콘카나발린을 이용한 단기간 건성안 동물 모델 유용성 연구

신기철,김형찬,고정화,위원량,이진학,김미금,Ki Cheul Shin,Hyung Chan Kim,Jung-Hwa Ko,Won Ryang Wee,Jin Hak Lee,Mee Kum Kim 대한안과학회 2007 대한안과학회지 Vol.48 No.5

Purpose: To evaluate the possibility of short-term dry eye model in rabbits by injection of concanavalin A (conA) to the lacrimal and haderian gland of rabbits. Methods: We injected conA (10 mg/ml, 0.05 ml) to the lacrimal and haderian gland of rabbits twice to induce inflammation of lacrimal gland and compared with saline-injected control by lacrimal gland biopsy with H&E staining for identification of inflammation. The ratio of lacrimal secretion was evaluated by Schirmer test (preinjection vs. postinjection of conA) for 10 days and the number of goblet cells was counted in 10 consecutive high power field using impression cytology with PAS staining. The corneal & conjunctival apoptotic cell deaths were investigated with TUNEL staining 10 days after injection. Results: Infiltration of inflammatory cells and destructed normal architecture of lacrimal gland was found only in conA injected group till 10 days. The Schirmer test showed marked reduction (0.56±0.26) by 5days after injection compared with control group (1.07±0.35) (p=0.02) and its significant difference was maintained till 10days. The number of goblet cell was 9.70±5.03/×200HPF, which was statistically significant decreased compared to control (47.50±17.13/×200HPF) at 10 days (p=0.00). Apoptotic cells were increased in injected eye (26.20±4.27) compared with those in control (16.60±2.70). Conclusions: Injection of conA to lacrimal glands in rabbit shows decrease of lacrimal secretion and similar cytological changes of the cornea and conjunctiva in human dry eye patients. It suggests its possible feasibility of short-term dry eye animal model for the 10 days.

당뇨 환자에서 연성 콘택트렌즈 착용에 의한 중심각막두께 및 각막내피세포의 변화

강준원,신기철,Joon Won Kang,Ki Cheul Shin 대한안과학회 2014 대한안과학회지 Vol.55 No.10

Purpose: To evaluate the changes in central corneal thickness and corneal endothelium in contact lens-wearing diabetic patients. Methods: This study included 113 patients who visited the Department of Ophthalmology, Konkuk University Medical Center from August 2006 to August 2007. Ultrasound pachymetry and noncontact specular microscopy were performed on the right eyes of 26 diabetic patients who regularly wore soft contact lenses (group 1), 27 diabetic patients who did not wear soft contact lenses (group 2), 30 soft contact lens-wearers without diabetes mellitus (DM) (group 3), and 30 normal subjects who did not wear soft contact lenses (group 4). Central corneal thickness, corneal endothelial cell density, endothelial cell coefficient of variation, and percentage of hexagonal endothelial cells were compared between the groups. Results: Average duration of diabetes in groups 1 and 2 was 4.38 and 4.41 years, respectively, and average duration of soft contact lens wear in groups 1 and 3 was 5.27 and 3.65 years, respectively. The central cornea was significantly thicker and the endothelial cell density was significantly lower in group 1 than in groups 3 and 4. The cell size coefficient of variation was higher in group 1 than in groups 2 and 4 and higher in group 3 than in group 4. The percentage of hexagonal cells was significantly lower in group 3 than in group 4. Conclusions: Central corneal thickness and endothelial cell density are more affected by DM than contact lens use, and corneal endothelial cell morphology is influenced more by contact lens use than DM. Contact lens use in diabetic patients significantly influences all characteristics of the corneal endothelium compared with those in normal subjects. Patients with DM should be advised not to wear contact lenses.J Korean Ophthalmol Soc 2014;55(10):1426-1431

안허혈증후군 3예

오세범(Se Beum Oh),신기철(Ki Cheul Shin),김형찬(Hyung Chan Kim) 대한검안학회 2007 Annals of optometry and contact lens Vol.6 No.1

목적: 안허혈증후군은 임상적으로 다양한 소견과 검사상의 특이 소견으로 인해 진단이 어려울 수 있으며, 또한 5년 사망률이 40%로 전신적 평가가 중요한 질환이다. 저자들은 내경동맥과 총경동맥 등의 폐쇄로 발생한 안허혈증후군 3예를 비슷한 시기에 경험하였기에 각 증례의 임상적 특성과 여러 검사결과에 대해 보고하고자 한다. 대상과 방법: 급격한 시력저하를 주소로 내원한 3명의 환자에 대해 전안부검사, 안저검사, 형광안저혈관조영술, 빛간섭단층촬영, 전기생리학적검사, 경동맥 검사 등을 시행하였다. 결과: 본 3예에서 공통적으로 급격한 시력저하가 있었으나 흑암시와 안구통 증상은 없었고, 안저검사에서 전반적인 망막부종, 망막동맥의 수축 및 망막정맥의 확장소견을 보였다. 형광안저혈관조영술상 지연된 팔망막순환시간과 동정맥통과시간을 보였으며, 망막전위도 검사상 a, b 파는 감소되거나 소실된 소견을 보였다. 1예에서 신생혈관녹내장이 있었고, 2예에서 홍채신생혈관 소견이 있었으며, 2예에서 시행한 빛간섭단층촬영상 허혈에 의한 내층망막의 반사도 증가 소견을 보였다. 경동맥 검사상 2예는 내경동맥폐쇄, 다른 1예는 총경동맥폐쇄소견을 보였다. 1예에서 본원 초진 6개월 후 뇌졸중으로 사망하였다. 결론: 저자들은 경동맥검사로 확진된 안허혈증후군 3예를 경험하였기에 보고하는 바이다. Purpose: We report 3 cases of ocular ischemic syndrome with obstruction in internal carotid artery and common carotid artery, which was confirmed by various ocular & systemic examinations. Methods: Several tests such as examination of anterior segment & fluorescein angiography, optic coherence tomography, electrophysiologic test, carotid examination were performed in 3 individuals who suffered decreased visual acuity at an accelerated rate. Results: All patients with sudden decreased visual acuity showed generalized retinal arterial narrowing, ilation of retinal veins and edematous change at posterior pole. Fluorescein angiography showed marked delayed filling of choroids and retinal arteries. Electroretinogram showed extinguished or decreased amplitude of a, b wave. 1 case showed neovascular glaucoma, 2 cases showed rubeosis iridis. Optical coherence tomography performed at two cases showed increased thickness and reflectivity of inner retina due to ischemia. Carotid artery examination showed occlusion of internal carotid artery in two cases and common carotid in one case. And one case died of cerebrovascular accident after six months from first visit. Conclusions: Ocular ischemic syndrome is a disease which is clinically difficult to diagnose because of various symptoms and sign. We report 3 cases of ocular ischemic syndrome which is confirmed with variety of ocular & special diagnostic methods.

단안시요법을 통한 인공수정체 삽입술의 1년 후 결과

유로미(Romi Yoo),신기철(Ki Cheul Shin) 대한안과학회 2016 대한안과학회지 Vol.57 No.12

목적: 단안시요법을 이용한 백내장 수술 후 1년째 임상적 결과 및 환자만족도를 살펴보고, 수술 후 2개월째 결과와 비교하였다. 대상과 방법: 2010년 2월부터 2014년 1월까지 단안시요법으로 백내장 수술을 시행 받고 1년 이상 추적관찰이 가능했던 30명을 대상으로 하였다. 수술은 양안 중 백내장이 심하여 먼저 수술 받은 눈을 정시에 맞추었고, 2-4주 후 반대 눈을 환자의 근거리 작업과 굴절이상을 고려하여 -1.50~-2.50D 근시에 맞추어 수술했다. 수술 전, 수술 후 2개월과 1년째 양안 원거리와 근거리 나안시력, 구면렌즈대응치, 부등시, 입체시를 측정하였고, 원거리와 근거리 시력 만족도, 안경 의존도를 조사하였다. 결과: 환자 평균 나이는 71.9세였고, 수술 2개월째와 1년째 양안 원거리 나안시력(logMAR)은 각각 0.03 ± 0.10, 0.08 ± 0.14, 양안 근거리 나안시력은 0.21 ± 0.15, 0.25 ± 0.14였고, 부등시는 1.28 ± 0.68, 1.29 ± 0.76 diopter, 입체시는 301.67 ± 296.61, 251.67 ± 269.28 arcsec였다. 수술 후 1년째 만족도는 원거리 시력에서 27명(90%)이, 근거리 시력에서는 22명(73.3%)이 ‘호전되었다’ 혹은 ‘매우 호전되었다’고 답했다. ‘안경을 전혀 쓰지 않는다’는 환자는 11명(36.7%)이었다. 결론: 단안시요법은 백내장 수술 후 발생하는 노안을 줄이는 효과적인 방법으로, 시력과 환자 만족도 등에서 양안 수술 후 1년째 결과가 수술 후 2개월째 결과와 크게 다르지 않았다. Purpose: In this study, the visual performance and patient satisfaction one year after monovision cataract surgery and the results after 2 months. Methods: Thirty patients who had bilateral cataract surgery between February 2010 and January 2014 treated with monovision therapy and received postoperative examinations for at least one year after surgery were enrolled in the present study. The eye with the more severe cataract had the surgery first and was corrected for distance vision targeted at emmetropia. The fellow eye was operated for near vision targeted to -1.50~-2.50 diopter (D) range considering the patient’s need for near task and preoperative refractive errors 2-4 weeks after the first operation. Binocular uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), spherical equivalent, anisometropia, stereopsis, patient satisfaction for far and near distance, and spectacle dependence were evaluated preoperatively and two months and one year postoperatively. Results: The mean age of patients was 71.9 years. Two months and one year after the surgery, the binocular UCDVA (log MAR) were 0.03 ± 0.10 and 0.08 ± 0.14, UCNVA were 0.21 ± 0.15 and 0.25 ± 0.14, anisometropia were 1.28 ± 0.68 and 1.29 ± 0.76 D, and stereopsis were 301.67 ± 251.28 and 251.67 ± 269.28 arcsec, respectively. One year after the surgery, the number of patients answering ‘Better’ or ‘Much better’ for distant vision was 27 (90%) and for near vision 22 (73.3%); 11 patients (36.7%) answered ‘Not dependent on spectacles at all’. Conclusions: Monovision is an effective method to correct presbyopia after bilateral cataract surgery. Visual performances and patient satisfaction at one year after cataract surgery were not different compared with those at two months.

백내장수술 중 전방 내 에피네프린과 인도시아닌그린 주입이 각막내피세포에 미치는 영향

김명애(Myung Ae Kim),조윤혜(Youn Hye Jo),이형우(Hyungwoo Lee),신기철(Ki Cheul Shin) 대한안과학회 2022 대한안과학회지 Vol.63 No.2

목적: 백내장수술 중 에피네프린과 인도시아닌그린, 그리고 이 두 약물의 중복 사용이 수술 후 각막내피세포수에 미치는 영향에 대해 확인하여 그 안전성에 대해 알아보고자 한다. 대상과 방법: 2017년 1월부터 2021년 10월까지 백내장수술을 받은 121명의 132안을 대상으로 에피네프린 사용군(n=20), 인도시아닌그린 사용군(n=49), 중복 사용군(n=12), 대조군(n=51)으로 나누어 후향적 의무기록을 분석하였다. 각 군별로 수술 전후 각막내피세포수 변화를 비교하였으며, 이와 연관된 인자를 분석하였다. 결과: 수술 전후 각막내피세포수 변화량(endothelial cell count change, △ECC) 비교 시 각막내피세포수는 모든 군에서 수술 후 감소되는 양상이었으나 각 군 간 유의한 차이는 보이지 않았다(p=0.845). 단순회귀분석에서 △ECC와 유의하게 연관된 인자는 수술 후 육각형세포비율, 백내장 핵경화 정도, 초음파 사용 시간, 초음파 누적소비에너지(beta=-0.216, 0.256, 0.351, 0.343, p=0.013, p=0.003, p<0.001, p<0.001)로, 다중회귀분석 시 △ECC에 유의하게 영향을 미치는 인자는 수술 후 육각형세포비율, 초음파 사용 시간(beta=-0.215, 0.367, p=0.010, p<0.001)으로 나타났다. 결론: 수술 후 각막내피세포수 감소와 밀접하게 연관된 인자는 수술 후 육각형세포비율, 초음파 사용 시간이었다. 에피네프린과 인도시아닌그린은 단독 또는 중복 사용 시 수술 후 각막내피세포의 유의한 손상은 관찰되지 않았으므로 안전하게 사용할 수 있을 것으로 판단된다. Purpose: To investigate the safety of single and combined use of epinephrine and indocyanine green during cataract surgery by evaluating the effects on corneal endothelial cells. Methods: From January 2017 to October 2021, 121 patients (132 eyes) who underwent cataract surgery were enrolled. Patients were divided into 4 groups: epinephrine (n = 20), indocyanine green (n = 49), epinephrine and indocyanine green combination (n = 12), and control (n = 51). Retrospective medical chart findings and endothelial cell count change data were compared among study groups before and after operation. Results: Endothelial cell count change (△ECC) decreased for all groups; however, a significant difference among groups was not observed (p = 0.822). Univariate linear regression showed that △ECC was associated with postoperative hexagonality, nuclear sclerosis grade, ultrasound time, and cumulative dissipated energy (beta = -0.216, 0.254, 0.368, 0.351 and p = 0.013, p = 0.003, p < 0.001, p < 0.001). Multivariate linear regression showed that △ECC was associated with postoperative hexagonality and ultrasound time (beta = -0.215, 0.367, p = 0.010, p < 0.001). Conclusions: Factors closely associated with postoperative endothelial cell loss were postoperative hexagonality and ultrasound time. No significant damage to the corneal endothelium was observed when epinephrine and indocyanine green were used alone or in combination. Thus, these agents appear safe for use in this context.