오노디 세포내 곰팡이 덩이에 의한 시신경병증 1예

한영수,양찬민,신재호,박인기,Young Soo Han,Chan Min Yang,Jae Ho Shin,In Ki Park 대한안과학회 2014 대한안과학회지 Vol.55 No.3

Purpose: To report a rare case of optic neuropathy caused by a fungal ball in an Onodi cell. Case summary: A 63-year-old female was referred to our clinic with relapsed visual loss and ocular pain in the right eye. She had been diagnosed as optic neuritis 14 days before and given pulse steroid therapy. She recovered to normal but relapsed 7 days before. In medical referral there was no suspected multiple sclerosis but only a few inflammation in the paranasal sinuses. On our initial examination, best corrected visual acuity was counting finger at 10 cm in the right eye, and 1.0 in the left eye, along with relative afferent pupillary defect in the right eye. The fundoscopic examinations disclosed disc swelling; nearly total visual field defect was observed on visual field examination and visual evoked potential test revealed decreased amplitude at P100 wave in the right eye. Clinical impression was relapsed optic neuritis. After the administration of pulse steroid therapy, her disc swelling was decreased and visual acuity was recovered to 0.6, however, visual acuity was exacerbated to 0.4 in 2 weeks. We checked outside brain magnetic resonance imaging (MRI) and the result showed optic neuropathy caused by a fungal ball in an Onodi cell. The patient was referred to otorhinolaryngologist and fungal ball was removed by endoscopic sinus surgery. 3 weeks after surgery the patient's visual acuity was 0.9, no disc swelling was found and visual evoked potential was recovered to normal. Conclusions: An Onodi cell lesion should be considered in the differential diagnosis of optic neuritis, identified by imaging studies and promptly removed by surgery for visual recovery. J Korean Ophthalmol Soc 2014;55(3):426-431

눈꺼풀속말림, 두줄속눈썹 환자에서 시축을 침범한 양안 각막 아밀로이드증

노성래(Sung Rae Noh),양찬민(Chan Min Yang),김태기(Tae Gi Kim),진경현(Kyung Hyun Jin) 대한검안학회 2017 Annals of optometry and contact lens Vol.16 No.2

Purpose: To report a rare case of bilateral secondary corneal amyloidosis with visual disturbance secondary to entropion and distichiasis. Case summary: A 41-year-old man was referred to our clinic for the evaluation of decreased visual acuity in both eyes. Upon admission, the patient’s best-corrected visual acuity was 0.6 OD and count finger OS. External evaluation revealed entropion in both lower eyelids as well as distichiasis involving all 4 eyelids cause irritation to cornea. Slit-lamp examination revealed corneal opacity in the right peripheral cornea and left center cornea. The appearance of corneal opacity is gray-whitish circle with diameter 5 mm in right and 4 mm in left, also presented with gelatinous irregular surface and neovascularization in the right eye. Penetrating keratoplasty was performed for decreased visual acuity in the left eye. Histopathologic analysis of corneal button revealed deposition of amorphous, eosinophilic material just beneath the corneal epithelium. These opacities stained with Congo red and demonstrated apple green birefringence and dichroism. Secondary localized amyloidosis of the cornea was diagnosed without any systemic involvement. Entropion repair and hyfrecation was performed 1 month after penetrating keratoplasty. By the 4 years after penetrating keratoplasty, the patient’s best-corrected visual acuity was 0.9 OD and the patient showed no evidence of corneal graft rejection and recurrence of amyloidosis. Conclusion: Irritation by eyelashes can cause corneal opacity and amyloidosis in patients with distichiasis or entropion.

결막 결석에 의한 상윤부각결막염 양상을 보인 1예

손보권(Bo Kwon Son),양찬민(Chan Min Yang),김태기(Tae Gi Kim),진경현(Kyung Hyun Jin) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 결막 결석에 의한 상윤부각결막염 양상을 보인 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 40세 남자 환자가 한 달 전 발생한 지속적인 좌안의 이물감, 통증 및 결막 충혈 증상으로 내원하였다. 세극등 검사에서 좌안 상부 안구결막의 충혈 및 이완, 상부 각막상피의 결손 및 띠모양의 각막혼탁이 관찰되었다. 상부 안검결막에서 다양한 크기의 결막 결석과 심한 염증이 발견되어 결막 결석의 기계적 자극에 의해 상윤부각결막염 양상을 보이는 것으로 생각하였다. 결석을 30게이지 주사바늘을 이용하여 제거한 후 치료용 콘택트렌즈를 착용하였으며 인공누액, 항생제, 스테로이드를 점안하였다. 치료 7일 후 상부 안구결막 충혈, 상부 각막상피의 결손, 미란 및 각막혼탁이 호전되었다. 이후 4개월간의 외래 경과 관찰 기간 동안 재발 및 특별한 합병증의 발생은 없었으며 상부 각막에 약간의 혼탁 소견만 남았다. 결론: 심한 결막 결석의 기계적 자극은 상윤부각결막염 양상으로 나타날 수 있다. 따라서 상윤부각결막염 양상을 보이는 환자를 진료시에 결막 결석의 가능성을 고려하고 상부 안검결막을 면밀히 관찰해야 한다. <대한안과학회지 2016;57(6):983-987> Purpose: To report a case of conjunctival lithiasis with clinical manifestations of superior limbic keratoconjunctivitis. Case summary: A 40-year-old male complained of pain, foreign body sensation and injection in the left eye lasting 1 month. The slit-lamp examination revealed injection of the superior bulbar conjunctiva, linear corneal band opacity, fine punctate staining and epithelial defect in the superior cornea area. After eversion of the left upper eyelid, there were many various-sized conjunctional concretions and inflammation in the superior tarsal conjunctiva. Therefore, we considered conjunctival lithiasis-induced clinical manifestations of superior limbic keratoconjunctivitis and then removed the conjunctival concretions using a 30-gauge needle. After the procedures, artificial tears, antibiotic eye drops, steroid eye drops and a therapeutic contact lens were applied. After 1 week, all symptoms and signs improved and there was no recurrence for 4 months. Conclusions: Mechanical stimulation by severe conjunctival lithiasis can induce clinical manifestations of superior limbic keratoconjunctivitis. Therefore, in patients with clinical manifestations of superior limbic keratoconjunctivitis, conjunctival lithiasis should be considered by observing the superior tarsal conjunctiva more closely. J Korean Ophthalmol Soc 2016;57(6):983-987

펨토초레이저 백내장수술 도입 초기의 단기 임상경과 및고식적 백내장수술과의 비교

최재환(Jae Hwan Choi),양찬민(Chan Min Yang),정나연(Na Yeon Chung),임동희(Dong Hui Lim),정태영(Tae-Young Chung) 대한안과학회 2018 대한안과학회지 Vol.59 No.5

Purpose: To evaluate the short-term clinical outcome of femtosecond laser-assisted cataract surgery at the initial phase and to compare it with results from conventional phacoemulsification. Methods: This retrospective study was performed on 50 eyes who underwent femtosecond laser-assisted cataract surgery and 50 eyes who underwent conventional phacoemulsification. The short-term outcomes included uncorrected and corrected distance visual acuity and spherical equivalent. The complications of femtosecond laser-assisted cataract surgery were evaluated, and the prevalences of complications between the initial 25 eyes and latter 25 eyes of the cases were compared to evaluate the importance of the learning curve. Results: There were no significant differences in uncorrected (p = 0.78) and corrected (p = 0.89) distance visual acuity between groups 1 month postoperatively. There was no difference in spherical equivalent (p = 0.09). The phacoemulsification time was not different between groups (p = 0.15). However, there was a significant decrease in cumulative dissipated energy in the femtosecond laser-assisted cataract surgery group (p = 0.04). There were complications during femtosecond laser-assisted cataract surgery, such as subconjunctival hemorrhage, miosis, early entry corneal incision, and incomplete corneal incision. The prevalence of complications in the latter 25 eyes was less than that of the first 25 eyes treated with femtosecond laser-assisted cataract surgery; the prevalence of subconjunctival hemorrhage was reduced significantly (p = 0.02). Conclusions: The short-term clinical outcomes of the femtosecond laser-assisted cataract surgery group at the initial phase were not different, and in some cases, better than those of the conventional phacoemulsification group. A learning period is therefore required during the initial phase of femtosecond laser-assisted cataract surgery. J Korean Ophthalmol Soc 2018;59(5):419-427