지암유집(止菴遺集)

이행진 한국고문연구회 1995 古文硏究 Vol.8 No.1

눈벌림 마비의 임상 양상 및 경과

이행진,신용일,이연희,Haeng Jin Lee,MD,Yong Il Shin,MD,Yeon Hee Lee,MD 대한안과학회 2014 대한안과학회지 Vol.55 No.12

Purpose: To improve the understanding of divergence paralysis by identifying its clinical characteristics. Methods: We performed a retrospective chart review analysis of patients diagnosed with divergence paralysis that were followed up for at least 6 months. Clinical features, including disease onset, course, neurological examinations, and imaging studies were evaluated. Results: Fifteen patients were included in the present study and the average age was 55.6 years. Thirteen patients had an acute onset and 2 had an insidious onset. The initial distance deviation ranged from 4 to 14 prism diopters (PD) of esotropia (mean, 8 PD esotropia) and near deviation ranged from 6 PD exophoria to 10 PD esophoria (mean, 1.2 PD esophoria). None of the patients developed additional neurological disorders associated with divergence paralysis during the follow-up period. Eleven of 13 patients with primary divergence paralysis continued to depend on the prism glasses with the same diopters. In the 2 patients with secondary divergence paralysis, distant diplopia disappeared as the underlying disease improved. Conclusions: In our study, the majority of divergence paralysis was not associated with neurological diseases and the patients had an acute onset. Primary divergence paralysis lasted for an extended period. However, secondary divergence paralysis was resolved quickly as the underlying disease improved.Korean Ophthalmol Soc 2014;55(12):1878-1882

<말(馬)> 명칭의 분절구조 연구(1) - <색깔>을중심으로 -

이행진 한국어내용학회 2003 한국어내용론 Vol.9 No.-

여성의 폐경기에 대한 문헌적 고찰

이행진 제주한라대학 1979 論文集 Vol.5 No.-

Most women at the menopause cannot adapt themselvse to their own external, internal change and lose their peace of mind, but it is said that some women at the menopause lead more complete sexual life than before because their burdensome menstruation and sense of unease to a possible chance of pregnancy are gone as the result of menopause. According to process of individual personaliy growth, and their life his ory there are differences in their problems raised to the menopause. Therefore women must have a correct understanding the meaning of menopause, and in that period they should live in perfect harmory not only in their own life but in their home and society.

비전형적인 안소견으로 진단이 어려웠던 망막모세포종 환아들의 임상양상

이행진(Haeng Jin Lee),조동현(Dong Hyun Jo),김정훈(Jeong Hun Kim),유영석(Young Suk Yu) 대한안과학회 2016 대한안과학회지 Vol.57 No.5

목적: 망막모세포종 환아에서 비전형적인 안소견으로 초기 진단이 어려웠던 환아들의 임상양상에 대해서 보고하고자 한다. 대상과 방법: 서울대학교 어린이병원 소아안과에서 1990년부터 2014년까지 망막모세포종으로 최종 진단을 받고 치료를 시행 받은 총 464명 중 초기 진단이 어려웠던 6명의 의무기록을 후향적으로 분석하였다. 초진 시 나이, 성별, 가족력, 초기 발현증상, 증상 발현과 진단까지의 기간, 진단 시 종양 상태, 안구적출술 후 조직병리학적 검사 결과, 추가적 치료 유무 그리고 환아의 생존 여부 등을 조사하였다. 결과: 총 6명 중 남아가 5명이었으며 초진 시 연령은 평균 32.9 ± 19.1개월이었다. 6명 모두 가족력과 주산기 과거력은 없었고 단안 이상으로 좌안이 5명이었다. 본원에 내원해 시행한 검사 후 초기 진단은 코우츠병, 포도막염이 각각 2명, 그리고 일차유리체증식증과 외상 전방출혈이 각각 1명이었다. 평균 8.3 ± 5.3주의 집중 추적관찰 기간 동안 2명에서 망막하액배액술 후 악성세포가 발견되었고 나머지는 안구크기 증가, 영상검사에서 석회화 소견 등이 보여 6명 모두 악성종양 의심하에 안구적출술을 시행했으며 조직병리검사에서 망막모세포종으로 최종 진단하였다. 이 중 시신경침범이 있었던 환아는 2명이었으며 이후 3명이 전신 항암화학치료를 추가로 시행받았으며 안구적출술 후 평균 7.6 ± 6.3년의 추적관찰 동안 본원에서 진료 받았던 5명 모두 최종 경과관찰 시 평균 10.6 ± 7.4세였으며 모두 생존해 있었다. 결론: 망막모세포종은 조기 진단과 치료가 중요한 질환이지만 망막모세포종 진단에 익숙한 3차 의료기관에서도 조기 감별이 어려운 경우가 있다. 종괴나 석회화 등과 같은 전형적인 임상양상을 보이지 않고 망막박리, 녹내장, 가성전방축농, 전방출혈 등의 초기 양상을 보이며 다른 질환과 감별이 확실하지 않을 때에는 늘 그 가능성을 염두에 두고 집중 관찰하면서 경과를 지켜보는 것이 중요하겠다. Purpose: To report the clinical characteristics of retinoblastoma patients whose diagnosis was difficult due to atypical ocular manifestations. Methods: Among retinoblastoma patients who were diagnosed and treated from January 1999 to December 2014 at Seoul National University Children’s Hospital, 6 patients whose diagnosis was difficult were retrospectively reviewed. Factors including age, sex, family history, initial findings, time to final diagnosis, histopathologic examination, additional treatment, and survival rate were evaluated. Results: Among 6 patients, 5 were male, and the mean age at the initial visit was 32.9 ± 19.1 months. None of the patients had family history, and all presented with unilateral lesion at the initial visit. The initial diagnoses were Coats’ disease and uveitis in 2 patients, respectively, and persistent hyperplastic primary vitreous and traumatic hyphema in 1 patient, respectively. During an intensive short-term follow-up of 8.3 ± 5.3 weeks, 2 patients showed malignant cells after external subretinal fluid drainage procedure, and 4 patients demonstrated increasing ocular size or calcification in imaging. These patients received enucleation under suspicion of malignancy and were finally diagnosed with retinoblastoma after histopathologic examination. There were 2 patients with optic nerve involvement, and 3 patients underwent additional systemic chemotherapy. Five patients were followed-up for 7.6 ± 6.3 years after enucleation, and the mean age at final follow-up was 10.6 ± 7.4 years. Conclusions: Retinoblastoma is one of the diseases in which early diagnosis and treatment are important. However, some cases are difficult to diagnose, even for experienced clinicians. If there are no typical manifestations such as mass or calcification and early findings show retinal detachment, glaucoma, pseudohypopyon, or hyphema, intensive short-term follow-up to exclude retinoblastoma is needed.

기름방울 백내장: 원인미상의 시력저하의 원인

이행진(Haeng Jin Lee),김정열(Jung Yeul Kim),이민우(Min Woo Lee),이연희(Yeon Hee Lee) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 원인미상의 시력저하의 원인 중 하나인 기름방울 백내장에 대해서 보고하고자 한다. 대상과 방법: 후향적으로 의무기록을 조사하여 시력저하의 원인을 알 수 없어 본원 신경안과 분과로 의뢰되어 기름방울 백내장으로 진단된 환자를 모았고 이들을 대상으로 병력, 검사소견, 경과 등의 임상양상에 대해서 조사하였다. 결과: 총 6명의 기름방울 백내장 환자가 포함되었다. 내원한 환자들의 나이는 38세에서 63세였고 초진 시 교정시력은 0.1부터 0.7이었다. 신경안과적 검사를 포함한 안과검사에서 수정체핵의 변화를 제외하고는 모두 정상이었으며 모두에서 망막검영기를 통하여 특징적인 안저 반사를 확인할 수 있었다. 이들 중 4명 5안에서 백내장 수술을 시행하였고 5안 모두에서 수술 후 1.0 이상의 교정시력이 확인되었다. 결론: 기름방울 백내장은 간과되는 원인미상의 시력저하의 원인 중 하나이다. 이 질환은 세극등 현미경에서 수정체핵이 변화가 미세하여 이상을 발견하기 어렵지만 망막검영을 통하여 특징적인 안저반사를 확인할 수 있다. 불필요한 노력과 비용의 소모를 막기 위하여 안과의사는 기름방울 백내장을 잘 이해하고 조기 진단할 수 있어야 하겠다. <대한안과학회지 2016;57(6):963-968> Purpose: To report cases of oil droplet cataract, one cause of decreased vision of unknown etiology. Methods: We performed a retrospective chart review analysis of patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity and diagnosed with oil droplet cataract. Clinical features including history, result of ophthalmologic examinations, and clinical course were evaluated. Results: Among the patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity, 6 patients were diagnosed with oil droplet cataract. The patients ranged from 38 to 63 years of age and their best corrected visual acuities at their first visits were between 0.1 and 0.7. Ophthalmologic examinations including neuro-ophthalmologic tests were normal except for changes in lens nucleus and peculiar fundus reflexes were observed using retinoscopy in all patients. Five eyes of 4 patients underwent cataract surgery and all 5 eyes achieved the best corrected visual acuity of 1.0 or higher. Conclusions: Oil droplet cataract is a cause of decreased visual acuity of unknown etiology that can be missed. The disease abnormalities are difficult to observe because only subtle changes in lens nucleus are apparent on slit lamp examination; however characteristic fundus reflexes can be identified using retinoscopy. Ophthalmologists should thoroughly understand the oil droplet cataract and diagnose it in the early stages to avoid misdiagnosis and unnecessary costs. J Korean Ophthalmol Soc 2016;57(6):963-968

대한민국의 안과 취약 지역 실태에 대한 연구

이행진(Haeng-Jin Lee),김현아(Hyuna Kim),김응수(Ungsoo Samuel Kim) 대한안과학회 2022 대한안과학회지 Vol.63 No.11

목적: 대한민국 전체 의료 기관의 약 90%가 도시에 분포하여 도시와 농촌 간 의료 자원 분포가 심한 불균형을 보이고 있다. 형평성있는 보건의료제도를 확립하기 위해서는 의료 기관 분포와 진료 현황을 파악하고 의료기관 접근 가능성을 살펴보는 것이 필요하다. 본 연구에서는 안과 보건 정책의 토대를 만들고자 안과 의료 기관의 실태를 파악하고자 하였다. 대상과 방법: 각 지역별 안과의원, 보건소와 보건지소의 안과 공중보건의, 군의료시설에서 안과 전문의의 유무를 파악하였다. 취약지역에서 안과 진료가 가능한 지역으로의 이동 시간 및 취약 지역의 인구 현황에 대해 알아보았다. 결과: 우리나라 안과의원 수는 2021년 2/4분기 기준으로 1,658개였으며 지역별로는 서울, 경기, 부산, 대구 순으로 분포하였다. 안과전문의는 3,610명이었고 서울, 경기, 부산, 대구 순으로 분포하였다. 전국 250개 시군구 중 안과의원이 없는 시군구는 20개, 안과전문의가 없는 시군구는 13개였다. 안검진을 위해 인근 지역으로 이동하는 데 걸리는 평균 소요 시간은 자차로 48.0 ± 38.1분, 대중교통으로는 75.1 ± 40.0분이었다. 해당 안과 진료의 빈곤 지역 내에서 총 인구는 558,336명이었으며 취약한 10세 이하의 소아는28,358명이었다. 결론: 안과 진료에 대한 취약 지역 현황을 바탕으로 지리적 접근성, 형평성과 효율성을 제고할 수 있는 보건의료체계 확립이 필요하다고 생각한다. 또한 영유아와 노인 안질환에 대한 검진의 중요성을 감안하고 이를 보완해 나갈 중장기적인 대책 수립과 적극적인 개선이 필요하겠다. Purpose: Approximately 90% of the medical institutions in Korea are located in cities, so there is a disparity in medical resource distribution between urban and rural areas. In order to establish an equal healthcare system, it is necessary to understand the distribution and treatments offered by medical institutions and to investigate access to these facilities. In the present study, we investigated medical institutions offering ophthalmic examinations for children in Korea. Methods: The presence or absence of regional eye clinics and ophthalmologists in public health centers, public health offices, and military medical facilities were investigated in different cities and counties. In addition, the population status and ophthalmic facilities in vulnerable areas were investigated. Results: In the second quarter of 2021, there were 1,658 regional eye clinics in Korea located in Seoul, Gyeonggi, Busan, and Daegu, respectively. There were a total of 3,610 ophthalmologists in Seoul, Gyeonggi, Busan, and Daegu, respectively. Among the 250 counties, 20 did not have eye clinics while 13 did not have an ophthalmologist. The average time required to reach the closest eye examination center was 48.0 ± 38.1 minutes by car and 75.1 ± 40.0 minutes by public transportation. The total population in vulnerable areas was 558,336, including 28,358 children under the age of 10 years. Conclusions: The present study identified vulnerable areas for eye examinations. Based on the findings, it is necessary to establish a healthcare system with improved accessibility, equity, and efficiency considering the importance of ophthalmic examinations in children and the elderly.

급성후천일치내사시 임상 양상과 증량한 내직근후전술 결과

김영은,이행진 대한안과학회 2023 대한안과학회지 Vol.64 No.11

목적: 급성후천일치내사시 환자들의 임상 양상과 증량된 내직근후전술 결과를 분석하고, 수술량에 대한 지표를 제시하고자 하였다. 대상과 방법: 2016년부터 2022년까지 급성후천일치내사시로 진단하고 내직근후전술을 시행한 환자를 대상으로 후향적으로 분석하였다. 내직근후전양은 다른 종류의 내사시를 수술할 때보다 평균 1-2 mm를 추가로 시행하였다. 수술 결과는 수술 6개월째 사시각과복시 유무를 기준으로 분석하였으며, 수술 성공을 위해 필요한 수술량과 증량이 더 필요하였던 군의 특징, 사시각에 따른 수술량 변화를 분석하였다. 결과: 총 38명이 포함되었고 평균 굴절이상은 -3.79 ± 3.11 diopters (D)였다. 수술 시 평균 나이는 25.6 ± 18.2세였고 수술 전 최대사시각은 38.1 ± 11.5 prism diopters (PD)였다. 내직근후전술 양은 6.25 ± 1.4 mm로 기존 내사시 수술량에 비해서 1.2 ± 1.0 mm 추가로 후전하였으며, 내직근후전 증량 정도는 24.1 ± 18.8%였다. 수술 성공률은 사시각 기준 92.1%였고, 감각 성공률은 97.4%였다. 내직근후전 증량 정도는 30 PD 미만, 30-40 PD 그리고 40 PD 이상군에서 각각 26.9%. 25.5%, 20.0%였다. 내직근후전량을 25% 초과로 증량한 군이 나이가 더 많았고, 사시각이 커질수록 수술량에 대한 수술 효과가 증가하였다. 결론: 급성후천일치내사시 수술의 성공적인 결과를 위해서는 수술량을 늘리는 것이 필요하였다. 내직근후전술을 하는 경우 평균 24% 의 증량이 필요하였으며, 수술량을 결정할 때 나이, 사시각 등과 같은 임상인자들을 같이 고려해야겠다. Purpose: To analyze the clinical characteristics of patients with acute acquired comitant esotropia, evaluate the outcomes of augmented medial rectus muscle recession, and propose indicators for determining the appropriate surgical dosage. Methods: Data of patients with acute acquired esotropia who underwent medial rectus recession between 2016 and 2022 were retrospectively analyzed. The amount of medial rectus muscle recession was 1-2 mm greater than for other types of esotropia. Surgical success was assessed by reference to the angle of deviation and diplopia status 6 months after surgery. We investigated the amount of additional recession required for favorable surgical outcomes, the characteristics of groups that required augmentation, and changes in surgical amount according to the deviation angle. Results: A total of 38 patients were included; the average refractive error was -3.79 ± 3.11 diopters (D). Patient age at the time of surgery was 25.6 ± 18.2 years and the preoperative deviation angle was 38.1 ± 11.5 prism diopters (PD). The amount of medial rectus muscle recession was 6.25 ± 1.4 mm, i.e., 1.2 ± 1.0 mm greater than during other surgeries. The average augmentation was 24.1 ± 18.8%. The motor surgical success rate was 92.1% and the sensory success rate was 97.4%. The required augmentation was 26.9% for those with angles of deviation < 30 PD, 25.5% for patients with angles between 30 and 40 PD, and 20.0% for those with angles > 40 PD. Patients who required augmentation > 25% were older, and the surgical effect was greater as the angle of deviation increased. Conclusions: To ensure successful surgical outcomes of patients with acute acquired comitant esotropia, it is essential to increase the amount of medial rectus recession compared to that during other surgeries; the average augmentation was 24% in this study.

Combined Cataract Extraction and Vitrectomy for Macula-sparing Retinal Detachment: Visual Outcomes and Complications

김경남,이행진,허동원,조영준,김정열 대한안과학회 2015 Korean Journal of Ophthalmology Vol.29 No.3

Purpose: To evaluate the visual outcome of combined phacoemulsification, intraocular lens implantation, andvitrectomy for macula-sparing rhegmatogenous retinal detachment. Methods: The results of combined vitrectomy with cataract extraction were retrospectively analyzed in patientswith preexisting cataracts and new-onset rhegmatogenous retinal detachment. To qualify, patients must alsohave had macular sparing in a region 6,000 μm in diameter on optical coherence tomography. The anatomicalsuccess rate, visual outcomes, and postoperative complications relating to visual acuity were evaluated. Results: In 56 patients followed postoperatively for more than 12 months, the initial and final surgical successrate was 96.4% and 100%, respectively. The mean preoperative logarithm of the minimum angle of resolutionvisual acuity was 0.05 and decreased to 0.11 postoperatively (p < 0.001). Of the 56 patients, 20 (35.7%) hadworse visual acuity postoperatively, compared with preoperatively (0.06 vs. 0.27, p < 0.001); these cases werecomprised of six patients with epiretinal membranes, 12 patients with a posterior capsule opacity, and twopatients with cystoid macular edema. In the remaining 36 patients, there were no significant differences invisual acuity preoperatively and postoperatively (0.04 vs. 0.03, p = 0.324). Conclusions: In patients with cataracts who develop macula-sparing rhegmatogenous retinal detachmentand whose visual prognosis is excellent assuming the retina can be reattached successfully, combinedphacoemulsification, intraocular lens implantation, and vitrectomy might be an effective treatment. However,the visual prognosis is significantly affected by postoperative complications such as an epiretinal membranes,posterior capsule opacity, and cystoid macular edema. Therefore, further studies should examine methods toprevent these postoperative complications. Purpose: To evaluate the visual outcome of combined phacoemulsification, intraocular lens implantation, and vitrectomy for macula-sparing rhegmatogenous retinal detachment. Methods: The results of combined vitrectomy with cataract extraction were retrospectively analyzed in patients with preexisting cataracts and new-onset rhegmatogenous retinal detachment. To qualify, patients must also have had macular sparing in a region 6,000 μm in diameter on optical coherence tomography. The anatomical success rate, visual outcomes, and postoperative complications relating to visual acuity were evaluated. Results: In 56 patients followed postoperatively for more than 12 months, the initial and final surgical success rate was 96.4% and 100%, respectively. The mean preoperative logarithm of the minimum angle of resolution visual acuity was 0.05 and decreased to 0.11 postoperatively (p < 0.001). Of the 56 patients, 20 (35.7%) had worse visual acuity postoperatively, compared with preoperatively (0.06 vs. 0.27, p < 0.001); these cases were comprised of six patients with epiretinal membranes, 12 patients with a posterior capsule opacity, and two patients with cystoid macular edema. In the remaining 36 patients, there were no significant differences in visual acuity preoperatively and postoperatively (0.04 vs. 0.03, p = 0.324). Conclusions: In patients with cataracts who develop macula-sparing rhegmatogenous retinal detachment and whose visual prognosis is excellent assuming the retina can be reattached successfully, combined phacoemulsification, intraocular lens implantation, and vitrectomy might be an effective treatment. However, the visual prognosis is significantly affected by postoperative complications such as an epiretinal membranes, posterior capsule opacity, and cystoid macular edema. Therefore, further studies should examine methods to prevent these postoperative complications.

시삭증후군 환자에서 빛간섭단층촬영의 소견

김정열,이행진,곽주영,이연희,Jung Yeul Kim,Haeng Jin Lee,Joo Young Kwag,Yeon Hee Lee 대한안과학회 2013 대한안과학회지 Vol.54 No.7

Purpose: To report a case of optic tract syndrome in which optical coherence tomography (OCT) demonstrated the specific findings of the retinal nerve fiber layer (RNFL). Case summary: A 32-year-old male patient visited the hospital with right side visual field defect in both eyes that occurred immediately after a traffic accident 8 months prior. The visual acuity of both eyes was normal, and a relative afferent papillary defect was evident in the right eye. In addition, suspicious band atrophy of the right optic disc and thinning of the superior and inferior arcuate bundle were observed in the left eye. On visual field examination, homonymous hemianopia was present. Optic tract syndrome was suspected, although there was no abnormality of the visual tract on MRI. On fast RNFL thickness 3.4 scan, a thinning of RNFL in the nasal and temporal segments in the right eye and superior and inferior segments in the left eye were observed. Based on the findings, optic tract syndrome was diagnosed in the left eye. Conclusions: We report specific OCT findings which can be useful when making a diagnosis of optic tract syndrome.