Changes in the Accommodation-convergence Relationship after the Artisan Phakic Intraocular Lens Implantation for Myopic Patients

류익희,한진우,이형근,김진국,한승한 대한안과학회 2014 Korean Journal of Ophthalmology Vol.28 No.2

Purpose: To evaluate the change of accommodation-convergence parameters after implantation of Artisanphakic intraocular lens (PIOL). Methods: Prospective study for the patients with the Artisan PIOL implantation was performed. A total of 37patients (3 males and 34 females) enrolled the study. Preoperatively, convergence amplitude, the stimulus accommodativeconvergence per unit of accommodation (AC/A) ratio and the near point of convergence (NPC)were evaluated. After the Artisan PIOL implantation, the identical evaluations were repeated at 1 week, 1, 3,and 6 months after the surgery. Results: Mean age was 24.3 ± 4.8 years old, and preoperative refractive error was -8.92 ± 4.13 diopters (D). After the implantation, mean refractive errors significantly decreased to within ±1.00 D, and noticeable complicationswere not found. The convergence amplitude and the stimulus AC/A ratio increased 1 month after thesurgery, but progressively stabilized afterward to near preoperative values. NPC didn’t show any significantchange over follow-up period up to 6 months. Conclusions: These results regarding implantation of the Artisan PIOL revealed the increase of accommodation-convergence relationship within first 1 month after the surgery, but progressive stabilization was notedduring follow-up periods.

선천주기교대눈떨림의 임상적 양상

류익희,장윤희,장지호,이종복,Ik-Hee Ryu,Yoon-Hee Chang,Jee-Ho Chang,Jong-Bok Lee 대한안과학회 2005 대한안과학회지 Vol.46 No.9

Purpose: To investigate clinical findings, diagnostic criteria and management for patients with congenital periodic alternating nystagmus (PAN). Methods: A retrospective analysis of clinical findings and electrooculography (EOG) of patients with congenital PAN was performed. Thirteen patients diagnosed with congenital PAN from March 1992 to December 2002 were included. Results: Of 13 patients, the median age at initial visit was 7 years old (range: 1 to 30 years). Eight patients had abnormal head posture. The mean value for the period of alteration was 265.7 seconds. Six patients who received either the modified Kestenbaum-Anderson procedure or four rectus muscle recession showed a significant decrease in amplitude and/or frequency of nystagmus, and showed statistically significant improvement in visual acuity in LogMAR after the procedures by 0.33±0.09 in right eye, 0.34±0.11 in the left eye, compared with preoperative acuities of 0.43±0.19 and 0.38±0.09 respectively. Conclusions: Congenital PAN requires the evaluation of nystagmus along with a thorough evaluation of eye movement and EOG. Close follow is necessary to evaluate the pattern of nystagmus. Also, either modified Kestenbaum-Anderson procedure or four rectus muscle recession could be effective, depending on the presence of abnormal head posture.

라식 혹은 라섹 후 근시퇴행 시 안압하강제와 0.1% 플루오로메토론의 병합치료 효과

류익희(Ik Hee Ryu),김희선(Hee Sun Kim),이희경(Hee Kyung Lee),김정섭(Jung Sub Kim),김진국(Jin Kuk Kim),김욱겸(Wook Kyum Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.1

목적: 라식 라섹 후 근시퇴행으로 인해 시력저하를 호소하는 환자에서 안압하강제와 0.1% 플루오로메토론을 함께 사용하여 약물치료를 시행하였을 때 시력과 굴절값에 미치는 효과를 알아보고자 하였다. 대상과 방법: 본원에서 라식 혹은 라섹 수술을 받은 환자 중 2015년 1월부터 2016년 1월까지 시력저하로 내원하여 근시퇴행으로 진단받고 약물치료를 받은 환자 155명(155안)을 대상으로 약물치료 전후의 시력 및 굴절이상을 비교하고, 라식 라섹에서 그 결과가 차이있는지 알아보았다. 결과: 약물치료 시작 시기는 수술 후 평균 64.1 ± 36.8개월 후였다. 약물치료 후 시력이 호전되고 근시량이 감소한 약물치료 반응군은 63명(41%)이었으며, 이들에서 시력 호전은 -0.21 ± 0.11 logMAR, 근시량의 감소는 0.56 ± 0.32디옵터였다. 약물치료 반응군 중 완전히 회복되는 경우는 24명(15%), 부분적으로 회복된 경우는 39명(26%)이었다. 약물치료에 시력이 호전되는 빈도는 라섹 후보다 라식 후에 더 높았으나 통계적으로 유의하지는 않았다. 결론: 라식 라섹 후 근시퇴행으로 인한 시력저하 시 안압 하강제와 0.1% 플루오로메토론을 함께 사용한 약물치료는 약 41% 환자에서 시력을 호전시킬 수 있는 방법이며, 라식, 라섹 후 모두에서 효과적인 방법이다. Purpose: To evaluate the effect of combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone on visual acuity and refractive errors in patients complaining of blurred vision due to myopic regression after laser-assisted in-situ keratomileusis(LASIK) or laser-assisted sub-epithelial keratectomy (LASEK). Methods: This study comprised 155 patients (155 eyes) who were diagnosed with myopic regression after LASIK or LASEK and received medical treatment from January 2015 to January 2016. The visual acuity and refractive errors were compared before and after medical treatment and evaluated to determine whether the results differ between LASIK and LASEK. Results: The mean time of medical treatment was 64.1 ± 36.8 months after surgery. The responder group whose vision was improved and whose myopic error was decreased after medical treatment was comprised of 63 patients (41%). Theirvisualacuity in this group improved -0.21 ± 0.11 logMAR, and the amount of myopic error decreased 0.56 ± 0.32 diopters. The full responder group was 24 patients (15%), and the partial responder group was 39 patients (26%). The frequency of response to medical treatment was higher after LASIK than after LASEK, but the difference was not statistically significant. Conclusions: The combined medical treatment with anti-glaucoma eyedrops and 0.1% fluorometholone was effective in 41% of patients with regard to visual acuity improvement when used for post-LASIK or post-LASEK myopic regression. The medical treatment was effective after both LASIK and LASEK.

근시성 맥락막신생혈관에서 Verteporfin을 이용한 광역학 치료

류익희 ( Lyu Ig Hui ) , 김봉균 ( Kim Bong Gyun ) , 이성철 ( Lee Seong Cheol ) 대한안과학회 2003 대한안과학회지 Vol.44 No.9

ICL 삽입술 후 일시적인 엎드린 자세가 Vaulting과 전방각에 미치는 영향

김욱겸,류익희,김진국,양훈.Wook Kyum Kim. MD. Ik Hee Ryu. MD. Jin Kuk Kim. MD. Hun Yang. MD 대한안과학회 2012 대한안과학회지 Vol.53 No.6

Purpose: To evaluate the effects of transient prone position on vault and anterior chamber angle parameters in ICL implanted patients. Methods: 40 eyes of 20 ICL implanted patients with at least 1 month of follow-up were included in the present study. The central ICL vault and anterior chamber parameters including angle opening distance at 500 (AOD500) were measured with the Visante anterior segment optical coherence tomography (OCT) (Carl Zeiss, Dublin, CA) in both the sitting and prone positions by tilting the OCT 90 degrees in the vertical axis and having the patient fixate downwards towards the floor. Results: The mean central vault was 0.55 ± 0.21 mm (SD) and 0.59 ± 0.21 mm (SD) in the sitting and prone positions, respectively (p < 0.0001). The nasal and temporal AOD500 were 0.26 ± 0.11 mm and 0.28 ± 0.08 mm, respectively in the sitting position, which decreased to 0.24 ± 0.10 mm and 0.26 ± 0.08 mm in the prone position, however, both were not statistically significant (p = 0.08, p = 0.09). AOD500 was inversely correlated with vault (r = -0.47; p = 0.0024). There were no significant correlations between increase of vault and anterior chamber depth or white to white nor ICL vault. Conclusions: Transient prone positioning of ICL implanted patients can induce a significant increase in ICL vault. J Korean Ophthalmol Soc 2012;53(6):761-766

20대 한국인에서 관찰되는 제2형 과립각막이상증의 다양한 표현형에 대한 고찰

서지형,류익희,홍진표,문자윤,최진석,전익현,김태임,김응권 대한안과학회 2022 대한안과학회지 Vol.63 No.12

목적: 제2형 과립각막이상증(granular corneal dystrophy type 2, GCD2)은 각막에 과립 및 격자형 침착물이 생기는 유전 질환으로, 동형접합자와 이형접합자가 있다. GCD2는 중심각막수술 후 악화되며, 이형접합자의 표현형에 개인차가 보고되는 바, 굴절수술이 잦은 국내 20대에서 관찰된 다양한 표현형을 조사하였다. 대상과 방법: 유전자(transforming growth factor β induced gene)검사 결과 R124H 변이가 발견되어 GCD2로 진단된 20대 환자 중동형접합자 1인, 복합이형접합자 1인, 단순 이형접합자임에도 과립형 참착물이 나이에 비하여 많은 1인, 보편적인 표현형의 이형접합자 1인, 각막에 초기 증상인 과립형 침착물이 보이지 않는 이형접합자 4인의 각막을 세극등현미경으로 관찰 및 촬영하였다. 결과: 동형접합자는 각막을 뒤덮는 융합성의 과립침착물을 보였다. 복합이형접합자의 경우 중심각막을 대부분 덮는 과립형과 격자형각막혼탁을 보였다. 단순 이형접합자임에도 단안에 30개 내외의 과립형 침착물이 존재하는 경우도 있었다. 투명각막으로 판정받았던이형접합자 4인 중에서 1인은 6개월 뒤 단안에 미세한 1개의 병변을, 1인은 3주 뒤 재검 시 단안에 매우 희미한 의심 병변 1개를 보였으며, 2인은 1회 조사 후에 투명각막으로 판정하였다. 결론: 20대의 GCD2 환자에서, 매우 혼탁한 각막부터 거의 투명한 경우까지 다양한 표현형이 나타남을 확인하였다. 병변 발견이 힘든GCD2 각막이 존재하므로 각막 중심부 수술 전 세심한 관찰과 검사가 필요하다.

Intraoperative Adjustment in Strabismus Surgery under Topical Anesthesia

장윤희,류익희,한승한,이성재,이종복 연세대학교의과대학 2006 Yonsei medical journal Vol.47 No.5

We evaluated the one-stage intraoperative adjustment strabismus surgery with adjustable suture under topical anesthesia. Medical records of the patients who had intraoperative adjustment surgery under topical anesthesia for horizontal or vertical strabismus in our hospital from March 1997 to March 2003 with follow-up of 6 months were analyzed retrospectively. Of the 71 patients, 48 patients had exotropia, 16 had esotropia, and 7 had hyper- or hypotropia. The overall success rates were 85.9% at 1 week, 83% at 1 month, 78.9% at 3 months, and 76.1% at 6 months after surgery. The procedure was not stopped in any patients, and no serious intra-operative or postoperative complications were noted. Intraoperative adjustment strabismus surgery under topical anesthesia is a simple, well-tolerated and effective procedure.

근시환자에서 당일 스마일수술과 계획 스마일수술의 결과 비교

김욱겸,류익희,김정섭,전가희,이인식,김희선,김진국 대한안과학회 2019 대한안과학회지 Vol.60 No.3

Purpose: To evaluate the clinical outcomes of one day small incision lenticule extraction (SMILE), which was performed on the same day as preoperative examinations in myopic patients. Methods: This study included 163 patients (163 eyes) who underwent SMILE with Visumax from January to June in 2017. We divided the patients into two groups. The one day SMILE group underwent surgery on the same day as the preoperative examinations including dilated fundus examinations. The scheduled group underwent the surgery on a different day. Only the right eye was included in the analysis. Visual acuity and refractive results were compared between groups. Results: The one day SMILE group included 83 patients and the scheduled SMILE group included 80 patients. At postoperative 1 month, the myopic errors were -0.07 ± 0.43 diopters (D) for the one day SMILE group and -0.09 ± 0.37 D for the scheduled SMILE group (p = 0.81); the astigmatic refractions were -0.48 ± 0.29 D and -0.46 ± 0.28 D, respectively (p = 0.57), the postoperative uncorrected visual acuities were -0.02 ± 0.11 logarithm of the minimum angle of resolution (logMAR) and -0.02 ± 0.11 logMAR, respectively (p = 0.79). At postoperative 6 months, the myopic errors were -0.06 ± 0.42 D for the one day SMILE group and -0.08 ± 0.34 D for the scheduled SMILE group (p = 0.81), and the astigmatic refractions were -0.48 ± 0.25 D and -0.48 ± 0.30 D, respectively (p = 0.99); the postoperative uncorrected visual acuities were -0.04 ± 0.09 logMAR and -0.05 ± 0.07 logMAR, respectively (p = 0.45). Conclusions: The postoperative results of the one day SMILE patients, whose surgery was performed on the same day as the preoperative dilating fundus examination were not significantly different compared with patients treated with conventional scheduled SMILE. 목적: 근시환자에서 산동 후 망막검사를 포함한 수술 전 검사와 수술을 하루에 진행하는 당일 스마일수술의 결과를 알아보고자 하였다. 대상과 방법: 2017년 1월부터 6월까지 본원에서 스마일수술을 받은 환자 163명(163안)을 대상으로 하였다. 수술 전 검사와 수술을 같은 날에 진행한 당일 스마일군과 검사 후 다른 날에 수술을 진행한 계획 스마일군으로 나누어 수술 후 1, 6개월의 근시, 난시 및 시력을 비교하였다. 결과: 당일 스마일군은 83명, 계획 스마일군은 80명이었으며, 수술 후 1개월에 근시는 각각 -0.07 ± 0.43디옵터, -0.09 ± 0.37디옵터였고(p=0.81), 난시는 각각 -0.48 ± 0.29디옵터, -0.46 ± 0.28디옵터였으며(p=0.57), 시력은 각각 -0.02 ± 0.11 logMAR, -0.02 ± 0.11 logMAR이었다(p=0.79). 수술 후 6개월에 당일 스마일군과 계획 스마일군의 근시는 각각 -0.06 ± 0.42디옵터, -0.08 ± 0.34 디옵터였고(p=0.81), 난시는 각각 -0.48 ± 0.25디옵터, -0.48 ± 0.30디옵터였으며(p=0.99), 시력은 각각 -0.04 ± 0.09 logMAR, -0.05 ± 0.07 logMAR이었다(p=0.45). 결론: 산동제로 동공이 약간 커진 상태에서 진행한 당일 스마일수술은 검사와 수술을 다른 날에 진행한 스마일수술법에 비하여 술 후 근시, 난시, 나안시력에서 유의한 차이를 보이지 않았다.

술 전 Crystalline Lens Rise가 안내후방인공수정체 삽입술 후 Vaulting에 미치는 영향

곽애영,류익희,김진국,김태임,하병진 대한안과학회 2012 대한안과학회지 Vol.53 No.12

Purpose: To evaluate the parameters affecting vaulting and correlation between preoperative crystalline lens rise and vaulting after implantable collamer lense (ICL) implantation. Methods: A total of 53 eyes of 34 patients who underwent ICL implantation were examined retrospectively. White-to-white (WTW) and anterior chamber depth (ACD) were obtained from scanning topography (ORB scan) before surgery. Preoperative crystalline lens rise (CLR) and vaulting at 6 months after ICL implantation were measured using anterior segment optic coherence tomography (AS-OCT). Multiple regression analysis was performed to evaluate the factors affecting central vaulting. Results: The mean preoperative crystalline lens rise was -120 ± 219 μm, and mean central vaulting 6 months after surgery was 544 ± 175 μm. Preoperative SE, WTW, ACD, and CLR were significantly correlated with vaulting at 6 months after surgery. With the use of meaningful variables, multiple regression analysis showed that CLR, WTW, ACD and SE, in that order of influence, had significant effects on vaulting and the multiple regression equation was obtained as follows: Vaulting (μm) = (160.913 × ACD (mm)) + (170.134 × WTW (mm)) + (-0.338 × CLR (μm)) + (-23.783 × SE (D)) - 2250.184. Conclusions: CLR had a stronger influence on vaulting after ICL implantation than the previously proven parameters: WTW, ACD, and SE. In addition to WTW, ACD and SE, CLR should also be considered a new criterion for estimating vaulting after ICL implantation.

굴절교정레이저각막절제술 후 0.1% 플루오로메토론과 트라닐라스트 점안액을 함께 사용한 결과

김욱겸(Wook Kyum Kim),류익희(Ik Hee Ryu),김희선(Hee Sun Kim),김진국(Jin Kuk Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.5

목적: 굴절교정레이저각막절제술(photorefractive keratectomy) 후 0.1% 플루오로메토론 사용으로 안압 상승이 발생한 경우, 트라닐라스트(0.5% tranilast, Krix&#9415;, JW pharmaceutical, Seoul, Korea) 점안액 추가 사용이 각막혼탁 예방과 안압 상승 억제에 효과가 있는지 알아보고자 하였다. 대상과 방법: 2014년 5월부터 2015년 5월까지 본원에서 굴절교정레이저각막절제술을 받고 0.1% 플루오로메토론 점안액 사용 중, 술 후 1개월에 안압 상승으로 안압하강제와 트라닐라스트 점안액을 추가한 환자 49명(49안)과 2012년 12월부터 2013년 10월까지 동일한 수술을 받고 트라닐라스트 점안액을 사용하지 않은 71명(71안)의 환자를 비교하였다. 결과: 술 후 6개월 시 시력은 트라닐라스트 사용군과 대조군에서 각각 logMAR -0.08 ± 0.05, logMAR -0.08 ± 0.04로 두 군 간에 차이가 없었다. 0.1% 플루오로메토론 사용 기간은 트라닐라스트 사용군에서 17.7 ± 3.3주, 대조군에서 20.5 ± 3.7주였다(p〈0.01). 안압하강제의 사용 기간은 트라닐라스트 사용군에서 술 후 18.4 ± 3.2주, 대조군에서 20.9 ± 3.7주였다(p〈0.01). 결론: 굴절교정레이저각막절제술 후 0.1% 플루오로메토론에 의한 안압 상승이 발생한 경우, 트라닐라스트 점안액 추가 사용은 각막혼탁을 예방하면서 0.1% 플루오로메토론의 사용 기간을 줄이고 안압하강제 사용을 최소화할 수 있는 방법이다. Purpose: To determine the effectiveness of the method for preventing corneal opacity and minimizing the intraocular pressure (IOP) increase after photorefractive keratectomy treated with 0.1% fluorometholone and tranilast (0.5% tranilast, Krix??, JW pharmaceutical, Seoul, Korea), especially in cases with elevated IOP. Methods: The patients who underwent photorefractive keratectomy from May 2014 to May 2015 were enrolled in the present study. The data of 49 patients (49 eyes) with elevated IOP at 1 month postoperatively and who used 0.1% fluorometholone and tranilast eye drops (tranilast group) were analyzed and compared with the control group consisting of patients who underwent the same surgery from December 2012 to October 2013 but used only 0.1% fluorometholone. Results: The visual acuity at postoperative 6 months was log MAR -0.08 ± 0.05 and log MAR -0.08 ± 0.04 in the tranilast group and control group, respectively. The eye drops were used postoperatively for 17.7 ± 3.3 weeks in the tranilast group and for 20.5 ± 3.7 weeks in the control group (p 〈 0.01). Anti-glaucoma eye drops were used for 18.4 ± 3.2 weeks and 20.9 ± 3.7 weeks postoperatively in the tranilast group and control group, respectively (p 〈 0.01). Conclusions: Adding tranilast eye drops to patients whose IOP was elevated because of 0.1% fluorometholone use after photorefractive keratectomy is an effective method for preventing corneal haze and minimizing IOP elevation.