미세절개백내장수술에서 투명각막절개창의 위치에 따른 난시 변화 분석

황웅주,변용수,주천기.Woong-Joo Whang. MD. Yong-Soo Byun. MD. Choun-Ki Joo. MD. PhD 대한안과학회 2011 대한안과학회지 Vol.52 No.1

Purpose: To determine if a difference exists in surgically-induced astigmatism (SIA) and the mean change in keratometric astigmatism in patients who underwent microcoaxial cataract surgery (MCCS). Methods: A prospective study including 193 eyes with astigmatism of greater than 0.5 diopters was performed. The eyes were randomized into two groups: (1) 95 eyes with steep axis incision, and (2) 98 eyes with temporal incision. A 2.2-mm microcoaxial phacoemulsification was performed. The UCVA, BCVA and corneal topography (Orbscan II, Bausch & Lomb) were measured preoperatively and three months postoperatively. Surgically induced astigmatism was calculated via vector analysis, and the mean change in keratometric astigmatism was also calculated. Results: There were no significant differences in UCVA or BCVA between the two groups three months postoperative. The mean SIA was 0.45 ± 0.27 diopters in the steep axis incision group and 0.30 ± 0.17 diopters in the temporal incision group. In the steep axis incision group, the mean keratometric astigmatism showed a mean reduction of 0.31 ± 0.37 diopter (WTR: 0.37 D; oblique: 0.35D; ATR: 0.16 D), while the mean keratometric astigmatism showed a mean increase of 0.06 ± 0.29 diopters (WTR: 0.15 D increased; oblique: 0.11 D increased; ATR: 0.13 D reduced) in the temporal incision group. There were statistically significant differences in SIA and change in astigmatism between the two groups (p = 0.002, p = 0.000). Conclusions: In MCCS, steep axis incision achieved superior astigmatism correction in patients having with-the-rule or oblique astigmatism of greater than 0.5 diopters. J Korean Ophthalmol Soc 2011;52(1):29-33

백내장 수술 시 3가지 각막 곡률 검사기의 비교

황웅주(Woong-Joo Whang),주천기(Choun-Ki Joo) 대한검안학회 2012 Annals of optometry and contact lens Vol.11 No.1

목적: 수동 각막 곡률 검사기와 IOLMaster 자동 각막 곡률 검사기, Pentacam을 통해 측정된 각막 곡률값을 비교하고, 백내장 수술 시에 효용성이 있는 기구를 찾고자 하였다. 대상과 방법: 백내장 수술을 시행한 71안(71명)을 대상으로, 술 전 수동 각막 곡률 검사기와 IOLMaster, Pentacam (true net power)을 통해 각막 곡률을 측정하고, 비교하였다. 술 후 3개월에 굴절값을 측정하여, 예측 오차와 예측 오차의 절대값을 비교하였다. 안축장의 길이 측정에는 IOLMaster를 이용하였으며, 예측값 계산에는 A-상수를 후향적으로 보정한 SRK-T공식을 사용하였다. 결과: 수동 각막 곡률 검사기와 IOLMaster, Pentacam true net power상의 각막 곡률은 43.93±1.39, 44.02±1.40, 42.93±1.43D였다. 예측 오차는 0.000±0.53, 0.000±0.51D, 0.000±0.57D였으며, 예측 오차의 절대값은 0.43±0.31, 0.42±0.29, 0.47±0.33D였다. 결론: IOLMaster 자동 각막 곡률 검사기를 통해 측정한 각막 곡률이 백내장 수술 시 상대적으로 유용했다. Purpose: To compare keratometric values obtained with a manual keratometer, the IOLMaster automated keratometer (Carl Zeiss), and the Pentacam rotating Scheimpflug camera (Oculus) in cataract surgery, and to characterize the refractive outcomes generated using each device. Methods: In this retrospective study, 71 eyes of 71 patients were analyzed. The keratometric values obtained with different devices (manual keratometer, the IOLMaster automated keratometer and Pentacam scheimpflug camera) were employed for IOL power calculation. Axial length was measured by the IOLMaster partial coherence interferometry. The predicted refraction was evaluated using the SRK-T formula and optimization was conducted. Multiple comparisons of averaged corneal powers were conducted and the averaged corneal power was used to calculate the predicted refraction. The absolute values of corneal astigmatism were calculated using the corneal powers for the flat and steep meridians ([Ks-Kf]), and those were also compared. After cataract surgery, mean errors and mean absolute errors were compared. Results: The mean keratometric values generated by manual keratometer, the IOLMaster automated keratometer, and the Pentacam Scheimpflug system (true net power) were 43.93±1.39, 44.02±1.40 and 42.93±1.43 diopter. The standard deviation of the mean errors from manual keratometer, IOLMaster optical biometer and Pentacam Scheimpflug system were 0.53D, 0.51D and 0.57D. The mean absolute values from manual keratometer, IOLMaster optical biometer and the Pentacam Scheimpflug system were 0.43±0.31, 0.42±0.29 and 0.47±0.33 diopter. Conclusions: Corneal power measurements with the IOLMaster optical biometer are a good choice for application to cataract surgery.

Zernike 다항식을 통한 수차와 콘택트렌즈

황웅주(Woong-Joo Whang) 대한검안학회 2021 Annals of optometry and contact lens Vol.20 No.2

Aberration refers to a phase difference in light caused by a variation in the refractive power. Zernike polynomials, the most widely used method for analyzing aberrations in the human eye, consist of various polynomials configured according to the radial order and angular frequency. Among them, aberrations with an angular frequency of zero are suppressed by pupil and retinal sensitivity. Contact lenses for correcting presbyopia have mechanisms that induce vertical coma or spherical aberration. Positive spherical aberration is induced after wearing Ortho-k lenses.

아스퍼질루스균에 의한 내인성 안내염 환자에서 뇌 기저 동맥 감염 동맥류가 동반된 증례

이미연,황웅주,이원기,Mee Yon Lee,Woong Joo Whang,Won Ki Lee 대한안과학회 2010 대한안과학회지 Vol.51 No.12

Purpose: To report a case of mycotic aneurysm of the cerebral basilar artery associated with bilateral endogenous aspergillus endophthalmitis. Case summary: A 41-year-old man with no underlying disease presented with decreased vision in both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis, and the authors performed a vitrectomy and lensectomy on the right eye. Hyphae were detected in the vitreous sample, and systemic amphotericin was administered. Three days after the operation, the patient became comatose due to a subarachnoid hemorrhage. Aspergillus antigen was detected in the vitreous sample and in the cerebrospinal fluid. Subarachnoid hemorrhage was due to the rupture of a mycotic aneurysm of the cranial basilar artery, complicated by aspergillus infection of the central nervous system. J Korean Ophthalmol Soc 2010;51(12):1671-1675

펨토초라식과 에피라식의 단기 임상결과 비교

김성일,황웅주,변용수,송지혜,나경선,주천기.Sung Il Kim. MD. Woong-Joo Whang. MD. Yong Soo Byun. MD. Ji Hye Song. MD. Kyung Sun Na. MD. Choun-Ki Joo. MD 대한안과학회 2010 대한안과학회지 Vol.51 No.12

Purpose: To compare short-term clinical results of femtosecond LASIK with those of epi-LASIK. Methods: Twenty subjects (40 eyes) underwent femtosecond LASIK and 20 subjects (40 eyes) underwent epi-LASIK for myopia with astigmatism. The results of each surgery were compared with regard to visual acuity, spherical equivalent, safety, efficacy, stability, predictability and high order aberration. Results: Postoperative uncorrected visual acuities were 0.51 ± 0.11, 0.95 ± 0.08, and 0.97 ± 0.08 for epi-LASIK and 0.76 ± 0.19, 0.97 ± 0.07, and 0.98 ± 0.06 for femtosecond LASIK at one week, one month, and two months after surgery, respectively. Femtosecond LASIK showed faster improvement in visual acuity. Postoperative spherical equivalents were -0.83 ± 0.24, -0.31 ± 0.19, and -0.27 ± 0.09 for epi-LASIK and -0.47 ± 0.21, -0.28 ± 0.15, and -0.25 ± 0.12 for femtosecond LASIK. Safety, efficacy, stability, and predictability showed no differences between the two groups. High order aberrations were increased significantly; however, no significant difference between the two groups was found. Conclusions: Both epi-LASIK and femtosecond LASIK are effective for surgical correction of myopia with fast visual rehabilitation. In addition, epi-LASIK and femtosecond LASIK showed good safeties, efficacies, predictabilities, and stabilities. J Korean Ophthalmol Soc 2010;51(12):1573-1578

소아에서 Wavefront 수차계를 이용한 굴절검사의 유용성

오시은(Si Eun Oh),황웅주(Woong Joo Whang),박미라(Mi Ra Park) 대한안과학회 2021 대한안과학회지 Vol.62 No.5

목적: 조절마비 후 wavefront 수차계, 자동굴절검사 및 망막검영법에 의한 굴절검사를 비교하여 소아에서 wavefront 수차계를 이용한 굴절검사의 정확성과 유용성을 평가하고자 하였다. 대상과 방법: 조절마비 후 wavefront 수차계, 자동굴절검사 및 망막검영법에 의한 굴절검사를 시행한 3세 이상 16세 이하 소아 65명 130안을 대상으로 하였다. 굴절검사값은 power vector (M, J0, J45) 및 원주렌즈의 절대값으로 변환하여 분석하였다. 각 검사 방법을 통한 굴절검사값 간의 일치도와 상관관계를 분석하였다. 망막검영법의 구면렌즈대응치 절대값 2 D를 기준으로 두 군으로 나누어 추가 비교하였다. 결과: 수차계와 자동굴절검사 모두 망막검영법에 비해 근시성 경향을 보였다(p=0.007, p<0.001). 경도의 굴절이상을 가지는 경우, 수차계로 측정한 M, J0, J45 벡터가 망막검영법과 통계적으로 차이를 보이지 않은 반면(p=0.674, p=0.699, p=0.766), 자동굴절검사는 M, J0, J45 벡터, 원주렌즈의 절대값 모두 망막검영법과 통계적으로 유의미한 차이를 보였다(모두 p<0.05). 큰 굴절이상을 가지는 경우 수차계와 자동굴절검사를 통하여 얻은 M 벡터는 망막검영법과 비교시 근시성 경향을 보이며 통계적으로 의미 있는 차이를 보였다(모두 p<0.001). 결론: Wavefront 수차계를 이용한 굴절검사는 경도의 굴절이상을 보이는 경우 기존의 자동굴절검사보다 망막검영법에 근사한 값을 보이나, 큰 굴절이상을 보이는 경우 수차계와 자동굴절검사는 모두 망막검영법과는 차이를 보였다. Purpose: To compare the refractive measurements from a wavefront aberrometer, autorefractor, and retinoscopy after cycloplegia in evaluating the usefulness and validity of refractive measurements by a wavefront aberrometer in children. Methods: A total of 130 eyes of 65 children, aged from 3 to 16 years, were examined using retinoscopy, a wavefront aberrometer (OPD-Scan III), and an autorefractor (KR-1) after cycloplegia. Refractive measurements were converted to power vectors (M, J0, and J45) and cylindrical absolute values for statistical analysis. The agreement between instruments was assessed and the correlations of measurements were evaluated. Subgroup analysis was performed on two subgroups: one representing less refractive error (|M| < 2 D on cycloplegic retinoscopy) and the other with larger refractive error (|M| ≥ 2 D on cycloplegic retinoscopy). Results: Compared with retinoscopy readings, the aberrometer and autorefractor yielded more myopic values (p = 0.007, p < 0.001). In the less refractive error group, the autorefractor results showed statistically significant differences from retinoscopy readings for M, J0, and J45 and the cylindrical absolute value (all p < 0.05); there were no statistically significant differences between M, J0, and J45 vectors of the aberrometer and those obtained using retinoscopy (p = 0.674, p = 0.699, p = 0.766). With the larger refractive error group, the M vectors of the aberrometer and autorefractor showed more myopic values than the M vector retinoscopy readings; the differences were statistically significant (all p < 0.001). Conclusions: The wavefront aberrometer yielded refraction readings closer to those obtained with retinoscopy than the automated refraction in the less refractive error group. With a larger refractive error, statistically significant differences (all p < 0.001) were found among the aberrometer, autorefractor, and retinoscopy readings.

COL8A2 유전자 돌연변이 유무에 따른 푹스이상증의 임상적 특징 및 예후

김현아(Hyun Ah Kim),황웅주(Woong Joo Whang),이지혜(Jee Hye Lee),채효진(Hyo jin Chae),김명신(Myung shin Kim),김만수(Man Soo Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.4

목적: COL8A2 유전자 돌연변이 유무에 따라 푹스이상증 환자들의 임상적 특징 및 예후에 차이가 있는지 비교해 보고자 하였다. 대상과 방법: 1996년부터 2015년까지 푹스이상증으로 처음 진단 받은 환자 81명(162안)을 COL8A2 유전자 돌연변이 유무에 따라 두군으로 나누었다. 두 군에 대하여 환자의 성별, 진단 시 나이, 가족력 유무, 당뇨의 유무, 기상 시 시력저하 증상의 유무, 시간경과에 따른 각막두께와 각막내피세포 수의 변화, 각막이식 여부 및 이식 수술 전 상태에 대하여 후향적으로 비교 분석하였다. 결과: 대상자 81명 중 COL8A2 유전자 돌연변이는 12명에서 관찰되었다. 유전자 돌연변이가 있는 군에서 가족력, 당뇨 및 기상 시 시력저하 증상이 유의하게 더 많았다(p=0.021, p=0.024, p=0.044, respectively). 또한, 유전자 돌연변이가 있는 군에서 처음 진단시 각막두께가 유의하게 더 두꺼웠으며 각막내피세포 수가 유의하게 더 적었고(p=0.020, p=0.005, respectively), 돌연변이가 있을 때 한 환자에서 양안 사이의 각막두께 및 각막내피세포 수의 차이가 더 적었다(p=0.043, p=0.022, respectively). 5년간 경과관찰 하던 중 유전자 돌연변이가 있는 군에서 60.0%, 없는 군에서 19.2%가 각막이식을 받아 유의한 차이를 보였다(p=0.014). 결론: COL8A2 유전자 돌연변이 검사를 통하여 초기에 양안성으로 진행 여부 및 각막이식이 필요할 가능성 등의 예후를 예측할 수 있다. Purpose: To compare the clinical characteristics and prognosis of Fuchs dystrophy patients according to COL8A2 gene mutation status. Methods: Eighty-one patients (162 eyes) initially diagnosed with Fuchs dystrophy from 1996 to 2015 were divided into two groups according to COL8A2 gene mutation status. Retrospective analysis was performed comparing gender, age at diagnosis, presence of family history, diabetes mellitus, symptoms of blurred vision in the morning, changes in central corneal thickness and endothelial cell density with time, need for corneal transplantation, and pre-operative corneal status in the two groups. Results: Of the 81 patients, 12 were shown to harbor a COL8A2 gene mutation. Individuals with mutation were significantly associated with presence of family history, diabetes mellitus, and blurred vision in the morning (p = 0.021, p = 0.024, p = 0.044, respectively). They also had significantly thicker central cornea and lower endothelial cell density at the time of diagnosis (p = 0.020, p = 0.005, respectively). The differences in central corneal thickness and endothelial cell density between the two eyes in one patient were significantly smaller in patients with gene mutation (p = 0.043, p = 0.022, respectively). Over a 5-year follow-up period, 60.0% of eyes in patients with gene mutation and 19.2% of eyes in patients without gene mutation underwent corneal transplantation, a significant difference between the two groups (p = 0.014). Conclusions: By testing for COL8A2 gene mutation, early binocular disease progression and the possible need for corneal transplantation in the future can be predicted among patients diagnosed with Fuchs dystrophy.

진행성 원추각막 및 굴절수술 후 각막확장증 환자의 각막콜라겐 가속교차결합술 시행 후 임상결과

홍경의(Kyung Euy Hong),황웅주(Woong Joo Whang),정소향(So Hyang Chung),주천기(Choun Ki Joo) 대한안과학회 2016 대한안과학회지 Vol.57 No.11

목적: 진행하는 원발성 원추각막 및 굴절수술 후 각막확장증 환자에서 바이브 엑스 라피드 용액을 이용한 각막콜라겐 가속 교차결합술 후 효용성과 안전성을 알아보았다. 대상과 방법: 2015년 2월부터 2015년 10월까지 진행성의 원발성 원추각막 및 굴절수술 후 각막확장증을 진단 받은 30명 45안을 대상으로 바이브 엑스 라피드 용액을 이용한 각막콜라겐 가속 교차결합술 시행술 전, 술 후1개월, 3개월, 6개월에 시력검사 및 굴절검사, 각막곡률을 측정하였고, 각막두께, 각막내피세포수의 변화를 분석하였다. 결과: 최대교정시력은 술 전 logMAR 0.51 ± 0.23에서 수술 6개월 후 logMAR 0.51 ± 0.26으로 변화가 없었고, 자동각막굴절측정기 CT-80 (Topcon, Tokyo, Japan) 최대 각막곡률, 전안부 촬영기(Oculus, Pentacam, Wetzler, Germany) 측정 최대 각막곡률과 각막지형도(OrbscanII, Bausch & Lomb, Salt Lake City, UT, USA) 측정 최대 각막곡률은 술 전 각각 49.11 ± 4.5D, 48.37 ± 3.31D, 48.98 ± 4.88D에서 술 후 6개월 각각 49.29 ± 4.34D, 46.99 ± 3.63D, 47.01 ± 3.62D로 전안부 촬영기와 각막지형도 측정값에서 통계적으로 유의하게 감소하였다(p〈0.05). 자동각막굴절기로 측정한 구면값, 난시값, 구면렌즈대응치 술 전 값과 수술 6개월 후 값은 각각 -4.85 ± 3.86, -3.96 ± 2.52, -6.86 ± 4.25에서 -4.98 ± 3.68, -3.98 ± .253, -6.9 ± 4.15로 큰 변화가 없었으나 유의한 의미를 갖지 않았다. 전안부 촬영기(Oculus, Pentacam, Wetzler, Germany) 측정 각막두께와 각막지형도(OrbscanII, Bausch & Lomb) 측정각막두께의 술 전 값과 수술 6개월 후 값은 각각 485 ± 26.27, 479.24 ± 27.89에서 471.64 ± 27.12, 472.52 ± 25.36으로 전안부 촬영기에서 유의한 변화가 있었다. 각막내피 세포수는 각막공초 점현미경(Confocal microscopy, ConfoScan 4, Nidek, Inc., Freemont, CA, USA)을 이용하여 측정하였고, 술 전 2,857 ± 390.49/mm2에서 술 후 6개월째, 2,639.21 ± 249.92/mm2로 유의한 변화가 있었으나, 그 외 유의한 합병증은 관찰되지 않았다. 결론: 각막콜라겐 가속 교차결합술은, 진행성 원추각막 및 굴절수술 후 각막확장증 진행을 억제하는 치료방법이며, 내피세포의 변화에 영향을 미칠 가능성이 있으므로 장기 관찰이 요구된다. 〈대한안과학회지 2016;57(11):1714-1722〉 Purpose: To report the clinical efficacy and safety of progressive keratoconic eyes in Korean patients treated with accelerated corneal cross-linking. Methods: This retrospective study focused on progressive keratoconic eyes in Korean patients that underwent accelerated corneal cross-linking from February 2015 to October 2015. Keratoconus was diagnosed in 45 eyes in 30 patients. After accelerated corneal cross-linking with VibeX rapid solution, best corrected visual acuity, maximum keratometry, mean keratometry, corneal thickness, corneal astigmatism, and endothelial cell count were measured at the preoperative visit and post operation 1 week, 1 month, 3 months, and 6 months. Results: Best corrected visual acuity (log MAR) was 0.51 ± 0.23 at pre operation and 0.51 ± 0.26 at post operation 6 months, showing no improvement. The maximum keratometry measured with Auto K, Pentacam, and Orbscan II at pre operation was 49.11 ± 4.5 D, 48.37 ± 3.31 D, and 48.98 ± 4.88 D and changed to 49.29 ± 4.34 D, 46.99 ± 3.63 D, and 47.01 ± 3.62 D postoperatively, respectively. Only Pentacam and Orbscan II measurements showed a statistically significant decrease (p 〈 0.05). Corneal thickness (at the thinnest area) was measured with Pentacam and Orbscan II; pre-operative and post-operative 6 month data showed changes from 485 ± 26.27 and 479.24 ± 27.89 to 471.64 ± 27.12 and 472.52 ± 25.36, respectively. Only the Pentacam method resulted in a statistically significant decrease. Endothelial cell count was measured with confocal microscopy and showed a statistically significant difference between pre-operative 2,857 ± 390.49/mm2 and post-operative 6 month 2,639.21 ± 249.92/mm2. Conclusions: This 6-month follow-up study of Korean keratoconus patients who underwent accelerated corneal cross-linking indicates that the method is effective in stabilizing the progression of keratoconus, according to maximum keratometry change. With regard to endothelial cell count change, further long-term evaluation is required. Other than endothelial cell count change, this procedure is expected to show long-term safety comparable to that of conventional corneal cross-linking. J Korean Ophthalmol Soc 2016;57(11):1714-1722

수술 전 안축장 구간에 따른 백내장수술 후 유효수정체위치 예측

김기현(Gee-Hyun Kim),황웅주(Woong-Joo Whang),김현승(Hyun-Seung Kim) 대한안과학회 2021 대한안과학회지 Vol.62 No.3

목적: 부분결합간섭검사로 측정되는 안구 생체계측치를 매개변수로 하는 백내장수술 후 유효수정체위치 예측 공식을 수술 전 안축장 구간별로 탐구해보고자 한다. 대상과 방법: 수술 전에 부분결합간섭검사를 시행하여 안축장;각막굴절력;전방깊이를 성공적으로 측정하였고;통상적인 백내장수술이 합병증 없이 이뤄진 736안을 후항적으로 선정;수술 전 안축장 1.0 mm 구간에 따라 7개의 군으로 분류하였다. 다중선형 회귀분석을 통해 수술 전 안축장;각막굴절력;전방깊이를 독립 매개변수로 하여 유효수정체위치를 예측하는 최적의 공식을 각 군에 따라 구해보았다. 결과: 수술 전 안축장이 22.0 mm에서 25.0 mm에 속하는 경우;각막굴절력이 유효수정체위치와 유의하게 연관되어 있었다. 수술 전 안축장이 23.0 mm에서 26.0 mm에 속하는 경우;전방깊이가 유효수정체위치와 유의하게 연관되어 있었다. 수술 전 안축장이 24.0 mm보다 짧고;26.0 mm보다 긴 경우;수술 전 안축장이 유효수정체위치와 강하게 연관되어 있었다. 수술 전 안축장;전방깊이;각막굴절력 세 변수 모두를 고려한 선형 회귀 공식을 통해 대체로 유효수정체위치를 가장 적절하게 예측할 수 있었으나;각 군에 따라 공식의 형태는 변하였다. 결론: 백내장 술 후 유효수정체의 위치는 술 전 안축장의 길이가 25.0 mm 미만인 경우는 안축장과 각막굴절력;24.0 mm에서 26.0 mm인 경우는 안축장과 전방깊이;그리고 26.0 mm 이상인 경우는 특히 안축장과 유의한 연관성이 있었다. Purpose: We derived optimal formulae permitting effective lens position (ELP) for patients differing in terms of their preoperative axial lengths as revealed by partial coherence interferometry. Methods: We included 736 eyes from 736 patients who underwent conventional cataract surgery at Yeouido St. Mary’s Hospital. The preoperative axial length (AL);corneal power (CP);and anterior chamber depth (ACD) measured via partial coherence interferometry served as independent variables for ELP prediction. The 736 eyes were divided into seven groups differing by 1.0-mm intervals in terms of the preoperative axial length. We sought correlations between the independent variables and the ELP;and defined the combinations that best predicted the ELPs of the seven groups. Results: The CP correlated significantly with the ELP for eyes with AL between 22.0 and 25.0 mm (all p < 0.01) and the ACD correlated significantly with the ELP for eyes with AL between 23.0 and 26.0 mm (all p < 0.01). Although a regression equation featuring all of the AL;ACD;and CP best predicted the ELP for the total of 736 eyes (p < 0.001);the optimal combination varied by the preoperative AL. Conclusions: The effects of CP;ACD;and AL on ELP vary by the preoperative AL. The optimal combination of preoperative variables predicting ELP thus varies as that parameter changes.

반복적인 전층각막이식실패 환자에서 데스메막박리 자동 각막내피층판이식술을 시행한 1예

황규덕(Gyu Deok Hwang),윤혜연(Hye Yeon Yun),하민지(Min Ji Ha),황웅주(Woong Joo Whang),장동진(Dong Jin Chang),황호식(Ho Sik Hwang),나경선(Kyung Sun Na) 대한안과학회 2021 대한안과학회지 Vol.62 No.3

목적: 두 차례의 전층각막이식 후 재차 이식 실패가 발생하여 데스메막박리 자동 각막내피층판이식술을 시행한 사례를 보고하고자 한다. 증례요약: 33세 인도 국적의 남자 환자로 우안 아메바각막염이 발생하여 인도에서 2차례 전층각막이식수술 및 각막윤부이식을 시행받은 후 본원에 내원하였다. 경과 관찰 도중 우안 이차성 녹내장 진단하에 아메드밸브이식술을 시행하였으며, 우안 각막신생혈관에 진행하여 우안 결막후전술 및 양막이식술을 시행하였다. 이후 각막이식 실패 상태로 진행하여 데스메막박리 각막내피층판이식술을 시행하였다. 수술 후 7개월째 우안 나안시력 20/320으로 특별한 합병증 없이 유지되고 있다. 결론: 전층각막이식 후 각막신생혈관 및 녹내장수술로 인한, 각막내피세포 부전으로 반복적인 이식 실패가 발생한 환자에 있어서 기질 상태가 양호할 경우 데스메막박리 자동 각막내피층판이식술을 시행하여 합병증 없이 좋은 시력회복을 보였기에 문헌고찰과 함께 보고하는 바이다. 추후 국내에서 더 많은 수술 환자를 대상으로 한 연구가 필요하다. Purpose: To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) for graft failure after re-penetrating keratoplasty (PK). Case summary: A 33-year-old man of Indian nationality who had developed right eye amoeba keratitis and had received two penetrating keratoplasties and allogeneic kerato-limbal transplant in India sought treatment at our hospital. During the follow-up, Ahmed valve transplantation was performed under the diagnosis of secondary glaucoma in his right eye; the patient also underwent conjunctival recession and conjunctival permanent amniotic membrane transplantation as corneal neovascularization had progressed. Subsequently, the corneal transplantation failed and DSAEK was performed. At 7 months after the operation, the right-eye visual acuity was 20/320 without any complications. Conclusions: DSAEK may restore good vision without complications in patients with repeated corneal graft failure after PK from corneal endothelial cell failure followed by corneal neovascularization and glaucoma surgery but with good stromal conditions. We present this case, along with a review of the literature. Future studies will require more surgical patients.