개방각녹내장에서 야간혈압하강, 경동맥혈류저하, 뇌의 허혈성 변화가 녹내장 진행에 미치는 영향

서홍융,진상욱,노세현,Hong Ryung Seo,Sang Wook Jin,Sae Heun Rho 대한안과학회 2013 대한안과학회지 Vol.54 No.9

Purpose: To investigate the effect of nocturnal dip, carotid artery blood flow, and brain ischemic change on the progression of glaucomatous visual field defect in open-angle glaucoma (OAG) when IOP is less than the target pressure. Methods: We classified OAG patients (74 patients, 148 eyes) who maintained IOP less than the target pressure as normal tension glaucoma (NTG; 52 patients, 104 eyes) or primary OAG (POAG; 22 patients, 44 eyes). Additionally, we performed 24-hr ambulatory blood pressure monitoring (24-hr ABPM), carotid artery color Doppler U/S (CAD), brain MRI, and visual field (V/F) tests on the patients. Nocturnal dips less than 10% were classified as non-dippers, and dips greater than 10% as dippers. The relationships among nocturnal dip, carotid artery blood flow, brain ischemic change, and progression of glaucomatous V/F defect were examined. Results: In the case of dippers, glaucomatous V/F defects were aggravated, with a relative risk of approximately 1.74 (NTG) and 2.91 (POAG) times that of non-dippers. In NTG, decreased carotid artery blood flow and brain ischemic change furthered glaucomatous V/F defects, with a relative risk of approximately 2.40 and 2.54 times that of normal carotid artery blood flow and brain MRI findings, respectively. However, in POAG, decreased carotid artery blood flow and brain ischemic change were not influenced by the progression of glaucomatous V/F defects. Conclusions: In dippers, decreased carotid artery blood flow and brain ischemic change caused a progression of glaucomatous V/F defects in NTG and POAG patients. Thus, performing 24-hr ABPM, CAD, and brain MRI should be helpful for glaucoma patients with progression of glaucomatous V/F defects even when the IOP is less than the target pressure. In addition, this analysis provides useful information regarding glaucoma diagnosis and treatment.

개방각녹내장에서 맥락막분수계역, 야간 혈압하강 및 녹내장성 시야결손의 상관관계

서홍융,김남영,노세현 대한안과학회 2014 대한안과학회지 Vol.55 No.7

Purpose: To investigate the influence of water-shed zone (WSZ) and nocturnal dip (ND) on the progression of the glaucomatous visual field (V/F) defects in open-angle glaucoma (OAG) patients when the intraocular pressure (IOP) was maintained under the target pressure. Methods: We performed fluorescence angiography (FAG), 24-hour ambulatory blood pressure monitoring (24-hr ABPM), and V/F tests. We examined the relationships among WSZ in early-FAG, ND over 10% (dip), and the progression of the glaucomatous V/F defects using chi-square, Fisher’s exact, and multivariate logistic regression tests. A p-value < 0.05 was considered statistically significant. Results: When considering the correlation between WSZ and dip, statistical significance was found in OAG (p = 0.024, odds ratio (OR) = 3.308) and normal tension glaucoma (NTG) (p = 0.029, OR = 4.364) patients. In patients with dip, glaucomatous V/F defects significantly progressed (OAG: p = 0.003, OR = 5.938, NTG: p = 0.005, OR = 13.929). In patients with WSZ, the glaucomatous V/F defects progressed in all groups (OAG: p = 0.002, OR = 5.156, NTG: p = 0.024, OR = 4.750, primary open angle glaucoma (POAG): p = 0.021, OR = 8.750). In the patients with WSZ involving optic nerve head, the glaucomatous V/F defects had progressed in OAG (p = 0.004, OR = 5.958) and NTG (p = 0.009, OR = 8.333) groups. Based on binary logistic regression analysis, dip (p = 0.010, OR = 6.227) significantly affected V/F progression only in OAG patients. Conclusions: In the OAG and NTG groups, ND over 10% influenced the progression of the glaucomatous V/F defects. The patients with WSZ tended to have ND over 10% in OAG and NTG groups and glaucomatous V/F defects progressed in all patients. Therefore, performing early FAG and 24-hr ambulatory blood pressure monitoring may be helpful for glaucoma patients with progressing glaucomatous V/F defects even when the IOP was maintained under the target pressure. J Korean Ophthalmol Soc 2014;55(7):1030-1038

한국인의 연령에 따른 눈꺼풀의 형태학적 변화

서홍융,안희배 대한안과학회 2009 대한안과학회지 Vol.50 No.10

목적: 한국인의 연령변화에 따른 눈꺼풀의 형태학적 변화를 알아보고자 하였다. 대상과 방법: 20대에서 70대까지 정상성인을 10세 간격으로 6개의 연령군으로, 남녀 각각 50명씩 총 600명을 대상으로 MRD1, 눈꺼풀 틈새의 높이, 위눈꺼풀의 양, 눈썹처짐의 정도, 가쪽 눈꺼풀 이완의 정도, 눈꺼풀지방돌출의 정도를 측정하였다. 결과: MRD1, 눈꺼풀틈새의 높이는 나이가 들수록 감소하였으나 유의성은 없었다. 위눈꺼풀의 양은 나이가 들수록 증가하여 60, 70대군에서 유의한 증가를 보였다. 눈썹처짐의 정도는 여성은 50대군부터 남성은 60대군부터 유의하게 처졌고, 특히 가측이 중심부에 비해 더 처짐을 보였다. 가쪽 눈꺼풀 이완증은 40대군부터 나타나기 시작하여 여성은 50대군부터 남성은 60대군부터 유의성을 보였으며, 특히 50대군 여성에서 더 유의한 처짐을 보였다. 눈꺼풀지방돌출은 나이가 들수록 증가하였으나 유의성은 없었다. 위눈꺼풀에 비해 아래눈꺼풀 지방이 더 많이 돌출되었으며, 그 중 중앙지방의 돌출이 가장 많았으나 다른 부분과의 유의한 차이는 없었다. 결론: 상기의 결과들이 앞으로 눈꺼풀 형태에 대한 연구와 눈꺼풀 수술 시 중요한 자료가 될 것으로 사료된다. Purpose: The morphological changes of the eyelids according to gender among different age groups in Korea were analyzed. Methods: Six-hundred adults without any ocular disease were selected, and sorted by age (ranging from 20 to 79 years), and gender. Each group consisted of 50 adults. Interpalpebral fissure (IPF), marginal reflex distance 1 (MRD1), amount of the upper lid, degree of browptosis, lateral hood width of the eyelid, and protrusion of the eyelid fat were measured. The measured values were analyzed to determine changes related to the aging process. Other age groups were analyzed and compared with the subjects between 20 and 30 years old, using the Student’s t-test with SPSS. Results: MRD 1 and IPF slightly decreased with age, but there was no statistical significance. The upper lid amount showed a statistically significant increase at the 7th and 8th decade. The degree of browptosis showed a statistically significant increase from the 7th decade of age in men, and from the 6th decade in women. In particular, the lateral browptosis was more drooped than the center browptosis. The lateral hood width of the eyelid showed a statistically significant increase from the 7th decade of age in men, and from the 6th decade in women. Eyelid fat was most protruded at the central lower part, but there was no statistical significance. Conclusions: It is important to understand the change related to aging in the study of eyelid morphology and eyelid operation. The results from present study may be used to determine standard for the safe amount of skin resection in Korean eyelid operations.

야간혈압하강이 녹내장의 진행에 미치는 영향

서홍융,류원열,노세현,Hong Ryung Seo,Won Yeol Ryu,Sae Heun Rho 대한안과학회 2010 대한안과학회지 Vol.51 No.11

Purpose: To investigate the effect of nocturnal dip influence on the progression of glaucomatous visual field defect. Methods: We performed 24hr ABPM and V/F tests on patients diagnosed with NTG (140 patients, 280 eyes) and POAG (84 patients, 168 eyes). Nocturnal dips below 10% were classified as non-dippers, and those above 10% were noted as dippers. The correlations among nocturnal dip, progression of glaucomatous visual field defect, and hypertension treatment were examined. Results: In NTG, dippers in both systolic and diastolic blood pressure furthered glaucomatous visual field defects, with a relative risk of approximately three times that of non-dippers. Hypertension treatment was not influenced by the progression of glaucomatous visual field defect but was influenced by dips in the systolic and diastolic pressures in NTG and in diastolic pressure in POAG. Nocturnal dips were more frequent in the group with progression of the visual field compared to those in the group with non-progression of the visual field in NTG. Conclusions: Dipper caused a progression of glaucomatous visual field defects in NTG and was influenced by hypertension treatment in NTG and POAG. Performing 24hr ABPM should be helpful for glaucoma patients with progression of a glaucomatous visual field defect even when the IOP is less than the target pressure. In addition, hypertension treatment should be considered an important factor in the treatment of glaucoma. J Korean Ophthalmol Soc 2010;51(11):1471-1478

개방각녹내장에서 수지온도 회복지연과 야간 혈압하강 및 녹내장성 시야진행의 상관관계

김남영,서홍융,노세현,Nam Yeong Kim,Hong Ryung Seo,Sae Heun Rho 대한안과학회 2015 대한안과학회지 Vol.56 No.1

Purpose: To investigate the effects of a delay in finger temperature recovery rate on the hand cold provocation test (HCPT) and a nocturnal dip greater than 10% (dipper) on the progression of glaucomatous visual field (VF) defects in open-angle glaucoma patients when the intraocular pressure (IOP) was well controlled lower than the target pressure. Methods: 30 patients (58 eyes) with normal tension glaucoma (NTG) and 13 patients (24 eyes) with primary open angle glaucoma, and 12 normal controls (24 eyes) were retrospectively enrolled in this study. We performed HCPT, 24 hour ambulatory blood pressure monitoring (24-hr ABPM), Goldmann applanation tonometer measurements, and VF tests on all subjects. The delay in finger temperature recovery rate was defined as a delay longer than 15% of the mean finger temperature of normal controls over 2 intervals among 5, 10, 15, and 20 minutes after the immersion of cold water. We examined the relationships among the delay in finger temperature recovery rate, dipper, and the progression of glaucomatous VF defects. Results: The finger temperature recovery rate in NTG patients was significantly delayed more than that of normal controls at 5, 10, and 15 minutes after the immersion. The delay in finger temperature recovery rate significantly correlated with dipper in NTG patients. Glaucomatous VF defects were significantly progressed in the presence of dipper in NTG patients. Delay in finger temperature recovery rate was significantly related to the progression of glaucomatous VF defects in NTG patients. In the binary logistic regression test, delay in finger temperature recovery rate was the only factor that was strongly related to the progression of glaucomatous visual field in NTG patients. Conclusions: When glaucomatous VF defects progressed despite the IOP being well controlled, 24-hr ABPM and HCPT for detecting vascular dysregulation might be helpful for diagnosis and treatment of glaucoma. J Korean Ophthalmol Soc 2015;56(1):70-79

한국인의 스펙트럼영역빛간섭단층촬영 변수의 나이에 따른 차이

서지영,서홍융,노세현,Ji Young Suh,Hong Ryung Seo,Sae Heun Rho 대한안과학회 2013 대한안과학회지 Vol.54 No.2

Purpose: We evaluated the thickness of RNFL and optic nerve head parameters with age in normal eyes using Spectral-Domain Optical Coherence Tomography (SD-OCT). Methods: A total of 128 normal Korean volunteers in different age groups were recruited (age range, 20-70 years). Results: A significant negative correlation in average RNFL thickness with increasing age was found. The inferior areas (130.31 ± 3.33 μm) were significantly thicker than other areas (superior area 119.05 ± 2.12 μm, nasal area 71.80 ± 0.57 μm, temporal area 77.72 ± 0.16 μm). The average C/D ratios (mean 0.38 ± 0.14) and vertical C/D ratios (mean 0.35 ± 0.11) both showed significant increases with age, and the vertical C/D ratio correlation coefficient was higher (average C/D ratio r = 0.249, vertical C/D ratio r = 0.537). However, rim area, disc area, and cup volume were not correlated with age. Conclusions: From these findings, we conclude that, in normal Koreans, the mean RNFL thickness decreases and the C/D ratio increases with age, with the increase in the vertical C/D ratio being greater.

RTVue 빛간섭단층촬영기로 측정한 맥락막 두께와 연관인자에 관한 연구

진상욱,최우석,서홍융,노승수,노세현 대한안과학회 2015 대한안과학회지 Vol.56 No.7

목적: 정상안압녹내장(normal tension glaucoma, NTG) 및 원발성개방각녹내장(primary open angle glaucoma, POAG)에서 RTVue(Optovue, Fremont, CA, USA)를 이용하여 측정한 황반하와 유두 주위 맥락막 두께를 비교하고 이에 영향을 미치는 인자들에 대해알아보고자 하였다. 대상과 방법: 퓨리에 영역 빛간섭단층촬영(Fourier-domain optical coherence tomography, FD-OCT)으로 측정한 황반하와 유두 주위 맥락막, retinal nerve fiber layer (RNFL), 그리고 ganglion cell complex (GCC) 두께를 비교, 분석하였다. 또한 황반하와 유두주위 맥락막 두께에 영향을 미칠 수 있는 인자들과의 상관관계를 비교, 분석하였다. 결과: 정상 대조군 32명, POAG 32명, NTG 52명이 포함되었다. 각 군 간 맥락막 두께를 비교한 결과, 황반하와 유두 주위 맥락막두께는 NTG에서 가장 얇았다. NTG에서는 황반하와 유두 주위 맥락막 두께에 영향을 미치는 인자는 나이, 안축장, 이완기 혈압의 야간혈압하강, 이완기 혈압의 변동성, GCC 두께였고, POAG에서는 나이, 안축장만이 영향을 미치는 인자였다. 결론: 정상인에 비해 POAG와 NTG에서 RTVue로 측정한 황반하와 유두 주위의 맥락막 두께가 더 얇았고 POAG보다 NTG에서 더 얇았다. NTG에서는 나이, 안축장, 큰 폭의 이완기 야간혈압하강과 혈압의 변동성이, POAG에서는 나이, 안축장이 맥락막 두께에 영향을 미치는 인자였다. Purpose: To compare the macular choroidal thickness, ganglion cell complex thickness, peripapillary choroidal thickness and retinal nerve fiber layer thickness among normal, primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients using RTVue (Fourier-domain optical coherence tomography; Optovue, Fremont, CA, USA). Methods: A retrospective analysis of 32 normal controls, 32 POAG and 52 NTG patients was performed. Choroidal thickness,ganglion cell complex thickness and retinal nerve fiber layer thickness were compared among normal controls, POAG and NTG subjects. Additionally, the factors influencing choroidal thickness (age, axial length, spherical equivalent, central corneal thickness,mean deviation, nocturnal dip, blood pressure variability) were analyzed. Results: A total of 32 normal controls, 32 POAG and 52 NTG patients were enrolled in this study. Macular and peripapillary choroidal thicknesses were significantly thinner in the NTG patients. In NTG subjects, the significant influencing factors associatedwith macular and peripapillary choroidal thicknesses were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant influencing factors associated with macular and peripapillary choroidal thicknesses were age and axial length. Conclusions: Choroidal thickness was significantly thinner in NTG patients compared with normal controls and POAG patients. Factors influencing choroidal thickness in NTG patients were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant factors influencing choroidal thickness were age and axial length.