craniofacial bone surgical history due to a traffic accident 6 years ago. Next day, the swelling had remained with proptosis and pus was recognized in the conjunctiva. We planned an emergency operation and removed the pus which was already spread inside the orbit. And the evaluation for sinusitis was consulted to the otorhinolaryngology department simultaneously. There were Prevotella oralis and methicillin-resistant Staphylococcus epidermidis bacterial infection in the intraorbital and sinus respectively. Afterwards, the vigorous dressing was done for over a month with intravenous antibiotics. Though the intraorbital infection was resolved, blindness and extraocular movement limitation were inevitable. In conclusion, close follow up of the maxillary sinus in facial bone fracture patients is important and aggressive treatment is needed when an infection is diagnosed.

백내장수술 후 발생한 비전형적 임상양상의 스트렙토코커스 디스갈락티아 안내염 2예

유웅선,강현지,정지성,신민호,정인영 대한안과학회 2019 대한안과학회지 Vol.60 No.3

Purpose: To report two cases of postoperative endophthalmitis caused by Streptococcus dysgalactiae subspecies equisimilis (SDSE), which appeared as hyperacute presentation and panophthalmitis. Case summary: A 68-year-old male was treated with cataract surgery and was evaluated the next day (less than 24 hours after surgery) because of acute loss of vision. There was severe inflammation and the visual acuity was light perception. The patient underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. The vitreous culture revealed SDSE. After PPV, regression of inflammation was observed, although the corneal edema had progressed. The cornea evolved to decompensate due to bullous keratopathy and visual acuity of the eye decreased to no light perception after 3 months. A 87-year-old male who underwent phacoemulsification and intraocular lens implantation 2 days previously was hospitalized due to severe ocular pain and visual loss. There was severe inflammation, and the visual acuity was no light perception. The patient received only intravitreal injections of antibiotics due to severe corneal necrosis. The aqueous humor revealed SDSE. Four days after intravitreal injection, erythema and swelling of the eyelid of the affected eye was observed, and diagnosed as panophthalmitis. After treatment with intravenous antibiotics, cellulitis of the eyelid was resolved. The eye progressed as phthisis after 3 months without recurrence. Conclusions: Postoperative SDSE endophthalmitis showed aggressive and hyperacute presentation, resulting in blindness despite prompt treatment. SDSE is an emerging organism and should be considered a potential cause of postoperative endophthalmitis. 목적: 백내장수술 후 Streptococcus dysgalactiae subspecies equisimilis (SDSE)에 의한 안내염으로 초급성 발현과 전안구염의 비전형적 증상을 보인 2예를 보고하고자 한다. 증례요약: 68세 환자가 백내장수술 후 24시간 이내에 발생한 시력저하로 내원하였으며, 시력은 광각 상태였으며 안구 내 심한 염증 소견으로 유리체절제술과 유리체내 항생제 주사를 시행하였다. SDSE가 동정되었으며 수술 후 염증은 호전되었으나 각막부종은 지속되었고 술 후 3개월째 수포각막병증과 안구위축으로 진행하였다. 87세 환자가 2일 전 백내장수술 후 시력저하와 안구통증으로 내원하였다. 내원 시 시력은 광각무 상태로 안구 내 심한 염증 소견과 각막궤사로 유리체내 항생제 주사만 시행하였다. SDSE가 동정되었고 술 후 4일째 전안구염 소견이 관찰되어 항생제 정맥주사 후 호전되었으나 술 후 3개월째 안구위축으로 진행하였다. 결론: 수술 후 발생한 SDSE 안내염은 초급성의 양상을 보이며 즉각적인 치료에도 호전되지 않아 실명으로 진행되기도 한다. SDSE는 최근 발견이 증가되는 추세로 수술 후 발생한 안내염에서 원인균으로 반드시 고려해야 할 것이다.

Primary Skin and Eye Irritation Study of Combined Vaccine (KGCC-95VI) Against Japanese Encephalitis and Hantaan Virus Infection

Shin, Kwang-Soon,Kim, Chul-Joong,Yun, Hyo-In,Park, Jong-Il,Cha, Shin-Woo,Shin, Hyeong-Soon Korean Society of ToxicologyKorea Environmental Mu 1997 Toxicological Research Vol.13 No.1

The primary skin and eye irritancy of the combined vaccine (KGCC-95VI) for the prophylaxis against Japanese encephalitis and Hantaan virus infection recently developed by Korea Green Cross Corporation was investigated. The KGCC-95VI was applied to the back skins of the New Zealand White rabbits. The rabbits were observed for 72 hours and did not exhibit erythema, eschar and edema. The eyes of the rabbits were exposed to the KGCC-95VI. The rabbits were observed for 7 days and did not exhibit any ocular findings on cornea, iris and conjuntivae. The KGCC-95VI is considered not to have the primary skin and eye toxicity in rabbits.

Klebsiella pneumoniae Orbital Cellulitis with Extensive Vascular Occlusions in a Patient with Type 2 Diabetes

양세정,박수연,이윤정,김희영,서지아,김신곤,최동섭 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.1

A 39-year-old woman visited the emergency room complaining of right eye pain and swelling over the preceding three days. The ophthalmologist’s examination revealed orbital cellulitis and diabetic retinopathy in the right eye, although the patient had no prior diagnosis of diabetes. It was therefore suspected that she had diabetes and orbital cellulitis, and she was started on multiple antibiotic therapies initially. She then underwent computed tomography scans of the orbit and neck and magnetic resonance imaging of the brain. These studies showed an aggravated orbital cellulitis with abscess formation, associated with venous thrombophlebitis,thrombosis of the internal carotid artery, and mucosal thickening of maxillary sinus with multiple paranasal abscesses. Three days later, initial blood culture grew Klebsiella pneumoniae. She recovered after incision and drainage and antibiotic therapy for 37 days. (Korean J Intern Med 2010;25:114-117)

Case report : Klebsiella pneumoniaeOrbital Cellulitis with Extensive Vascular Occlusions in a Patient with Type 2 Diabetes

( Sae Jeong Yang ),( Soo Yeon Park ),( Yun Jeong Lee ),( Hee Young Kim ),( Ji A Seo ),( Sin Gon Kim ),( Dong Seop Choi ) 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.1

A 39-year-old woman visited the emergency room complaining of right eye pain and swelling over the preceding three days. The ophthalmologist`s examination revealed orbital cellulitis and diabetic retinopathy in the right eye, although the patient had no prior diagnosis of diabetes. It was therefore suspected that she had diabetes and orbital cellulitis, and she was started on multiple antibiotic therapies initially. She then underwent computed tomography scans of the orbit and neck and magnetic resonance imaging of the brain. These studies showed an aggravated orbital cellulitis with abscess formation, associated with venous thrombophlebitis, thrombosis of the internal carotid artery, and mucosal thickening of maxillary sinus with multiple paranasal abscesses. Three days later, initial blood culture grew Klebsiella pneumoniae. She recovered after incision and drainage and antibiotic therapy for 37 days. (Korean J Intern Med 2010;25:114-117)

2015년 주요 의료판결 분석

유현정,이동필,이정선,정혜승,박태신 대한의료법학회 2016 의료법학 Vol.17 No.1

2015년 한해에도 의료분야에서 다양한 판결이 선고되었다. 요양원 입소자에 대하여 요양원측 과실로 상해가 발생하여 요양원을 운영하는 사회복지법인이 환자의 진료를 의뢰한 사건에서 진료계약의 당사자 확정 기준이 제시되었고, 뇌사상태에 빠진 환자 가족의 무의미한 연명치료 중단 요구에 대하여 병원이 이를 거부하고 계속 진료한 경우 청구 가능한 진료비에 관한 판단이 이루어졌다. 안전성이 확인되지 아니하여 2011. 2. 보건복지부로부터 사상 초유의 시술중단조치를 받았던 눈미백수술에 관하여 법원은 시술 자체의 위법성을 인정하지는 아니하였으나 임상시험 단계에 있어 비용 대비 효과가 확립되어 있지 않다는 사실을 설명하지 아니한 설명의무 위반으로 전 손해의 배상을 명하였다. 의료과실을 적극적으로 인정한 판결로는 척추수술 후 마미증후군이 발생한 사건들에서 수술과정상 과실이 인정된 사례가 상당수 있었고, 병원감염 사건에서 감염을 유발한 과실을 인정한 판결이 선고되었다. 응급의료에 관한 법률상 응급장비 설치의무와 응급상황 발생시 조치의무를 구분하여 의료과실을 인정한 판결이 선고되었고, 극히 드문 희귀질환이라 하더라도 그에 대한 적절한 조치를 취하지 않은 의료기관에게 과실을 인정한 판결이 선고되었다. 손해배상의 범위와 관련하여 항소심 신체재감정 결과 노동능력상실률이 1심보다 작아지자 시간의 경과에 따라 노동능력상실률을 달리 적용하거나 환자의 상태에 따라 노동능력상실률을 신체감정 결과보다 낮게 인정하는 등 실체진실에 부합하는 판결이 선고되었다. 의료과실로 손해가 발생한 경우 의료사고 후 발생한 진료비에 책임제한이 적용되는지 여부와 관련하여 법원은 병원에서 환자 상태의 치유 또는 악화를 방지하는 정도의 치료만 계속되었다면 환자에게 진료비 지급을 청구할 수 없다는 이유로 병원 측의 상계주장을 배척하였다. 사전심의를 받지 않은 의료광고를 금지하고 그 위반시 처벌하는 의료법 규정에 대하여 사전심의기관인 대한의사협회 등의 행정기관성을 부인할 수 없어 사전검열에 해당한다는 이유로 위헌결정이 내려졌다. 임상에서 흔하게 시행되고 있는 PRP 치료가 법정비급여에 해당하는지 여부에 관하여 법원은 법정비급여 여부는 이론적인 가능성이나 실제 실시 여부 등에 따라 결정되는 것이 아니라 의학적 안전성·유효성을 인정받은 후 요양급여 또는 비급여대상으로의 편입절차를 거쳐야 함을 분명히 하였다. 또한 법원은 요양병원 적정성 평가에 관한 행정소송에서, 구조부문의 조사방식이나 절차상 위법을 인정하면서도 그 위법사유의 정도가 당연무효에까지는 이르지 아니하고 평가기관의 고의·과실이 없다는 이유로 건강보험심사평가원과 국민건강보험공단에 부당이득반환이나 손해배상의무가 없다는 판단을 하였다. 향후 더욱 다양하게 제기되는 쟁점들에 관하여 명쾌한 법리를 통해 실체진실에 다가가는 판결을 기대해본다. There were also various decisions made in medical area in 2015. In the case that an inmate in a sanatorium was injured due to the reason which can be attributable to the sanatorium and the social welfare foundation that operates the sanatorium request treatment of the patient, the court set the standard of fixation of a party in medical contract. In the case that the family of the patient who was declared brain dead required withdrawal of meaningless life sustaining treatment but the hospital rejected and continued the treatment, the court made a decision regarding chargeable fee for such treatment. When it comes to the eye brightening operation which received measure of suspension from the Ministry of Health and Welfare for the first time in February, 2011, because of uncertainty of its safety, the court did not accept the illegality of such operation itself, however, ordered compensation of the whole damage based on the violation of liability for explanation, which is the omission of explanation about the fact that the cost-effectiveness is not sure as it is still in clinical test stage. There were numerous cases that courts actively acknowledged malpractices; in the cases of paresis syndrome after back surgery, quite a few malpractices during the surgery were acknowledged by the court and in the case of nosocomial infection, hospital’s negligence to cause such nosocomial infection was acknowledged by the court. There was a decision which acknowledged malpractice by distinguishing the duty of installation of emergency equipment according to the Emergency Medical Service Act and duty of emergency measure in emergency situations, and a decision which acknowledged negligence of a hospital if the hospital did not take appropriate measures, although it was a very rare disease. In connection with the scope of compensation for damage, there were decisions which comply with substantive truth such as; a court applied different labor ability loss rate as the labor ability loss rate decreased after result of reappraisal of physical ability in appeal compared to the one in the first trial, and a court acknowledged lower labor ability loss rate than the result of appraisal of physical ability considering the condition of a patient, etc. In the event of any damage caused by malpractice, in regard to whether there is a limitation on liability in fee charge after such medical malpractice, the court rejected the hospital’s claim for setoff saying that if the hospital only continued treatments to cure the patient or prevent aggravation of disease, the hospital cannot charge Medical bills to the patient. In regard to the provision of the Medical Law that prohibit medical advertisement which was not reviewed preliminarily and punish the violation of such, a decision of unconstitutionality was made as it is a precensorship by an administrative agency as the deliberative bodies such as Korean Medical Association, etc. cannot be denied to be considered as administrative bodies. When it comes to the issue whether PRP treatment, which is commonly performed clinically, should be considered as legally determined uninsured treatment, the court made it clear that legally determined uninsured treatment should not be decided by theoretical possibility or actual implementation but should be acknowledged its medical safety and effectiveness and included in medical care or legally determined uninsured treatment. Moreover, court acknowledged the illegality of investigation method or process in the administrative litigation regarding evaluation of suitability of sanatorium, however, denied the compensation liability or restitution of unjust enrichment of the Health Insurance Review & Assessment Service and the National Health Insurance Corporation as the evaluation agents did not cause such violation intentionally or negligently. We hope there will be more decisions which are closer to substantive truth through clear legal principles in respect of variously arisen issues in the future.