점안약제에 사용된 여과 장치의 세균여과 효과

김균형,오재령,김준헌,김효명,Kyun Hyung Kim,Jaeryung Oh Ph,D,Joon-Heon Kim,Hyo-Myung Kim Ph,D 대한안과학회 2007 대한안과학회지 Vol.48 No.10

Purpose: A filtering system (ABAK system, Thea, France) was developed and has been used to prevent the abuse of preservatives and to decrease the complications that may result from them. However, the bacteria filtering effect of the system has not been reported yet. In this study, we attempt to verify its efficacy. Methods: Staphylococcus epidermidis was diluted to two different concentrations, 107 and 105 CFU (Colony-Forming-Unit)/ml. To determine the inward-filtering effect of the system (reverse direction), 0.5 ml of each bacterial concentration was aspirated through the ABAK system, and the solutions that filtered through were cultivated. The results were compared with the controls in which the same amounts of bacterial solutions were dropped from a dropper by squeezing the bottle. For the outward-effect (forward direction), 1ml of bacterial solution from each concentration was put into the bottle with a syringe. Solutions were re-collected by filtering them out through the ABAK system by squeezing the bottle and also by aspirating them from the bottle with a syringe. Both solutions were cultivated, and the results were compared. Each test was repeated 5 times. Results: In control solutions that did not pass through the filter, bacteria were cultivated consistently in repeated tests. However, bacteria were not cultivated in solutions that had passed the filter in both concentrations and in both directions. Conclusions: Filtering systems prevent solutions from contamination, and even if the bottles are polluted with Staphylococcus epidermidis initially, the bacteria would be filtered out. The effectiveness of the filtering systems was also demonstrated in high bacterial concentrations.

깊은 위눈꺼풀고랑 환자에서 자가진피 골막고정술의 수술 결과

김균형,이태수,황상준,Kyun Hyung Kim,Tae Soo Lee Ph,D,Sang Jun Hwang 대한안과학회 2008 대한안과학회지 Vol.49 No.6

Purpose: To evaluate the efficacy of autologus dermis-fixation on the orbital periosteum in patients with superior sulcus deformity. Methods: From September 2005 to February 2007, an appropriate amount of a rolled autologus dermis was added to the site of superior sulcus deformity by means of fixation to the orbital periosteum via lid crease incision. Four patients had superior sulcus deformity after undergoing evisceration or other ocular surgeries. Results: Superior sulcus deformities in all patients could be corrected satisfactorily with bilateral symmetry. During the follow-up period, no complications such as mechanical ptosis and recurrence of superior sulcus deformity were observed. Conclusions: The authors believe that autologus dermis-fixation to the orbital periosteum might be a useful method to correct superior sulcus deformity without disturbing movement of the upper eyelid. A study with a larger series of patients and longer follow-up period might be necessary in the future to obtain more information about autologous dermis-fixation to the periosteum in patients with superior sulcus deformity. J Korean Ophthalmol Soc 49(6):878-885, 2008

IOLMaster, Lenstar, Orbscan 및 수동 방법을 이용한 각막윤부직경 비교

정윤,김균형,MD,Kyun Hyung Kim,MD 대한안과학회 2013 대한안과학회지 Vol.54 No.8

Purpose: To compare and evaluate device efficacy using white-to-white (WTW) diameter measurements by IOLMaster<sup>®, Lenstar<sup>®, Orbscan II<sup>®, and a manual method with anterior segment photographs in normal eyes. Methods: Three sets of WTW diameter measurements were obtained from 62 normal eyes of 31 patients, using the Orbscan II<sup>®, Lenstar<sup>®, IOLMaster<sup>®, and a manual method with anterior segment photographs. Repeatability of each device was evaluated by coefficient of variation. ANOVA and Pearson's correlation were used to compare the differences among the devices. Bland Altman plot was performed to assess measurement agreement among the devices. Results: The mean WTW distance was 11.79 ± 0.46 mm with Orbscan II<sup>®, 12.05 ± 0.38 mm with Lenstar<sup>®, 12.15 ± 0.36 mm with IOLMaster<sup>®, and 12.30 ± 0.40 mm with a manual method. There were significant differences in the results among the methods (ANOVA, p < 0.05). There were significant correlations between the devices except Orbscan II<sup>® (Pearson's correlation, r > 0.8, p < 0.05). The coefficient of variation of Orbscan II<sup>® was larger than those of Lenstar<sup>® and IOLMaster<sup>®. Conclusions: The WTW measurement using Orbscan II<sup>® has low correlations with other devices and lower repeatability. Our findings suggest that partial coherence interferometry should be considered as a new standard.

컴퓨터 작업으로 인한 눈 피로의 객관적 평가 방법

서영우,김균형,강수연,김성우,오재령,김효명,송종석,Young-Woo Suh,Kyun-Hyung Kim,Su-Yeon Kang,Seoung Woo Kim,Jae Ryung Oh,Hyo-Myung Kim,Jong-Suk Song 대한안과학회 2010 대한안과학회지 Vol.51 No.10

Purpose: To develop methods for the objective measurement of ocular fatigue. Methods: Fifteen patients were enrolled in the present study. Subjects performed visual tasks on a computer for one hour. A survey of ocular fatigue was conducted with a questionnaire. Tear break-up time, blinking rate, ocular protection index, conjunctival injection, maximal blinking interval, temperature of the ocular surface, and visual evoked potential were evaluated before and immediately after the task. Surface electromyography of the orbicularis oculi muscle was performed before and during the task. Results: The survey showed increases in subjective ocular fatigue in all subjects. Tear break-up time, ocular protection index and maximal blinking interval decreased, while temperature of the ocular surface increased after the task. Conjunctival injection showed a tendency to increase. Electromyography, and visual evoked potential did not change significantly. Conclusions: In the present study, tear break-up time, ocular protection index, maximal blinking interval, and temperature of the ocular surface changed as ocular fatigue increased. Therefore, these measures can be objectively used for the evaluation of ocular fatigue. J Korean Ophthalmol Soc 2010;51(10):1327-1332

부분조절내사시 환자에서 발생한 악성고열증 1예

권성욱,김균형,김운영,김승현,Sung Wook Kwon,Kyun Hyung Kim,Woon Young Kim,Seung Hyun Kim 대한안과학회 2008 대한안과학회지 Vol.49 No.8

Purpose: Malignant hyperthermia is hypermetabolic disorder of skeletal muscle that manifests during general anesthesia. Strabismus and ptosis are important risk factors in ophthalmology field for malignant hyperthermia. We report a case of malignant hyperthermia in patient with partially accommodative esotropia. Case summary: A 6-year-old patient was supposed to undergo a surgical correction for 20 prism diopters of right esotropia after correction of hypermetropia. Because the patient showed tachycardia and hyperthermia just after inhalation of sevoflurane, we interrupted general anesthesia and cancelled the surgery. The patient was transferred to the intensive care unit. In this case, no significant familial and past histories were found. Intractable tachycardia and hyperthermia that had not responded to conservative management improved after two administration of dantrolene sodium. The patient was returned to the ward three days later. As the patient showed no other complication, he was discharged. Conclusions: In malignant hyperthermia, early diagnosis, appropriate management, and prompt administration of dantrolene sodium are important factors for better prognosis. Preoperatively, full explanation of possible complication and history taking are needed. Careful observation is necessary during anesthesia and surgery. J Korean Ophthalmol Soc 49(8):1356-1359, 2008

세균각막염 원인균주의 항생제 감수성과 초기 항생제 선택의 적절성

윤제환,정지웅,문현승,문호석,신경환,김균형,Je Hwan Yoon,Jee Woong Jung,Hyun Seung Moon,Ho Seok Moon,Kyung Hwan Shyn,Kyun Hyung Kim 대한안과학회 2013 대한안과학회지 Vol.54 No.1

Purpose: The present study aims to determine the common pathogens involved in the etiology of bacterial keratitis and to analyze not only the antibiotic susceptibility of bacterial isolates from patients with bacterial keratitis but also the propriety of initial treatment. Methods: A retrospective study of 161 eyes in 161 patients with bacterial keratitis, who were diagnosed by cultures from 2000 to 2011, was performed. Causative bacteria and antibiotic susceptibility were evaluated in consecutive 6-year periods. Results: The most common bacteria was the pseudomonas species in the 2 time periods tested and cefazolin with tobramycin was the most commonly used antibiotic (125 cases, 77.6%) for initial treatment of bacterial keratitis. In vitro testing showed gram-negative susceptibility to tobramycin and ciprofloxacin was over 70%, gram-positive susceptibility to cephalothin and vancomycin was 100% and there was no significant difference between the 2 time periods tested. Eight cases had resistance to the initial treatment, but only 1 case showed treatment failure. Conclusions: Antibiotics used for initial treatment of bacterial keratitis were able to obtain a proper effect but several cases showed bacterial resistance to antibiotics. Thus, continued testing is essential to monitor for antibiotic resistance.

인천 지역에 거주하는 고령인구에서의 건성안 유병률 및 위험인자

정훈석,임정수,오대규,지미정,백혜정,신경환,김균형,Hoon Seok Jeong,Jung Soo Lim,Dae Kyu Oh,Mi Jung Chi,Hye Jung Paik,Kyung Hwan Shyn,Kyun Hyung Kim 대한안과학회 2011 대한안과학회지 Vol.52 No.10

Purpose: To investigate the prevalence, clinical manifestations, and risk factors of dry eye syndrome (DES) among people over 50 years old in the Incheon area. Methods: A cross-sectional prevalence study was performed on 462 people over 50 years old in Dong-gu, Incheon. DES was defined as the constant or frequent presence of symptoms of both dryness and irritation. Symptoms and past medical history were assessed by a survey. Eye examination included slit lamp examination, Schirmer test, and tear break-up time (T-BUT). Age, sex, living habits, systemic and eye diseases were also analyzed to determine the risk factors of DES. Results: The prevalence of DES was 26.2%. The major symptoms were as follows in descending order: dryness (77.9%), tearing (75.2%), and sandiness (72.7%). An average of 12.1 ± 6.0 mm in the Schirmer test and 6.7 ± 2.4 seconds in the T-BUT were significantly different in the DES group from the normal group (<em>p</em> < 0.001). Variables such as age, sex, living habits, and eye diseases were not related to the diagnosis of DES, whereas diabetes was the only risk factor of DES with statistical significance (<em>p</em> = 0.03). Conclusions: In the present study, the prevalence of DES among people over 50 years old in the Incheon area was 26.2%. Schirmer test and T-BUT were considered to be helpful tools for the diagnosis of DES, and diabetes was a significant risk factor of DES. J Korean Ophthalmol Soc 2011;52(10):1135-1141

나병환자에서 무봉합 투명각막절개 백내장 수술 후 발생한 안내염

한대헌(Dae Heon Han),손희진(Hee Jin Sohn),김균형(Kyun Hyung Kim),신경환(Kyung Hwan Shyn),남동흔(Dong Heun Nam) 대한검안학회 2009 Annals of optometry and contact lens Vol.8 No.1

목적: 나병을 앓고 있는 환자에서 무봉합 투명각막절개창을 이용한 백내장 수술 후 안내염을 경험하였기에 보고하고자 한다. 대상과 방법: 나병, 천식, 만성신부전의 과거력이 있는 71세 남환이 수개월 전부터 시작된 양안 시력저하를 주소로 내원하였다. 좌안 백내장과 관련하여 좌안 무봉합 투명각막절개창을 이용한 초음파유화술 및 후방인공수정체삽입술을 시행하였다. 술 후 8일째 좌안 최대교정시력 0.4로 양호한 회복을 보였으나, 술 후 14일째부터 시작된 좌안 시력저하 및 통증을 술 후 14일째 호소하였다. 당시 좌안 최대교정시력 0.02였고, 전방 내 투명각막절개창에서 뻗어나가는 형태의 백색의 막과 전방축농을 확인하였으며, 초음파검사에서 안내염이 의심되었다. 결과: 당일 좌안 유리체 내 항생제주입술을 시행하였으나 호전 없어 이틀 뒤 좌안 23게이지 경결막무봉합 유리체절제술, 전방세척술 및 막제거술을 시행하였고, 투명각막절개창을 봉합하였다. 술 후 2달째 좌안 최대교정시력은 0.5로 호전되었다. 결론: 백내장 수술 후 안내염 발생의 위험의 위험인자를 가지고 있는 환자에서는 공막절개창을 사용하거나 투명각막절개창에 예방적 봉합술을 시행하는 것을 고려해야 할 것이다. Purpose: To report a case of endophthalmitis which occurred two weeks after clear corneal incision cataract surgery in a patient with leprosy. Methods: A 71-years-old man visited our clinic because of visual disturbances in both eyes lasting several months. Therewere histories of leprosy, bronchial asthma, and chronic renal failure. We performed sutureless clear cornea phacoemulsification with posterior chamber intraocular lens implantation in the left eye. Eight days after the cataract surgery, best-corrected visual acuity (BCVA) was 0.4. On the postoperative 14 days, he presented with a sudden loss of vision and eyeball pain lasting 2 days and BCVA was 0.02. There were whitish membrane radiating to the anterior chamber from the clear corneal wound and hypopyon in the anterior chamber. On the eyeball ultrasonography, there were vitreous opacities. Results: Diagnosed with infectious endophthalmitis, we performed intravitreal antibiotics injection. Then, 23- gauge transconjunctival sutureless vitrectomy, anterior chamber irrigation and fibrinous membrane removal were performed. The previous clear corneal wound was sutured. BCVA was 0.5 and there was no evidence of recurrence on 2 months after vitrectomy. Conclusions: In patients with risk factors for infection such as leprosy, scleral or sutured corneal cataract incision should be used rather than unsutured clear corneal incision.

2012년 한국백내장굴절수술학회 및 대한안과학회 회원 설문 조사

위재민(Jae Min Wi),문호석(Ho Seok Moon),김균형(Kyun Hyung Kim),신경환(Kyung Hwan Shyn) 대한안과학회 2015 대한안과학회지 Vol.56 No.8

목적: 국내 백내장 수술의 최근 경향과 그간의 변화를 알아보기 위해 1995년 이래 열여섯 번째로 설문 조사를 시행하였다. 대상과 방법: 한국 백내장굴절수술학회 회원 및 안과학회 회원 301명을 대상으로 총 108 문항의 제16차 설문 조사를 2013년 7월 실시하여 20.6%의 응답률을 얻었고, 2006년, 2009년에 시행된 기존 설문 조사와 비교하였다. 결과: 응답자의 연령은 30대가 46%로 가장 많았고 40대 43%, 50대가 10%였다. 백내장 수술의 입원 기간은 점점 감소하여 당일 퇴원이 보편화되었다. 마취방법은 점안마취가 69%로 가장 많은 비율을 차지하였고, 절개창의 무봉합법은 72%에서 시행되었다. 백내장 수술 시 사용하는 인공수정체의 광학부 재질은 소수성 아크릴(acrylic)이 76%로 가장 많았으며 지속적인 증가 추세에 있었다. 유수정체용 인공수정체 삽입술은 41%의 회원이 시행 중이었으며, 노안 교정인공수정체, 난시교정 인공수정체 등 특수 인공수정체에 대한 관심은 예전과 비교하여 지속적인 증가 추세에 있음을 알 수 있었다. 이 외에도 백내장 수술 후의 난시 발생을 최소화하기 위해 난시 정도에 따라 다양한 방법들이 시도되고 있었다. 하지만 Femtosecond laser cataract surgery 등 새로운 백내장 수술 방법에 대한 관심은 예상외로 높지 않았고, 도입 여부를 묻는 질문에도 회의적인 의견이 대부분이었다. 결론: 이번 조사로 국내 백내장 수술의 최근 경향 및 변화를 알 수 있었다. Purpose: This study investigated the current trends and changes in the field of cataract surgery in Korea. Methods: The members of the Korean Society of Cataract and Refractive Surgery (KSCRS) and the members of the Korean Ophthalmological Society (KOS) participated in a survey on cataract surgery in 2012, the 16th survey, consisting of 108 multi-ple-choice questions, mailed in July 2013 to 301 KSCRS and KOS members. Sixty two (20.6%) members answered the questions. Current data were compared with previous surveys performed in 2006 and 2009. Results: Most of the respondents (46%) were in the fourth decade, 43% in the fifth decade and 10% in the sixth decade of life. The duration of hospital stay had decreased annually and the use of topical anesthesia (69%) was the most preferred. Self-seal-ing wound construction was the main wound closure technique in phacoemulsification (72%). The most preferred intraocular lens (IOL) for cataract surgery was hydrophobic acrylic (76%) which showed an increasing trend. The implantation of phakic IOL was performed by 41% of the respondents and interest in the value added IOLs such as presbyopia IOL and toric IOL had in-creased annually. In addition, to minimize astigmatism following cataract surgery, several methods were performed according to the degree of astigmatism. However, there was little interest in new cataract surgery techniques such as femtosecond laser and many respondents were skeptical whether to adopt the femtosecond laser cataract surgery system. Conclusions: This survey summarized current trends and changes in the field of cataract surgery in Korea.