사용자조절소프트웨어를 이용한 백내장 수술의 임상결과

노창래,김수영,주천기.Chang Rae Rho. M.D.. Su Young Kim. M.D.. Choun Ki Joo. M.D.. Ph.D. 대한안과학회 2006 대한안과학회지 Vol.47 No.5

Purpose: To compare the effectiveness and safety of the hyperpulse phaco mode based on the custom control software with those of the conventional continuous phaco mode. Methods: This study included 560 eyes of 496 patients, which were divided into 2 groups according to the mode of phacoemulsification. Each group was further stratified into 4 groups according to their nuclear opacity. The following parameters were compared between groups having the same degree of nuclear opacity: the best corrected visual acuity preoperatively, at 1 day and 2 months postoperatively, the change of endothelial cell count and hexagonality preoperatively and at 2 months postoperatively, as well as the total phaco energy used in the operation. Results: There were no significant differences in visual acuity between control and experiment groups. As for change in endothelial cell count, there were also no statisticallysignificant differences. Hexagonality was significantly higher in the nuclear opacity groups 3 and 4 of the hyperpulse mode than those of the continuous mode. The absolute phaco time was significantly less in the nuclear opacity groups 1, 2 and 3 of the hyperpulse mode than those of the continuous mode. Conclusions: Phacoemulsification using the custom control software showed an advantage decrease in the total phaco energy and corneal endothelial cell damage. This result will improve the postoperative prognosis.

소아에서 발생한 안부대상포진 1예

노창래,이승재,전은정,정성근,Chang Rae Rho,Seung Jae Lee,Eun Jeong Jeon,Sung Kun Chung 대한안과학회 2006 대한안과학회지 Vol.47 No.7

Purpose: We report a case of herpes zoster ophthalmicus in a 7-year-old child. Methods: A 7-year-old boy presented with acute onset of vesiculopapular rash covering his left forehead, upper eyelid, and side of the nose. He was admitted via the pediatrics clinic and was referred to ophthalmology clinic for ophthalmologic examinations. Results: On admission zoster ophthalmicus was limited to his skin and conjunctiva, but the disease progressed to zoster keratitis, uveitis, and meningitis. The patient was treated with topical, oral, and intravenous acyclovir. He had an uneventful recovery and was discharged. Conclusions: We experienced a case of zoster ophthamicus and meningitis in a patient without an apparent history of chickenpox.

통원 백내장 수술 후 개별 교육이 불안과 자가관리 수행에 미치는 영향

조경숙,노창래,Kyung-Sook Cho,Chang Rae Rho 대한안과학회 2012 대한안과학회지 Vol.53 No.3

Purpose: To investigate the influence of additional postoperative individualized teaching on the anxiety levels and self-care compliance of postoperative care in patients after one-day cataract surgery. Methods: The present study included 80 cataract patients who underwent phacoemulsification and posterior intraocular lens insertion performed by a single operator between January 2011 and February 2011. The control group consisted of patients who received postoperative education from an ophthalmology coordinator based on previous hospital policy. The experiment group consisted of patients who received additional individualized postoperative education from an operator in the recovery room. Trait anxiety on operation day, state anxiety on postoperative day 1, and self-care compliance and postoperative satisfaction at postoperative 1 month were evaluated. Results: There were no significant differences of trait anxiety levels on operation day or state anxiety on postoperative day 1 between the control and experiment groups. The experiment group revealed a higher score on the postoperative self-care compliance questionnaire, especially regarding care of the operation site. Conclusions: Individualized postoperative education increases self-care compliance level and contributes to improve postoperative recovery after one-day cataract surgery. J Korean Ophthalmol Soc 2012;53(3):412-419

소아에서 발생한 안와의 B-세포 림프모구성 림프종 1예

김정섭,노창래,도상희,박경신,양석우,Jung Sub Kim,M,D,Chang Rae Rho,M,D,Sang Hee Doh,M,D,Gyeong Sin Park,M,D,Suk Woo Yang,M,D 대한안과학회 2007 대한안과학회지 Vol.48 No.1

Purpose: We report a case of orbital B-cell lymphoblastic lymphoma in a 7-year-old boy. Methods: A 7-year-old boy presented with proptosis and periorbital swelling of his left eye following a periorbital blunt trauma 1-month prior. During the course of routine ophthalmologic and radiologic examinatinos, the swelling spontaneously subsided without specific treatment. An outpatient follow-up was planned, but the swelling recurred 6 months later. An orbital CT and MRI showed an irregular mass with an indistinct margin in the left orbit, for which an incisional biopsy was performed. Results: The orbital mass consisited of monotonous small to medium sized lymphoid cells with evenly dispersed open chromatin, thin nuclear membrane and inconspicuous nucleoli. Immunohistochemistry revealed that the cells were positive for CD79a and TdT, but negative for CD3 and CD5. These findings were compatible with a diagnosis of B cell lymphoblastic lymphoma. Conclusions: Lymphoblastic lymphoma of the orbit should be suspected and considered in the differential diagnosis for children with acutely progressing orbital mass.

베스트병의 빛간섭단층촬영 소견

김현경,노창래,이원기,김기석,Hyun Kyung Kim,M,D,Chang Rae Rho,M,D,Won Ki Lee,M,D,Ki Seok Kim,M,D 대한안과학회 2008 대한안과학회지 Vol.49 No.5

Purpose: To report the optical coherence tomography (OCT) findings of three cases in various stages of juvenile-onset vitelliform macular dystrophy (Best disease). Case summary: Medical records of six eyes from three patients diagnosed with Best disease were reviewed retrospectively. We evaluated the clinical features of the fundus, the electro-oculogram, and the optical coherence tomography (OCT) results. In the fundi of the three patients with Best disease, the characteristic stages of vitelliform, pseudohypopyon, and scrambled egg appearance were identified. Optical coherence tomography findings in the eyes of the patients with Best disease showed two types of outer retina-choroid complex (ORCC) changes, including splitting with intervening hyporeflective areas and elevation over hyporeflective area. Conclusions: The OCT findings showed variable patterns according to the progression of Best disease. In the pseudohypopyon stage, both neurosensory detachment and retinal pigment epithelial detachment appearance were identified. The exact location of the resulting lesions seems to depend on the relative impediment of fluid movement caused by the mutation of bestrophin.

한국 원추각막 환자의 실태 조사 및 유전 역학 연구

주천기,노창래,목지원,리영준,김동해,박영기,Choun-Ki Joo,MD,PhD,Chang Rae Rho,MD,Jee Won Mok,PhD,Young Jun Lee,MD,PhD,Dong Hae Kim,MD,Young Ki Park,MD 대한안과학회 2012 대한안과학회지 Vol.53 No.6

Purpose: To report the characteristics and genetic epidemiology of keratoconus patients in the Korean population based on questionnaires, ophthalmologic findings, and genetic studies. Methods: From September 2007 through August 2009, an epidemiologic investigation was performed through questionnaires and ocular examination of 190 keratoconus patients. To investigate the genetic cause, blood samples were taken from the keratoconus patients. Genetic analysis of keratoconus was performed through the analysis of sensitive candidate genes. Results: The mean age of the study subjects was 29.6 years. Seventy-seven percent of the subjects rubbed their eyes with 17 percent suffering from atopy, allergy, and asthma. Thirty-two percent of subjects demonstrated Vogt’s striae as the most frequent biomicroscopic keratoconus finding. No family history was found. Genetic analysis showed sensitive genetic variations of VSX1, LUM, and IL1B. Conclusions: Epidemiology of Korean keratoconus patients was investigated through research and genetic study resulting in discovery of sensitive genes. J Korean Ophthalmol Soc 2012;53(6):839-848

트리플 카우-히치 방법을 이용한 인공수정체의 공막고정술

주종수,이유경,노창래,변용수,주천기,Jongsoo Joo,You Kyung Lee,Chang Rae Rho,Yong-Soo Byun,Choun-Ki Joo 대한안과학회 2011 대한안과학회지 Vol.52 No.11

Purpose: To report the results of scleral suture fixation using a hydrophilic acrylic intraocular lens (IOL) with 3 hollow haptics through a small corneal incision, the Triple Cow-Hitch Method. Case summary: Three-point suture fixation of a XL Stabi ZO IOL was performed in 5 eyes of 5 patients with aphakia after penetrating keratoplasty (PKP), vitrectomy and subluxated lens extraction. Postoperatively, the corrected distance visual acuity and spherical equivalent improved in all measured eyes. There were no cases of pigment dispersion or cystoid macular edema (CME). Conclusions: In this preliminary study, the triple cow-hitch method of suturing a hydrophilic acrylic IOL is an alternative to the conventional 2-point scleral fixation of sutured IOLs. J Korean Ophthalmol Soc 2011;52(11):1370-1376

사이클로스포린 A 0.05% 투여군 간 안전성 및 유효성을 비교평가하기 위한 제3상 임상시험

양순원(Soon won Yang),변용수(Yong Soo Byun),노창래(Chang Rae Rho),김수영(Su Young Kim),조양경(Yang Kyung Cho),김은철(Eun Chul Kim),정성근(Sung Kun Chung),주천기(Choun Ki Joo) 대한안과학회 2016 대한안과학회지 Vol.57 No.12

목적: 중등증 이상의 건조각막결막염과 관련된 안염증질환으로 인해 눈물생성이 억제된 환자를 대상으로 사이클로스포린 0.05% 시험약과 대조약을 12주간 투여한 후 각 군의 각막염색 점수 변화로 안구건조 완화효과를 평가하여 시험약이 대조약에 비해 임상적으로 열등하지 않음을 입증하고자 하였다. 대상과 방법: 본 임상시험은 다기관, 무작위배정, 이중눈가림, 활성군 대조, 병행설계 임상시험으로 디자인하였다. 시험대상자가 임상시험에 참여할 것을 동의하면, 2주간의 Run-in 기간을 가지며, 시험대상자들은 2주의 Run-in 기간 동안 인공눈물을 필요시 증상이 있는 눈에 1일 수회 점적하였다. Run-in 기간을 완료한 후, 시험군 또는 대조군으로 무작위 배정하였다. 무작위 배정된 시험대상자는 12주 동안 4주 간격으로 유효성 및 안전성 평가를 실시하였다. 결과: 본 임상시험결과 사이클로스포린 0.05% 시험약과 대조약 투여 후 12주에 각막염색 점수 변화량을 비교한 결과, Per Protocol Set 분석군에서 시험군이 대조군과 비교하여 비열등함을 만족하는 것으로 분석되었다. 이는 Full analysis set 분석군에서도 동일한 결과를 나타내었다. 본 임상시험 기간 동안 나타난 모든 이상반응을 분석한 결과, 군 간 차이는 통계적으로 유의하지 않았다(p=0.1107). 또한 이상반응 외에 내약성평가, 임상병리 검사, 활력징후에서도 임상적으로 유의한 변화를 나타내는 항목은 없었다. 결론: 결과적으로 사이클로스포린 A 0.05% 시험약은 대조약과 같이 유효하고 안전하게 사용할 수 있는 약제라고 사료된다. Purpose: To evaluate and compare the efficacy and safety of cyclosporine 0.05% (Cyporin N eye drops 0.05%) to an active comparator (Restasis??) in moderate to severe dry eye patients. Methods: This is a multicenter, randomized, double-blind, parallel, active control, non-inferiority, phase Ⅲ study. Patients had a 2-week run-in period (during the run-in period, patients used artificial tears, if applicable), and afterward 158 patients were randomly assigned treatment for 12 weeks with cyclosporine 0.05% (with artificial tears, if applicable), in which the efficacy and safety were evaluated every four weeks. Results: Corneal staining tests showed that in the per protocol set group, the study group was not inferior to the control group; the results for the full analysis set analytic group were the same. The number of adverse events reported from the 158 patients was not significantly different between groups (p = 0.1107). Additionally, other evaluations, including tolerability evaluations, clinical pathology examinations, and vital signs, show that there is no difference in terms of safety between the groups. Conclusions: Cyclosporine A 0.05% (Cyporin N eye drops 0.05%) is considered to have the same efficacy and safety compared to the active comparator.

데스메막각막내피이식술 후 이식편 실패가 온 환자에서의 데스메막각막내피이식술

김기현(Gee-Hyun Kim),하민지(Min Ji Ha),장동진(Dong Jin Chang),황웅주(Woong Joo Whang),변용수(Yong-Soo Byun),황형빈(Hyung Bin Hwang),나경선(Kyung Sun Na),노창래(Chang Rae Rho),이현수(Hyun Soo Lee),정소향(So Hyang Chung),김은철(Eun Chu 대한안과학회 2021 대한안과학회지 Vol.62 No.5

목적: 데스메막내피각막이식술(Descemet membrane endothelial keratoplasty) 시행 후 이식편 실패가 발생한 환자에게 데스메막내피각막이식술을 재시도하여 성공한 경험을 보고하고자 한다. 증례요약: 47세 여자 환자에게 좌안 푹스 각막내피이상증(Fuchs’ endothelial dystrophy) 진단으로 본원에서 좌안 데스메막내피각막이식술을 시행하였다. 특별한 합병증은 없었으나 수술 6주 후 각막부종 및 수포가 발생하여 갈수록 악화되었으며, 시력 또한 감퇴되어수술 7개월 후 이식편 실패 진단하에 좌안 데스메막내피각막이식술을 다시 시행하였다. 재수술 후 8개월째 특별한 합병증 없이 각막은 투명하며 최대교정시력 0.6 내외로 유지되고 있다. 결론: 데스메막내피각막이식술 시행 후 이식편 실패가 발생한 환자에서 데스메막내피각막이식술을 재시행하였는데, 수술 중 기존의 데스메막은 어렵지 않게 온전히 제거할 수 있었으며 합병증 없이 성공적인 결과를 얻을 수 있었다. Purpose: To report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK. Case summary: A 47-year-old female underwent primary DMEK in her left eye with a diagnosis of Fuchs’ endothelial dystrophy. At 6 weeks later, corneal stromal edema with epithelial and subepithelial bullae was first observed. From that point on, the condition of the cornea and the visual acuity continued to degrade. After 7 months, a second DMEK procedure (i.e., a repeat DMEK) for graft failure was performed successfully without any complications. Since the second procedure, the cornea has been clear, and the best-corrected visual acuity has remained at 0.6 for 8 months. Conclusions: To manage graft failure after primary DMEK, we performed a second DMEK procedure. The removal of the previous graft was easy, and there were no complications. Thus, repeat DMEK may be a feasible procedure.

전층각막이식술 후 이식편 실패가 온 환자에서의 데스메막내피각막이식술

손우영(Woo Young Son),하민지(Min Ji Ha),황웅주(Woong Joo Whang),변용수(Yong-Soo Byun),황형빈(Hyung Bin Hwang),나경선(Kyung Sun Na),노창래(Chang Rae Rho),이현수(Hyun Soo Lee),정소향(So Hyang Chung),김은철(Eun Chul Kim),조양경(Yang Kyu 대한안과학회 2021 대한안과학회지 Vol.62 No.6

목적: 전층각막이식술(penetrating keratoplasty) 후 이식편 실패가 온 환자에게 이차적으로 데스메막내피각막이식술(Descemet membrane endothelial keratoplasty, DMEK)을 성공적으로 시행한 1례를 보고하고자 한다. 증례요약: 46세 남자 환자는 양안 원추각막으로 30년 전 우안 전층각막이식술, 14년 전 좌안 전층각막이식술을 받고 경과 관찰하던 중 1년 6개월 전부터 좌안 이식편 실패로 좌안 시력이 서서히 감소하였다. 좌안 이식편 실패에 대해 이차 각막이식술로 데스메막내피각막이식술을 시행하였다. 수술 후 13일째 각막 비측 1/4의 이식편이 분리되어 있는 것이 발견되어 1차례 추가적인 공기주입술을 시행하였다. 수술 후 8달째 환자는 나안시력 0.5까지 확인되었으며 각막은 투명한 상태로 이식편 거부반응 없이 잘 유지되고 있다. 결론: 전층각막이식술 후 이식편 실패가 온 환자에서 이차적인 각막이식술로 데스메막내피각막이식술을 성공적으로 시행하였고 결과도 양호하였다. Purpose: To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. Conclusions: Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.