웨이브프론트의 연속 측정방법으로 분석한 눈물막의 불안정성에 따른 고위수차 변화

최시환,신용일 대한안과학회 2012 대한안과학회지 Vol.53 No.8

Purpose: To evaluate the changes of higher order aberration according to tear-film instability measured serially by KR-1W wavefront every second for 10 seconds. The present study also analyzed the relationship between higher order aberration and the tear-film break-up time, Schirmer test, and superficial punctate keratitis. Methods: The 228 eyes of 114 patients randomly selected from patients who visited hospital were measured once every second for 10 seconds after eye blinking by continuous measurement using wavefront. Results: Higher order aberration increased overtime, and the higher order aberration value measured at the tenth second subtracted from the value of the first second was statistically significant (p = 0.004). In addition, the increment in higher order aberration between 9 seconds and 10 seconds was statistically significant (p = 0.01). The group of patients with a tear-film break-up time less than 6 seconds showed the greatest changes when measuring the higher order aberration difference value between the tenth and first seconds, which was statistically significant (p = 0.002). The group of patients where the Schirmer test results were longer than 10 millimeters and who had superficial punctate keratitis showed the greatest statistically significant changes when measuring the difference in higher order aberration values between the tenth and first seconds (p = 0.008, p = 0.005, respectively). Conclusions: Analysis of higher order aberration by wavefront could be useful in cases of decreased optical quality, diagnosis and evaluation of treatment in dry eye syndrome. J Korean Ophthalmol Soc 2012;53(8):1076-1080

두가지 눈추적장치를 사용한 라식 후 중심이탈의 분석

최시환,이연희,김진하,Si-Hwan Choi,Yeon-Hee Lee,Jin-Ha Kim 대한안과학회 2005 대한안과학회지 Vol.46 No.3

Purpose: To evaluate the efficacy of two excimer laser systems with eye-tracker in the term of decentration amount. Methods: We performed LASIK with LaserScan LSXTM (group 1, 39 eyes) and Allegretto WaveTM (group 2, 94 eyes), both of which were equipped with eye-tracker. The amount of decentration was measured on a difference map that was obtained from preoperative and postoperative corneal topography, and was compared between the two groups. Results: The amount of decentration was significantly higher in group 1 (0.39±0.22 mm) than in group 2 (0.29±0.18 mm) (p=0.018). When these groups were subdivided by preoperative spherical equivalent, in case of under -6.0 D, the amount of decentration between the two groups (0.31±0.16 mm in group 1, 0.28±0.15 mm in group 2, p=0.380), whereas in case of over -6.0 D, the amount of decentration was significantly higher in group 1 (0.48±0.26 mm) than in group 2 (0.30±0.21 mm) (p=0.020). Conclusions: Allegretto WaveTM showed better centration ability than LaserScan LSXTM and this superiority was more profound in highly myopic eyes.

단안 안검봉합에 의한 병아리 안구크기의 변화

최시환,김세윤,서병로,민병무 충남대학교 의과대학 지역사회의학연구소 1991 충남의대잡지 Vol.18 No.2

In an attempt to elucidate the eyeball enlargement by eyelid suture, two-day old white Leghorn chickens (n=20) were lightly anesthetized with ether and monocular upper and lower eyelids were sutured together with 6-0 black silk. The other eye was used as control group. Refractive error, corneal curvature, or axial length by ultrasonography were assessed before the study, and 3 weeks and 6 weeks after lid suture. Dimensional changes, intraocular pressure, and weight of enucleated eyeball were measured at 6 weeks. The results of the study were as follows: 1. The eyelid sutured group developed significant axial elongation (11.00±0.36mm vs 10.69±0.24mm, mean±SD, by ultrasonography; 12.57±0.66mm vs 12.02±0.41mm by micrometer), equatorial length (15.48±0.45mm vs 15.32±0.48mm), and weight (1.51± 0.12g vs 1.39±0.09g) in comparison with control group. 2. Corneal sag and diameter, intraocular pressure, and refractive error were not significantly different between both groups. Our results support the hypothesis that form-vision deprivation induces the enlargement of eyeball, especially the posterior segment of the eyeball.

인공수정체안의 생체 측정

최시환,이성복 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

In case of exchange of intraocular lenses(IOL) in pseudophakia, errors can happen in measuring axial length because of existing IOL. Therefore, we examined the accuracy of axial length measurement in pseudophakia by measuring axial lengths of pre- and post-operation. Eighty nine eyes of 77 patients were divided into four groups in the order of description (AMO SI3ONB, Staar AQ2003V, Pharmacia 720A, and HOYA UY-60SA) : Group 1 and 2 for silicone lenses, and 3 and 4 for PMMA lenses. We compared pre- and post-operative axial lengths with Ocuscan (Alcon, U.S.A.). The postoperative axial lengths were measured by phakic, aphakic, and pseudophakic mode. In pseudophakic mode, the velocity in IOL part was set at the rate of 980 and 1532 m/sec for Group 1 and 2, and 1532 and 2718 m/sec for Group 3 and 4. The preoperative average axial lengths of four groups were 23.34, 22.92, 22.88 and 23.73 mm, respectively. The postoperative average axial lengths of Group 1 and 2 were 23.20 and 23.07 mm at the rate of 980 m/sec in pseudophakic mode, and for Group 3 and 4, the lengths were 22.88 and 23.81 mm at the rate of 2718 m/sec in pseudophakic mode, and they were very close to the preoperative values. We can get the closest values to preoperative axial length by setting the velocity in pseudophakic mode at the rate of 980 m/sec for silicone lens and 2718 m/sec for PMMA lens.

토안에서 금판 삽입술의 효과

최시환,박영규,박우찬 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.1

Lagophthalmos can result in serious keratopathy because of corneal exposure and inadequate lacrimation. Four patients underwent gold plate insertion to rehabilitate paralysis of the eyelid caused by facial nerve palsy. Gold plate insertion resulted in exellent eyelid closure, protection, and cosmesis. There were no infections or extrusions. Lagophthalmos and exposure keratitis were resolved or were significantly improved in these patients. In selected patients this technique reestablishes a voluntary blink and provides corneal protection without the limitation of tarsorrhaphy. Gold plate insertion has become the procedure of choice for eyelid rehabilitation.

초자체 출혈에 있어서 조직형 플라스미노젠 활성제의 효능

최시환 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.1

Tissue plasminogen activator(tPA) is a fibrin-specific fibrinolytic agent that has recently been shown to be effective in accelerating the clearance of hyphema. Intravitreal injection of tPA can promote repid lysis of experimental intravitreal fibrin clots. The purpose of this study was to investigate the efficacy of intravitreal tPA injection for the treatment of vitreous hemorrhage in the phakic non-vitrectomized rabbit eyes. Vitreous hemorrhages were produced by intravitreal injections of 0.55ml of autologous whole blood in twenty-five rabbit eyes with intact vitreous. The injection of 25 or 100 microgram of tPA in fifteen eyes resulted in the clearance of vitreous hemorrhage in 99±19 or 34±6.5 days respectively. This was significantly faster than control eyes in which the clearance was not seen until 131±17 days later. No tractional retinal datachment was observed.

각막형태검사법을 이용한 각막양상과 눈의 굴절력과의 관계

최시환,민병무,김용백,김창식,안승일 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

We evaluated the topography of 200 normal cornea of Korean. The mean age was 37 years and mean refractive astigmatism was 0.82±0.69D. The corneal patterns were classified by Dr. Bogan such as round, oval, symmetric bow tie, asymmetric bow tie, and irregular pattern. Its incidence was 14.0%, 11.0%, 16.0%, 30.0% and 29.0%, respectively. There was no statistically significant difference in the distribution of topographic pattern in male and female and among age groups. The symmetric bow tie type had the greatest spherical equivalent and astigmatism and there was no statistically significant difference in those two values between round and oval group. Two bow-tie groups were not also statistically significantly different from each other in spherical equivalent and astigmatism. However, two bow tie groups were significantly different from round and oval group. So, it was possible to divide corneal topographic pattern into three groups such as round and oval, two bow tie, and irregualr group. We could understand normal corneal status related to corneal pattern and refractive power through this qualitative system for classifying corneal topography.

안구길이, 수정체전낭-망막길이, 굴절상태 및 각막굴절력간의 상호관계

최시환,박주희,박우찬 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

Axial length is major determinant of ocular refractive power. The purpose of this study was to establish the interrelationship among axial length, anterior lens capsule to retina length(ACRL), refractive states, and corneal refractive power. We measured above four variables of 364 normal adult eyes. The results were as follows: 1. The mean axial length and ACRL of all 364 eyes were 24.93(±1.25mm) and 21.59(±1.20mm) respectively. 2. The mean axial length and ACRL of 63 eyes within ±1 diopter were 23.64(±0.82mm) and 20.34(±0.79mm) respectively. 3. Refractive states, axial length, and ACRL were closely associated. The coefficient of correlation between refractive states and axial length is r=-0.7542(p<0.001), the one between refractive states and ACRL is r=-0.7526(p<0.001). 4. The coefficient of correlation between corneal refractive power and axial length is r=-0.3589(p<0.001), the one between corneal refractive power and ACRL is r=-0.3727(p<0.001). 5. Axial length/ACRL ratio of 63 eyes within ±1 diopter is 1.16(±0.02).

베게너 육아종증 환자에서 시행한 성공적인 내시경적눈물주머니코안연결술

최시환,이민우,이종주,이성복 대한안과학회 2015 대한안과학회지 Vol.56 No.9

목적: 베게너 육아종증 환자에게 발생한 코눈물관 폐쇄를 내시경적눈물주머니코안연결술로 치료한 1예를 보고하고자 한다. 증례요약: 내원 3년 전 베게너 육아종증을 진단 받고 rituximab 투여 뒤 현재는 안정된 상태로 azathioprine 100 mg을 복용 중인36세 여자 환자가 1년 전부터 시작된 좌안 눈물 흐름 및 고름이 차는 증상을 주소로 내원하였다. 초진 시 좌안의 눈물띠 높이가 우안에 비해 높았으며 더듬자 검사상 hard stop, 눈물소관 관류술상 점액이 역류되었고, 비강은 육아종에 의하여 중간 코선반이 관찰되지 않았다. 눈물주머니조영술에서 좌안 근위부 코눈물관 폐쇄 소견을 보였으며 안면부 3차원 단층 영상에선 좌측 눈물주머니오목에 경계가 명확한 6×5×6 mm 크기의 눈물낭종이 관찰되었다. 비강내 육아종에 대하여 유착해리술을 시행한 후 내시경적눈물주머니코안연결술을 시행하였고, 재유착을 예방할 목적으로 silastic sheet를 비중격에 봉합하였다. Silastic sheet는 2주 후, 실리콘 관은 4개월째에 제거하였다. 술 후 5개월째 좌안 눈물흘림은 없었으며, 눈물소관 관류술에서 잘 관류되었고 골공을 통해 fluorescein dye가 잘 흘러 만족할 만한 결과를 얻었다. 결론: 베게너 육아종증 환자에게 발생한 코눈물관 폐쇄에서 육아종으로 비강이 좁아져 있더라도 내시경적눈물주머니코안연결술로 치료가 가능하다고 생각된다. Purpose: To report a case of nasolacrimal duct obstruction occurring in a patient with Wegener granulomatosis treated successfully with endoscopic dacryocystorhinostomy. Case summary: A 36-year-old female diagnosed with Wegener’s granulomatosis 3 years prior and treated with rituximab and currently taking azathioprine 100 mg presented with a 1-year history of left epiphora and mucus in the left eye. Her left tear meniscus was higher than the right and was a hard stop with lacrimal probe when a lacrimal probing test was performed. Mucus was regurgitated during lacrimal irrigation and middle turbinate was not observed due to granuloma in the nasal cavity. Dacryocystography showed proximal nasolacrimal duct obstruction and a well-defined dacryocystocele 6 x 5 x 6 mm in size was observed on the left lacrimal fossa on facial 3D computed tomography. After synechiolysis for a granuloma in the nasal cavity, endoscopic dacryocystorhinostomy was performed and silastic sheet sutured on the nasal septum to prevent resynechia. After 2 weeks and 4 months, the silastic sheet and silicon tube were removed, respectively. The patient was asymptomatic following surgery and there was no regurgitation during lacrimal irrigation test. The ostium was patent at 5 months after surgery using the endoscopic dye test. Conclusions: Nasolacrimal duct obstruction occurring in a patient with Wegener’s granulomatosis can be treated effectively with endoscopic dacryocystorhinostomy even if the nasal cavity is narrow due to granuloma.

각막공여를 위한 굴절교정수술 여부의 식별

최시환,이연희,윤여민,이재림,Si-Hwan Choi,M,D,Yeon-Hee Lee,M,D,Yie-Min Yun,M,D,Jae-Lim Lee,M,D 대한안과학회 2005 대한안과학회지 Vol.46 No.2

Purpose: To provide fundamental data for screening for prior refractive surgery in donor cornea. Methods: The corneal curvature map and pachymetric measurements were analyzed in 68 eyes that had undergone corneal refractive surgery. Differences in the corneal curvature of the center and periphery, differences in the corneal thickness of the center and periphery, and the shape factor on the curvature map in postoperative eyes were compared with preoperative measurements. Results: Measurement of the central corneal curvature subtracted from the peripheral corneal curvature was -1.64±0.71D in the preoperative eyes and 3.10±1.68D in the postoperative eyes. With a criterion of -0.23D, the sensitivity and specificity were 100% and 98.5%, respectively. The shape factor was 0.24±0.09 in the preoperative eyes and -0.82±0.45 in the postoperative eyes. With a criterion of 0.058, the sensitivity and specificity were both 100%. Measurement of the central corneal thickness subtracted from the peripheral corneal thickness was 97.60±25.42 ?m in the preoperative eyes and 163.47±38.5 ?m in the postoperative eyes. With a criterion of 123.0 ?m, the sensitivity and specificity were 89.7% and 88.4%, respectively. Conclusions: Regional differences in corneal curvature and shape factor may be very useful parameters in screening for prior refractive surgery in donor cornea. The difference in corneal thickness may also be a useful parameter.