알레르기결막염의 병리와 치료

황형빈 대한의사협회 2017 대한의사협회지 Vol.60 No.3

조혈모세포이식 환자에서 전신 스테로이드 요법이 건성안의 경과에 미치는 영향

황형빈,전은정,정성근,Hyung Bin Hwang,M,D,Eun Jeong Jeon,M,D,Ph,D,Sung Kun Chung,M,D,Ph,D 대한안과학회 2008 대한안과학회지 Vol.49 No.6

Purpose: To evaluate the effects of systemic steroid therapy on the development of dry eye syndrome (DES) in graft-versus-host disease (GVHD) resulting from hematopoietic stem cell transplantation (HSCT) in hematologic malignancy (HM) patients. Methods: We analyzed 108 HSCT patients. We measured tear film break‐up time (BUT) and basal tear secretion, and checked for corneal lesions. BUT under 10 seconds and basal tear secretion under 10 mm gave a diagnosis of DES. Significant corneal lesions were also described in this gorup. We compared the clinical aspect and frequency of dry eye according to GVHD and also compared clinical aspects of dry eye in GVHD patients before and after systemic steroid therapy. Results: Fifty-six patients (51.9%) developed GVHD, including 51 patients (91.1%) in the GVHD group and 31 patients (59.6%) in the non-GVHD group. The frequency of DES was statistically significant in the GVHD group (p<0.05). BUT and basal tear secretions were 4.08±1.76 sec and 6.05±2.57 mm in the GVHD group and 5.37±1.83 sec and 7.08±1.54 mm. There were 32 peoples (57.1%) with corneal lesions in the GVHD group and 13 peoples (25.0%) in the non-GVHD group. Based on these results, DES was statistically significant in the GVHD group. In the GVHD group, BUT and basal tear secretion levels were 4.08±1.76 sec and 6.05±2.57 mm before systemic steroid therapy and 5.20±2.91 sec and 6.73±1.80 mm after the therapy. The difference was statistically significant (p<0.05), so we concluded that systemic steroid therapy relieved DES. Before steroid therapy, 32 peoples (57.1%) had corneal lesions, and this number decreased to 25 peoples (44.6%) after steroid therapy. The difference was not statistically significant, but we presumed that steroid therapy improved the corneal lesions (p>0.05). Conclusions: The severity and frequency of DES were high in the GVHD group. At the same time, systemic steroid therapy could relieve DES in GVHD patients. Therefore, proper medical treatment and ocular examinations should be performed for HSCT patients. J Korean Ophthalmol Soc 49(6):891-896, 2008

치성 감염에서 비롯된 눈주위 괴사성 근막염 1예

황형빈,도상희,양석우,Hyung Bin Hwang,Sang Hee Doh,Suk Woo Yang,Ph,D 대한안과학회 2008 대한안과학회지 Vol.49 No.6

Purpose: We report a case of periocular necrotizing fasciitis originating from dontogenic infection. Case summary: A 53-year-old man, who had suffered from severe periodontitis one week prior, visited our clinic due to a 2-day history of rapidly progressing left mandibular and periorbital swelling and pain. By the time of his visit, he had lost vision in the left eye and had moderate swelling, expression of pus, and skin explosion with necrotizing discoloration of the left lid and lower facial area. MRI of the orbits revealed soft tissue necrosis, gas accumulation, and subperiosteal abscess formation of the left orbit. We administered systemic antibiotics and surgically excised the left periorbital necrotic tissue. A constant expression of pus material was also achieved, decreasing painful swelling. We considered exenteration of the left eye to block the spread of necrosis to adjacent intact tissue; however, the left eye was fairly well-preserved with the exception of mild lagophthalmos developed by the excision of necrotic skin. Streptoccocal species was observed in microbiologic cultures of pus and necrotic tissue and ‘necrotizing inflammation’ was described on tissue biopsy, with the findings consistent with necrotizing fasciitis. Conclusions: Through the diagnosis of necrotizing fasciitis originating from an odontogenic infection, the proper administration of antibiotics and surgical management were achieved. As a result, we were able to preserve the eye. J Korean Ophthalmol Soc 49(6):993-999, 2008

안구건조증의 병리와 치료동향

황형빈 대한의사협회 2016 대한의사협회지 Vol.59 No.9

Dry eye disease (also known as keratoconjunctivitis sicca) is a multifactorial disease of the tear film and ocular surface. It results in various symptoms of discomfort such as pain, tearing, fatigue, and headache. Visual function can also deteriorate, and quality of life is negatively affected. Tear film instability which may lead to damage to the ocular surface with an inflammatory reaction is key to the pathogenesis of dry eye disease. This review discussed the classification, pathogenesis, diagnostic approaches, and treatment options of dry eye disease.

가토 각막상피제거 후 염화벤잘코늄 첨가여부에 따른 가티플록사신의 창상치유효과 비교

황형빈,노창래,정성근,Hyung Bin Hwang,Chang Rae Roh,Sung Kun Chung 대한안과학회 2008 대한안과학회지 Vol.49 No.6

Purpose: This study was performed to compare the effect of fourth-generation fluoroquinolones gatifloxacin on epithelial healing and penetration into the aqueous humor following corneal epithelial removal. The administered drugs were ZymarTM and Gatiflo®, which differ from each other by the presence of benzalkonium chloride. Methods: Eighteen eyes of nine New Zealand white rabbits were randomized to receive either ZymarTM or Gatiflo® following anterior keratectomy with a diameter of 6.0 mm. Eyes were dosed with either antibiotic according to Food and Drug Administration (FDA) approval; specifically, ZymarTM and Gatiflo® were dosed every two hours for the first two days and then four times daily for the following five days. Starting from postoperative day 0, photos were taken daily to measure the area of the residual epithelial defects. Anterior chamber paracentesis was performed to determine the drug concentration at postoperative days 1, 2, and 7. Results: The mean healing times after ZymarTM and Gatiflo® treatment were 3.0±0.71 and 3.2±0.84 days, respectively (P=0.813). No statistically significant differences in the mean healing time and the mean area of the healed corneal wound were noted between the two groups. No difference in anterior chamber concentration was observed between the two groups at postoperative day 7 (P=0.362). Conclusions: Although the two drugs differ in that on drug has preservatives, no significant differences were found in the epithelial healing effect or anterior chamber concentration after short-term dosing for 1 week in this trial. J Korean Ophthalmol Soc 49(6):987-992, 2008

당뇨망막병증에서 범망막광응고술 후 발생하는 시력 감소에 대한 트리암시놀론 후테논낭하주입술의 예방효과

황형빈,박영훈 대한안과학회 2009 대한안과학회지 Vol.50 No.6

Purpose: To evaluate the efficacy of a prophylactic posterior sub-Tenon’s capsule injection of Triamcinolone acetonide (TA) against macular edema and visual dysfunction by panretinal photocoagulation (PRP) in patients with severe nonproliferative and proliferative diabetic retinopathy. Methods: Thirty-eight eyes of 19 patients who have diabetic retinopathy without macular edema and whose retinopathy was bilateral and symmetrical were evaluated. Triamcinolone was injected into the posterior sub-Tenon’s capsule in one eye of the patients and nothing was injected in the other eye as a control. Two weeks later, PRP was performed every other week for 4 sessions on both eyes in all patients. The clinical course of visual acuity and macular edema was monitored for up to approximately 6 months after the initial PRP. Results: There was no statistically significant difference of visual acuity before PRP in the 2 groups (p>0.05), and there was no macular edema in any patient. For a follow-up period of 6 months, visual dysfunction was more severe in the TA-injected eye than the control. However, the difference was not statistically significant (p>0.05) throughout the follow-up period except at the 20-week time point. On the other hand, macular edema occurred in 2 eyes (10.5%) of the TA-injected group, and in 4 eyes (21.1%) of the control group. IOP elevation as a complication caused by TA-injection occurred in 2 eyes (10.5%). However, IOP was controlled successfully by anti-glaucomatic eye drops. Conclusions: Posterior sub-Tenon’s capsule injection of Triamcinolone is a safe and effective treatment modality for preventing PRP-induced visual dysfunction and macular edema. 목적: 심한 비증식당뇨망막병증 혹은 증식당뇨망막병증 환자에서 예방적 후테논낭하 트리암시놀론 주입술이 범망막광응고술로 인한 황반부종과 시력 저하의 예방에 효과가 있는지 알아보고자 한다. 대상과 방법: 황반부종이 없고 또한 이전에 황반부종에 대한 치료를 받은 과거력이 없으며, 양안의 당뇨망막병증 병기가 비슷한 환자 19명 38안을 대상으로, 한 눈에는 후테논낭하 트리암시놀론 주입술(posterior subtenon Triamcinolone injection)을 시행하고(실험군), 반대편 눈에는 트리암시놀론 주입술을 시행하지 않았다(대조군). 2주 후 양안의 범망막광응고술을 1주 간격으로 4회 걸쳐 시행하였으 며, 전향적인 방법으로 6개월 동안 양안의 시력과 황반부종의 발생 및 변화 여부 등의 임상결과 차이를 알아보았다. 결과: 트리암시놀론 주입술 전 시력은 두 군 간의 차이가 없었으며(p>0.05), 시술 후 6개월간의 경과 관찰 중 대조군보다 실험군에서 시력 감소의 정도가 작은 경향을 보였으나, 그 차이는 경과 관찰 20주째를 제외하고는 통계적으로 유의할 만한 수준은 아니었다(p>0.05). 한편 황반부종은 실험군에서 2안(10.5%)이 발생하여 4안(21.1%)이 발생한 대조군보다 발생 빈도가 작았음을 확인할 수 있었다. 트리암시 놀론의 후테논낭하 주입술로 인한 합병증으로 2안(10.5%)에서 안압이 상승하였으나 점안 안압하강제로 안압이 성공적으로 조절되었다. 결론: 후테논낭하 트리암시놀론 주입술은 범망막광응고술로 인한 시력 저하 및 황반부종의 발생을 줄여주는데 안전하고도 효과적인 치료방법이라고 생각된다.

무색 인공수정체렌즈안과 광변색 인공수정체안에서의 수술 전후 스트레이라이트의 비교

김인혁,황형빈,신승주,정성근,In Hyuk Kim,MD,Hyung Bin Hwang,MD,Seung Joo Shin,MD,Sung Kun Chung,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.2

Purpose: To compare visual acuity and intraocular straylight after implantation of clear and photochromic intraocular lenses (IOLs) in a mesopic lighting condition. Methods: Clear IOLs were implanted in 95 eyes of 72 patients (clear IOL group), and photochromic IOLs were implanted in 22 eyes of 16 patients (photochromic IOL group). Best-corrected visual acuity (BCVA) was measured indoors before surgery and 1 month after surgery. Straylight values were measured indoors before surgery and 1 and 2 months after surgery using the C-quant straylight meter (Oculus GmbH, Wetzlar, Germany). Results: There were no significant differences between the 2 groups in BCVA at 1 month postoperatively (p = 0.587). Mean straylight values of clear and photochromic IOL groups were 2.76 ± 1.89 log (s) and 2.88 ± 2.04 log (s) preoperatively, 1.39 ± 0.84 log (s) and 1.32 ± 0.26 log (s) at 1 month postoperatively, and 1.43 ± 0.92 log (s) and 1.45 ± 0.50 log (s) at 2 months postoperatively. There were no significant differences between the 2 groups in indoor straylight values (p = 0.778, 0.709, 0.929, before surgery, 1 and 2 months after surgery respectively). Repeated-measure analysis of straylight values also showed no significant difference between the 2 groups (p > 0.05). Conclusions: There were no significant differences in BCVA and straylight values between clear and photochromic IOL groups under a mesopic light condition. Therefore, photochromic IOL could be suitable choice for cataract patients who spend significant time under mesopic conditions. J Korean Ophthalmol Soc 2014;55(2):190-195

비측 안와에서 발생한 이소성 눈물샘 선상 낭포암 1예

도상희,황형빈,양석우,Sang Hee Doh,Hyung Bin Hwang,Suk-Woo Yang 대한안과학회 2007 대한안과학회지 Vol.48 No.7

Purpose: We report a case of ectopic adenoid cystic carcinoma developed on the nasal orbital side adjacent to the nasal cavity. Methods: A 60-year-old man developed progressive right ocular proptosis and pain for 3 years. The patient had undergone regular medical examination in a hospital but eventually visited our hospital due to aggravated symptoms. Orbit MRI and CT showed a 24×36×17 mm-sized lower signal mass on the medial side of the right medial rectus muscle and also showed erosion of the orbital bone in the superior and medial orbital walls. An endoscopic biopsy was done after transferring him to the ENT department. A frozen section of the tissue in the operating room showed no malignant evidence, and the mass was excised by endoscopic surgery. The permanent pathological result was adenoid cystic carcinoma. The authors recommended orbital exenteration, but the patient refused the procedure and was seen in follow-up visits after receiving chemotherapy and radiologic therapy. Some orbital mass remained in the posterior orbital area immediately directly after endoscopic excision. The patient underwent his first session of Cyberknife radiosurgery therapy after concurrent chemotherapy and radiologic therapy. Conclusions: Ectopic adenoid cystic carcinoma should be considered as a differential diagnosis of nasal orbital mass lesions.

접촉식과 광학적 방식에 의한 전방깊이 측정값의 비교

박율리,황형빈,정성근.Yuli Park. MD. Hyung Bin Hwang. MD. Sung Kun Chung. MD. PhD 대한안과학회 2013 대한안과학회지 Vol.54 No.8

Purpose: To assess the reproducibility and reliability of applanation A-scan ultrasonography (Pacscan 300A, Sonomed Inc., Chicago, IL, USA) and optical measurements with IOL Master<sup>® (Carl Zeiss Meditec, Germany), Pentacam<sup>® (Oculus, Wetzlar, Germany), and Orbscan II<sup>® (Orbtek Inc., Laredo, TX, USA) when measuring anterior chamber depth (ACD). Methods: In this study of 188 eyes of 94 patients, ACD estimation prior to cataract surgery was preformed by the applanation A-scan method and IOL Master<sup>®, Pentacam<sup>®, and Orbscan II<sup>® optical methods. Repeatability from each device was evaluated by coefficient of variation, standard deviation, and intraclass correlation coefficient. RM-ANOVA on Ranks was used to compare the differences in ACD among the devices. The Bland-Altman plot was performed to assess agreement in measurements between the devices. Results: The mean ACD according to the applanation A-scan method and IOL Master<sup>®, Pentacam<sup>®, and Orbscan II<sup>® optical methods were 2.89 ± 0.49 mm, 3.25 ± 0.45 mm, 3.21 ± 0.46 mm, and 3.19 ± 0.47 mm, respectively, and the differences were statistically significant (p < 0.01). The coefficient of variation for the 4 methods was 2.50% in the A-scan, 0.87% in the IOL Master<sup>®, 1.25% in the Pentacam<sup>®, and 1.04% with Orbscan II<sup>®, and reproducibility was higher with the optical principle devices. The correlation coefficient between A-scan and IOL Master<sup>® was 0.65, between IOL Master<sup>® and Pentacam<sup>® 0.91, between IOL Master<sup>® and Orbscan II<sup>® 0.90, between A-scan and Pentacam<sup>® 0.69, between A-scan and Orbscan II<sup>® 0.71, and between Pentacam<sup>® and Orbscan II<sup>® 0.93. Conclusions: Applanation A-scan provided lower measurements for ACD compared with IOL Master<sup>®, Pentacam<sup>® and Orbscan II<sup>®. There was good agreement between results obtained with the latter 3 methods, and reproducibility was high with optical measurements. The coefficient of variation was low for IOL Master<sup>®.

2.2 mm 미세각막절개 백내장수술 시 회전진동방식 초음파유화술과 직선운동방식 초음파유화술을 이용한 임상결과 비교

임성아,황형빈,김현승,Sung A Lim,Hyung Bin Hwang,Hyun Seung Kim 대한안과학회 2013 대한안과학회지 Vol.54 No.10

Purpose: To compare clinical outcomes of a 2.2 mm microcoaxial cataract surgery, using torsional mode and longitudinal mode. Methods: In this comparative study, patients with bilateral cataract were assigned to get microcoaxial cataract surgery by torsional mode of infiniti in one eye and longitudinal mode of Stellaris<sup>® in the other eye. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), mean amount of balanced salt solution (BSS) used and surgical complications. Patients were seen 1, 7, 30, and 60 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell count and surgically induced astigmatism (SIA). Results: The study evaluated 68 eyes of 34 patients (nuclear opalescence (NO)2: 40 eyes, and NO3: 28 eyes). CDE was significantly lower in torsional mode (3.52 ± 2.93) than in longitudinal mode (6.20 ± 3.32) (p = 0.001). Torsional mode (60.88 ± 21.18 ml) had more BSS use than longitudinal mode (34.58 ± 13.54 ml) (p < 0.001). There were no significant differences in postoperative BCVA, CCT change, endothelial change, and SIA (p > 0.05). Conclusions: The torsional mode may provide lower level of phacoemulsification energy than the longitudinal mode and Torsional mode is considered effective and safe phacoemulsification. However the surgical outcomes were not significantly different in 2.2 mm microcoaxial cataract surgery of moderate cataract. So surgeon can choose any phaco machine based on experience and preference.