Comparison of Systemic Adverse Events Associated with Intravitreal Anti-VEGF Injection: Ranibizumab versus Bevacizumab

황덕진,Yong Woo Kim,우세준,박규형 대한의학회 2012 Journal of Korean medical science Vol.27 No.12

The aim of this study was to compare the incidence of systemic adverse events in patients treated with intravitreal injections of bevacizumab or ranibizumab, and to evaluate whether compared to ranibizumab administration, bevacizumab constitutes a higher risk for systemic adverse events. A retrospective review was conducted for 916 consecutive patients treated with at least 1 intravitreal injection of bevacizumab or ranibizumab. Cox regression was performed to assess whether a variable had predictive value for occurrence of new systemic adverse events and to account for different follow-up times. A total of 702 patients were analyzed; 503 patients received bevacizumab alone, and 199 patients received ranibizumab alone. Systemic adverse events occurred in 10 of 702 patients (1.4%):7 in the bevacizumab group (7/503; 1.4%) and 3 in the ranibizumab group (3/199; 1.5%). This difference was not statistically significant (Fisher’s exact test, P = 0.573). Cox proportional hazards analysis of 4 models did not reveal a covariate that significantly changed the hazard for systemic adverse events. In conclusion, compared to ranibizumab,bevacizumab may not increase the risk of systemic adverse events in patients receiving intravitreal injections.

심한 비증식당뇨망막병증에서 Calcium Dobesilate가 내측황반두께에 미치는 영향

황덕진 대한검안학회 2023 Annals of optometry and contact lens Vol.22 No.2

Purpose: To investigate the effect of calcium dobesilate on inner macular thickness measured with optical coherence tomography in the eyes with severe non-proliferative diabetic retinopathy (NPDR). Methods: The study participants were 28 patients (n = 28 eyes) who had severe NPDR without severe diabetic macular edema and who were followed up after treatment with calcium dobesilate for ≥ 3 months. Central macular thickness (CMT), total macular volume (TMV), and ganglion cell complex (GCC) at baseline and the 3 months follow-up were analyzed retrospectively. The matched patients with bilberry dried extract were selected and compared as a control group. Results: In the calcium dobesilate group, the CMT and TMV measured before and 3 months after treatment were 265.36 ± 16.31 μm, 8.72 ± 0.45 mm3 and 262.39 ± 15.13 μm, 8.67 ± 0.46 mm3, respectively. A significant decrease in observation time was observed (p = 0.009, p = 0.010). GCC decreased from 106.31 ± 8.16 μm to 105.18 ± 7.53 μm (p = 0.036), of which retinal nerve fiber layer decreased from 34.27 ± 3.96 μm to 33.93 ± 3.80 μm (p = 0.219), and GCL from 39.47 ± 3.61 μm to 38.87 ± 3.217 μm (p = 0.012), inner plexiform layer changed from 32.56 ± 2.24 μm to 32.39 ± 2.14 μm (p = 0.211). Conclusions: In patients with severe NPDR, a decrease in inner retinal thickness was observed after 3 months of taking calcium dobesilate, and the ganglion cell layer showed a significant decrease in thickness. 목적: Calcium dobesilate를 복용한 심한 비증식당뇨망막병증 환자들의 복용 전후 내측황반부두께의 변화를 알아보고자 하였다. 대상과 방법: 본원에서 심한 비증식당뇨망막병증으로 진단된 후 3개월 이상 calcium dobesilate를 복용하고, 경과 관찰된 28명 28안을 대상으로 약물 투여 전, 3개월 후 빛간섭단층촬영으로 측정한 중심망막두께, 전체황반부피, 내측황반부두께, 즉 망막신경섬유층(retinal nerve fiber layer, RNFL), 신경절세포층(ganglion cell layer, GCL), 내망상층(inner plexiform layer, IPL)의 두께 자료를 후향적으로 분석하였다. 동일한 조건의 bilberry dried extract을 복용한 대조군을 선정하여 비교하였다. 결과: 환자군에서 치료 전, 치료 후 3개월 시점에 측정한 중심망막두께와 전체황반부피는 치료 전과 비교하여 치료 3개월 경과 관찰 시점의 유의한 감소가 관찰되었다(p = 0.009, p = 0.010). 내측황반부두께는 106.31 ± 8.16 μm에서 105.18 ± 7.53 μm로 감소하였는데(p = 0.036), 그중 황반부신경섬유층, 황반부내망상층은 유의한 감소가 없었고(all p > 0.05), 황반부신경절세포층은 39.47 ± 3.61 μm에서 38.87 ± 3.21 μm로 유의하게 감소하였다(p = 0.012). 결론: 심한 비증식당뇨망막병증 환자에서 calcium dobesilate 복용 후 3개월 경과 관찰 시에 내측황반부두께 감소가 관찰되었고 그중 신경절세포층은 유의한 두께 감소를 보였다.

갑상샘눈병증과 혈청 자가항체의 관련성에 관한 연구

황덕진,김윤정.Duck Jin Hwang. MD. Yun Jeong Kim. MD 대한안과학회 2010 대한안과학회지 Vol.51 No.9

Purpose: The same autoimmune process is thought to cause thyroid associated ophthalmopathy (TAO) and Graves disease. The aim of this study is to determine whether thyroid autoantibody is related to the development of thyroid associated ophthalmopathy. Methods: A retrospective chart analysis was performed on patients with a newly diagnosed Graves’ disease, who presented to our ophthalmology clinic between January 2006 and December 2009. Thyroid autoantibody titers were obtained at the time of diagnosis and were used to determine the presence or absence of TAO. In addition, any correlations between thyroid autoantibodies were analyzed in patients with TAO. Results: Thyroid autoantibody levels correlated with the development of TAO. Fifty-eight (69%) out of 84 patients with positive thyroid-stimulating hormone receptor antibody (TRAB) levels at the time of diagnosis had TAO. Only 50 (51%) of the 99 patients with negative TRAB levels had TAO. This difference between the two groups was statistically significant (odds ratio, OR=2.2, p=0.013). A statistically significant correlation with the development of TAO was also found in thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb), respectively (OR=0.5, p=0.317; OR=0.3, p=<0.001). In patients with TAO, the correlation between TPOAb and TgAb levels was very high (r=0.64, p=<0.001). Conclusions: A significant association was determined to exist between the development of TAO and thyroid autoantibody level. This result demonstrates the clinical utility of thyroid autoantibody for the diagnosis of TAO in patients with newly diagnosed Graves disease. J Korean Ophthalmol Soc 2010;51(9):1167-1173

전환 정액일괄도급 계약방식 프로젝트의 리스크 분석

황덕진,문승재,유호선,Hwang, Duk-Jin,Moon, Seung-Jae,Yoo, Ho-seon 한국플랜트학회 2011 플랜트 저널 Vol.7 No.2

Due to the recent uncertainty of market situations such as the escalation of petroleum prices, increased production capacities of plants, limitations of the available EPC (Engineering, Procurement, Construction) contractors, and the increase of raw material prices, EPC contractors have had a tendency to include a higher reserve contingency in the lump-sum turnkey contract price. In order to overcome the changes in the market, the plant project construction industry has started to apply the converted lump-sum turnkey contract in plant construction market. This study was focused to find the associated risks and to analyse the identified risks on recent trend of application of the new contract type, which is the converted lump-sum turnkey contract. It was recognized from the analysis that quality and cost have more high priority risks than other project objectives. This paper also suggests the mitigation plan for identified risks to achieve project objectives appropriate to the converted lump-sum turnkey project from the viewpoint of an EPC contractor keeping transparency with owner.

특발성 망막전막의 유리체 절제술 후 시력과 망막두께의 장기변화 관찰

황덕진,나경익,권순일,박인원,Duck Jin Hwang,MD,Kyeong Ik Na,MD,Soon Il Kwon,MD,In Won Park,MD,PhD 대한안과학회 2012 대한안과학회지 Vol.53 No.3

Purpose: To evaluate the clinical outcomes of visual acuity and foveal thickness after vitrectomy for an idiopathic epiretinal membrane (ERM). Methods: We retrospectively reviewed the records of 62 patients (62 eyes) with ERM who had been treated with vitrectomy between 2004 and 2009. Visual acuity and central macular thickness from optical coherence tomography imaging were obtained preoperatively and at every postoperative follow-up visit. Results: Mean preoperative visual acuity and central macular thickness were 0.495 ± 0.292 log MAR and 414.645 ± 95.528 μm, respectively. Mean visual acuity and central macular thickness 1 month after surgery were 0.389 ± 0.373 log MAR and 341.484 ± 73.676 μm, respectively. Visual acuity improved within 9 months and central macular thickness significantly decreased 12 months after surgery. Most of the changes in visual acuity and central macular thickness took place during the first 3 months. The only parameter which was significantly correlated with final visual acuity was preoperative visual acuity (0.635) (p < 0.001). Conclusions: Visual acuity and central macular thickness improved 12 months months after vitrectomy in patients with idiopathic ERM. Preoperative visual acuity had a significant correlation with final visual acuity. J Korean Ophthalmol Soc 2012;53(3):434-439

Oral Administration of Cilostazol Increases Ocular Blood Flow in Patients with Diabetic Retinopathy

황덕진,신주영,유형곤 대한안과학회 2017 Korean Journal of Ophthalmology Vol.31 No.2

Purpose: To investigate the effect of cilostazol on ocular hemodynamics and to determine whether the administrationof cilostazol increases the ocular blood flow in patients with diabetic retinopathy. Methods: This prospective observational study investigated the effect of orally administered cilostazol on diabeticretinopathy. Before and after administration for 1 week, pulsatile ocular blood flow (POBF) and retrobulbarhemodynamics were measured using a POBF analyzer and transcranial Doppler imaging, respectively. Visual acuity, intraocular pressure, and blood pressure were also evaluated before and after treatment. Results: Twenty-five eyes of 25 patients were included in this study. POBF increased significantly (16.8 ± 4.6μL/sec vs. 19.6 ± 6.2 μL/sec, p < 0.001) after administration of cilostazol, while no significant change was identifiedin visual acuity, intraocular pressure, and blood pressure. Mean flow velocity in the ophthalmic artery asmeasured with transcranial Doppler imaging also increased significantly after medication (23.5 ± 5.6 cm/secvs. 26.0 ± 6.9 cm/sec, p = 0.001). The change in POBF directly correlated with the change in mean flow velocity(r = 0.419, p = 0.007). Conclusions: Cilostazol was effective in increasing ocular blood flow in patients with diabetic retinopathy, possiblyby modulating retrobulbar circulation.

황반원공을 동반한 2형 황반부 모세혈관 확장증의 수술 결과

이수찬,황덕진,이경민,박영숙,손준홍 한국망막학회 2019 Journal of Retina Vol.4 No.2

Purpose: To report the surgical outcomes of cavitation or full thickness macular hole (FTMH) developing in macular telangiectasia (Mac- Tel) type 2. Methods: This is a retrospective study of patients who underwent vitrectomy for MH or lamellar hole (LH) developed in MacTel. Patients with characteristic findings of MacTel on optical coherence tomography (OCT) and fluorescein angiography or with characteristic OCT findings in both eyes were classified as having MacTel (MacTel with FTMH: 4 eyes, MacTel with cavitation: 4 eyes) postoperative outcomes including best corrected visual acuity (BCVA) and macular configuration by OCT were reviewed. Results: In the FTMH group, BCVA improved to more than 0.2 logMAR in 2/4 eyes and decreased in 2/4 eyes. In the cavitation-associated group, BCVA improved in 1/4 eyes, remained unchanged in 3/4 eyes, and decreased in no eyes. The FTMH was closed in 3/4 eyes, and in 4 patients with cavitation, all defect sites were recovered after surgery. Conclusions: The surgical outcome for MacTel-associated cavitation or FTMH was worse than that of conventional LH or MH. However, it was better than that found in past reports. Thus, surgical treatment can be considered in cases of continuous visual deterioration.

불응성 당뇨황반부종에서 빛간섭단층촬영혈관조영의 특징 고찰

이학준,황덕진 한국망막학회 2022 Journal of Retina Vol.7 No.1

Purpose: To evaluate the characteristics of patients with diabetic macular edema (DME) unresponsive to intravitreal bevacizumab injection using optical coherence tomography angiography (OCTA) taken before the administration of combined intravitreal bevacizumab and posterior subtenon triamcinolone injection. Methods: This retrospective study included 16 eyes of 16 patients with DME that did not respond to intravitreal bevacizumab injection. We defined refractory DME as ≥ 300-μm CMT (central macular thickness) and a < 30-μm CMT reduction after three consecutive bevacizumab injections or increased CMT after two consecutive bevacizumab injections. Vessel density (VD) of the superficial retinal capillary plexus (SCP) and deep retinal capillary plexus (DCP) was measured using OCTA before combination therapy with intravitreal bevacizumab and posterior subtenon triamcinolone injection. We evaluated whether there are factors that can predict treatment response to combination therapy. Results: VD of the SCP and DCP before injection was 38.10% ± 2.67% and 36.08% ± 3.45%, respectively. The larger the VD difference between the SCP and DCP before injection (SCP VD–DCP VD), the greater the decrease in CMT and improvement in visual acuity 1 month after injection (p = 0.035, p = 0.025, respectively). Conclusions: OCTA in patients with DME unresponsive to bevacizumab injection showed that a greater VD difference between the DCP and SCP was associated with a greater decrease in CMT and improvement in visual acuity after combined intravitreal bevacizumab-subtenon triamcinolone injection therapy. 목적: 유리체강 내 베바시주맙 주사 치료에 불응성인 당뇨황반부종에서 유리체강 내 베바시주맙-후테논낭하 트리암시놀론 병합치료를 시행하기 전 촬영한 빛간섭단층촬영혈관조영의 특징을 확인하고 병합요법에 대한 치료 반응 여부를 예측할 수 있는 인자를 확인하고자 하였다. 대상과 방법: 중심황반두께가 300 μm 이상이며 한 달 간격 3번의 연속된 베바시주맙 주사 이후 중심망막두께가 30 μm 이상 감소되지않거나 2번의 연속된 베바시주맙 주사 이후에도 중심망막두께가 증가된 환자를 불응성 당뇨황반부종으로 정의하였으며, 이들 중 16명16안을 대상으로 후향적 의무기록 분석을 시행하였다. 병합요법 전에 촬영한 빛간섭단층촬영혈관조영술을 분석하여 superficial retinal capillary plexus (SCP)와 deep retinal capillary plexus (DCP)의 vessel density (VD)를 알아보았다. 결과: 빛간섭단층촬영혈관조영술로 측정한 주사 전 SCP와 DCP의 VD는 각각 38.10% ± 2.67%, 36.08% ± 3.45%였다. 주사전 SCP와 DCP의 VD 차이(SCP VD–DCP VD)가 클수록 주사 1개월 후 중심망막두께 감소량과 시력개선 정도가 큰 경향성을 보였다(각각 p = 0.035, p = 0.025). 결론: 불응성 당뇨황반부종 환자에서 시행한 빛간섭단층촬영혈관조영술에서 DCP의 VD가 SCP의 VD보다 많이 감소되어 있을수록병합요법 후 한 달째 중심망막두께가 더 많이 감소하였고 시력개선이 컸다.

편측성 중심망막동맥폐쇄 환자에서 맥락막 두께의 시간에 따른 변화

김동익,황덕진 한국망막학회 2021 Journal of Retina Vol.6 No.2

Purpose: To investigate the changes in the choroidal thickness of patients with central retinal artery occlusion (CRAO) over time and compare it with the changes in the fellow eye. Methods: Medical records were retrospectively reviewed for patients diagnosed with CRAO from November 2014 to May 2020. The central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) were measured at the time of diagnosis and at 1, 3, 6, and 12 months after diagnosis using optical coherence tomography and compared with the values of the fellow eye. Results: This study included 32 patients, and the mean age was 76.3 ± 10.0 years. When classified according to the degree of obstruction, seven patients presented incomplete occlusion, 21 patients presented partial occlusion, and four patients presented total occlusion. At diagnosis, the CFT of the eye with CRAO was thicker than that of the fellow eye (p = 0.017). It decreased continuously from 1 month to 12 months after diagnosis. The SFCT at baseline and 12 months after diagnoses did not differ significantly. However, from the time of diagnosis to 12 months after diagnosis, the decrease in the SFCT was greater in the eye with CRAO than in the fellow eye (p = 0.018). Conclusions: The SFCT of the eye with CRAO significantly decreased 12 months after diagnosis, and this reduction was more than that in the fellow eye. 목적: 중심망막동맥폐쇄 환자의 맥락막 두께의 변화를 시간에 따라 분석하고 반대안과 비교하여 살펴보고자 하였다. 대상과 방법: 2014년 11월부터 2020년 5월까지 중심망막동맥폐쇄로 진단받은 환자들을 대상으로 의무기록을 후향적으로 분석하였다. 빛간섭단층촬영을 이용하여 진단 시와 진단 후 1, 3, 6, 12개월 추적 관찰 시의 중심황반 두께, 중심와 아래 맥락막 두께를 측정하였고, 반대안과 그 값을 비교하였다. 결과: 총 32명이 포함되었으며 평균 연령은 76.3 ± 10.0세였고 폐쇄 정도에 따라 분류하였을 때 불완전폐쇄 7명, 부분폐쇄 21명, 전체폐쇄 4명이었다. 진단 시 중심황반 두께는 반대안에 비하여 두꺼웠으며(p = 0.017) 진단 후 1개월부터 12개월까지 지속해서 감소하였다. 진단 시와 진단 후 12개월에 중심와 아래 맥락막 두께는 양안 간에 차이가 없었으나 12개월 동안 중심와 아래 맥락막 두께의 감소량은 중심망막동맥폐쇄가 발생하였던 눈에서 반대안에 비하여 컸다(p = 0.018). 결론: 중심망막동맥폐쇄가 발생한 눈의 중심와 아래 맥락막 두께는 12개월 경과 관찰하였을 때 유의하게 감소하였고, 반대안에 비하여더 많은 양이 감소하였다.

Bietti Crystalline Retinopathy Confirmed by Mutation of CYP4V2 Gene in a Korean Patient

박영주,황덕진,성문우,박성섭,우세준 대한안과학회 2016 Korean Journal of Ophthalmology Vol.30 No.1