알터나리아 각막염의 임상양상과 예후

유인천,강인성,윤경철,In Cheon You,M,D,In Seong Kang,M,D,Kyung Chul Yoon,M,D,Ph,D 대한안과학회 2007 대한안과학회지 Vol.48 No.4

Purpose: To investigate the risk factor, clinical manifestations, treatment results, and prognosis in Alternaria keratitis. Methods: Thirteen eyes of 13 patients who were diagnosed as Alternaria species by corneal smear and culture were included. The past history, visual acuity, location and size of ulceration, hypopyon, treatment results, and prognosis were analyzed retrospectively. Results: Nine (69.2%) were women, and 4 were men. The mean age was 65.23±8.70 years. Eleven eyes (84.6%) had previous history of corneal traumas by soil or plant material. In 7 eyes (53.8%), the lesions were located at the corneal center. The average size of ulceration was 13.90±21.80 mm2. Four eyes (30.8%) had hypopyon. The initial visual acuity was less than 0.1 in 10 eyes (76.9%). The final visual acuity improved more than 2 lines in 10 eyes (76.9%) and more than 1 line in 12 eyes (92.3%), and did not change in 1 eye (7.7%). The treatment success was achieved in 12 eyes (92.3%). Conclusions: Early diagnosis and specific antifungal treatments of Alternaria keratitis can lead to a good prognosis.

스테노트로포모나스 말토필리아 각막염의 임상양상과 예후

유인천,이승현,박영걸,윤경철,In Cheon You,M,D,Seung Hyun Lee,M,D,Yeoung Geol Park,M,D,Ph,D,Kyung Chul Yoon,M,D,Ph,D 대한안과학회 2007 대한안과학회지 Vol.48 No.7

Purpose: To investigate the risk factor, clinical manifestations, treatment results, and prognoses in Stenotrophomonas maltophilia keratitis. Methods: Ten eyes of 10 patients who were diagnosed with, Stenotrophomonas maltophilia by corneal smear and culture were included in this study. Each patient`s past history, visual acuity, location and size of ulceration, hypopyon, treatment results and prognosis were analyzed retrospectively. Results: Seven pateints (70.0%) were men, and 3 were women. The mean age was 62.9±11.3 years. Only 2 eyes (20.0%) had previous histories of corneal traumas. Polymicrobial infections, including 3 cases infected with Pseudomonas species and 2 cases infected with Fusarium species, were detected in 7 eyes (70.0%). The lesions were located at the corneal center in 6 eyes, and hypopyon was observed in 9 eyes. The average size of ulceration was 28.5±19.6 mm2. Seven eyes (70.0%) underwent surgical treatment. The initial visual acuity was less than 0.02 in 9 eyes (90.0%). The final visual acuity improved in 3 eyes (30.0%) and was less than hand movement in 7 eyes (70.0%). Conclusions: Stenotrophomonas maltophilia keratitis occurs in patients with a compromised ocular surface, is often polymicrobial, and is associated with poor prognoses.

배양 양성 감염각막염의 임상양상 및 항생제감수성 변화: 10년간의 국내 다기관 연구

유인천(In-Cheon You),이상범(Sang-Bumm Lee),서경률(Kyoung Yul Seo),김미금(Mee Kum Kim),윤경철(Kyung-Chul Yoon),고재웅(Jae Wong Koh),이지은(Ji Eun Lee),김성재(Seong-Jae Kim),KOAIDS 대한안과학회 2021 대한안과학회지 Vol.62 No.4

목적: 최근 10년간 감염각막염 중 배양검사상 균주가 확인된 환자에 대하여 여러 임상양상에 대해 알아보고자 한다. 대상과 방법: 2008년 1월부터 2017년 12월까지 전국 8개 병원에서 균주가 확인된 감염각막염 956명의 의무기록을 후향적으로 분석하여, 선행요인, 원인균, 치료 방법, 예후 등을 분석하였다. 결과: 감염각막염의 가장 흔한 선행요인은 안외상(33.2%)이었다. 초기시력은 안전수지 이하가 449안(47.0%)이었다. 각막궤양은 중심부에서 흔하였고, 크기는 4 mm² 이하가 가장 많았다. 전방축농이 동반된 경우는 295안(30.9%)이었다. 배양된 균주는 총 1,039균으로 그람음성균 443균주(42.6%)가 가장 많았다. 가장 흔한 균은 그람음성균은 녹농균, 그람양성균은 피부포도알균, 진균은 푸사륨이었다. 수술 치료는 201안(21.0%)에서 양막이식술 66안, 안구내용제거술 44안 순이었다. 최종시력은 0.2보다 좋은 시력이 422안(44.1%)이었다. 그람양성균은 목시플록사신과 반코마이신에, 그람음성균은 레보플록사신과 세프타지딤에 높은 감수성을 보였지만 일부 장알균과 슈도모나스 등에서 저항성을 보였다. 결론: 국내 감염각막염은 안외상으로 흔히 발생하였고 그람음성균이 가장 많았다. 대표적인 원인균은 피부포도알균, 녹농균, 푸사륨이었다. 입원 후 약물 및 수술적 치료로 시력이 호전된 경우가 많았지만 일부 저항성을 보이는 세균과 진균에 대해서는 주의가 필요하다. 세균에서 불량한 임상결과에 이르는 위험인자는 초기시력 0.02 미만, 전방축농, 65세 이상 나이, 각막중심부 궤양이었고 진균은 70세 이상 나이였다. Purpose: To analyze the clinical manifestations of culture-proven infective keratitis patients over a recent 10-year period. Methods: We retrospectively reviewed the medical records of 956 cases of infective keratitis between January 2008 and December 2017 at eight tertiary hospitals. The study was performed to analyze the risk factors, causative microbial organisms, therapeutic outcomes, and prognosis. Results: The most common risk factor of keratitis was trauma (33.2%). Initial visual acuity (V/A) was finger count or less in 449 eyes (47.0%). The common location of keratitis was central, and the size was 4 mm2 or less. Hypopyon was observed in 295 eyes (30.9%). Of the 1,039 cultured isolates, 443 (42.6%) grew Gram-negative bacteria with the most common being Pseudomonas aeruginosa. The most prevalent Gram-positive bacteria was Staphylococcus epidermidis, and fungi was Fusarium species. Surgical treatments were performed in 201 eyes (21.0%), followed by amniotic membrane transplantation (66 eyes) and evisceration (44 eyes). Final V/A was 20/100 or more in 422 eyes (44.1%). Gram-positive organisms were highly susceptible to moxifloxacin and vancomycin, and Gram-negative organisms were highly susceptible to levofloxacin and ceftazidime. An increase in resistance to these antibiotics was detected for Enterococcus and Pseudomonas. Conclusions: In South Korea, infective keratitis occurs frequently in eyes with trauma. Staphylococcus epidermidis, Pseudomonas aeruginosa, and Fusarium species are commonly identified etiologies of microbial keratitis. The appropriate administered medical and surgical treatments of suspected infectious keratitis can lead to visual improvement with particular care taken to minimize infection related to resistant bacteria and fungal microbes as needed. An initial V/A of 0.02 or less, the presence of hypopyon, age of 65 years or more, and a central lesion were associated with poor clinical outcome of bacterial keratitis. Age of 70 years or more was a significant risk factor for poor clinical outcome of fungal keratitis.

감염성 각막궤양에 의한 절박천공에서 구조 전층각막이식술의 효과

정인영,유인천,박영걸,윤경철,In-Young Jeong,In-Cheon You,Yeoung-Geol Park,PhD,Kyung Chul Yoon 대한안과학회 2007 대한안과학회지 Vol.48 No.7

Purpose: To investigate the effect of tectonic penetrating keratoplasty for the treatment of impending perforations caused by infectious corneal ulcers. Methods: We analyzed preoperative and postoperative visual acuity, lesion location and size, graft size, postoperative outcome, and complications in 19 patients (19 eyes) with impending perforations due to infectious corneal ulcers. All patients underwent tectonic penetrating keratoplasty and had a minimum follow-up period of 6 months. Results: In our study, eight eyes (42.1%) had herpes simplex keratitis, 6 eyes (31.6%) had bacterial keratitis, and 5 eyes (26.3%) had fungal keratitis. Twelve eyes had a lesion located in the central cornea, while 7 eyes had a lesion located in the paracentral cornea. Visual acuity improved in 13 eyes (68.4%) and anatomical success was achieved in 16 eyes (84.2%). Three eyes (15.8%) developed a graft melting secondary to rejection. Complications included bullous keratopathy (3 eyes, 15.8%), graft infection (3 eyes, 15.8%), neovascularization (2 eyes, 10.5%), and secondary glaucoma (1 eye, 5.3%). Conclusions: Tectonic penetrating keratoplasty maintains ocular integrity and effectively treats impending perforations caused by infectious corneal ulcers.

아크로모박테르 자일로속시단스에 의한 각막궤양 1예

김유라,유인천,이혜수,You Ra Kim,In Cheon You,Hye Soo Lee 대한안과학회 2011 대한안과학회지 Vol.52 No.11

Purpose: To report a case of corneal ulcer caused by Achromobacter xylosoxidans in a farmer. Case summary: A previously healthy 68-year-old man presented with unilateral redness and irritation after his eye was grazed by a cow’s tail. The patient had previously been treated in a local clinic for four days without improvement. Bacterial staining, culture, and an antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of A. xylosoxidans. The patient was treated with moxifloxacin and ceftazidime eyedrops. After three months of treatment, the infection was resolved with mild scarring. Conclusions: Although it is a rare pathogen, A. xylosoxidans should be considered as a potential pathogen in patients presenting with corneal ulceration due to trauma from an object contaminated by soil or animal feces and having a slowly progressive disease and localized infiltrate but showing Gram-negative bacilli on smear examination. J Korean Ophthalmol Soc 2011;52(11):1362-1365

건성안이 동반된 갑상샘안병증 환자에서 사이클로스포린 A 점안액 사용 후 눈물막과 안구표면의 변화

오한진,유인천,윤경철,Han Jin Oh,In Cheon You,Kyung Chul Yoon 대한안과학회 2007 대한안과학회지 Vol.48 No.5

Purpose: This study was performed to evaluate the changes of tear film and ocular surface after using cyclosporine A in patients with thyroid-associated ophthalmopathy accompanied by dry eye. Methods: Corneal sensitivity test (CST), tear break-up time (BUT), basal tear secretion test (BST), fluorescein staining (FS), tear clearance rate (TCR), and conjunctival impression cytology were evaluated in 28eyes of 28 patients with thyroid-associated ophthalmopathy accompanied by dry eye before and after using 0.1 cyclosporine A. Results: CST (P=0.03), BUT (P<0.01), and BST (P=0.01) were shown significant improvements after 3 month treatment with topical 0.1% cyclosporine A. There are also shown improvments of impression cytologic findings, reduction of the degree of conjunctival squamous cell metaplasia (P=0.02) and increment of the density of goblet cell (P=0.04) after 3 month treatment. But TCR and FS were shown no significant changes after treatment. Conclusions: The improvement of parameters of tear films and ocular surface suggest the treatment with 0.1% cyclosporine A for dry eye in thyroid ophthalmopathy was effective.

간헐외사시에서 단안 내직근절제 및 외직근후전술의 수술성공인자

정태선,유인천,박상우,박영걸,Tae Sun Jeong,In Cheon You,Sang Woo Park,Yeoung Geol Park 대한안과학회 2006 대한안과학회지 Vol.47 No.12

Purpose: To investigate the factors associated with surgical success in cases of unilateral medial rectus resection and lateral rectus recession in the intermittent exotropia. Methods: Ninety-eight patients with basic-type intermittent exotropia were included in this study. They underwent unilateral recession of the lateral rectus and resection of the medial rectus muscle and were followed postoperatively for at least one year. Surgical results were analyzed to assess the association with preoperative factors, including the angle of deviation, difference of deviation between near and far, stereoacuity at far using B-VAT?, and Worth 4 dot test (W4DT) at near, and postoperative factors, including the position at near and far at one week, stereoacuity at far using B-VAT? at one year, and W4DT at near and far. Surgical success was defined as esotropia within 5 prism diopters (PD) at near and far or within 10PD at near and far at one year postoperatively. Results: Patients with a preoperative difference of deviation between near and far within 5PD had a better surgical outcome than patients with 6~10PD (p=0.03). There was a statistically significant relationship between position at one week postoperatively (especially esotropia or orthotropia at near and far) and success ratio (p<0.05). Other factors were not statistically related to surgical success (p>0.05). Conclusions: The difference of preoperative deviation between near and far within 5PD and within 5PD esotropia and orthotropia at near and far at one week postoperatively were significantly associated with a good surgical outcome and could be good prognostic indicators.

건성안 환자의 눈물에서 인터페론유도 T 세포 화학주성인자의 농도와 눈물표면인자와의 상관관계

김황균,유인천,윤경철,Hwang Gyun Kim,M,D,In Cheon You,M,D,Kyung Chul Yoon,M,D,Ph,D 대한안과학회 2008 대한안과학회지 Vol.49 No.10

Purpose: This study was performed to evaluate the level of I-TAC in tears of patients with dry eye syndrome and its correlation with the tear surface parameters. Methods: I-TAC levels were measured by enzyme-linked immunosorbent assay (ELISA) in tear samples collected from 33 dry eye patients (16 patients with Sjögren syndrome and 17 patients with non-Sjögren syndrome) and 15 control subjects. The correlations between I-TAC levels and tear surface parameters including tear film break-up time (BUT), basal tear secretion, tear clearance rate (TCR), corneal sensation, keratoepitheliopathy and conjunctival goblet cell density were analyzed. Results: The mean levels of I-TAC were 717±377 pg/ml in patients with dry eye and 444±119 pg/ml in control subjects (P=0.003). The mean levels in Sjögren syndrome patients (1261±324 pg/ml) were significantly higher than those of non-Sjögren syndrome patients (614±131 pg/ml, P=0.003). I-TAC levels correlated significantly with basal tear secretion (P=0.006), TCR (P=0.007), keratoepitheliopathy (P=0.022) and goblet cell density (P<0.001), but did not correlate with BUT (P=0.110) and corneal sensation (P=0.090). Conclusions: The level of I-TAC is elevated in tears of patients with dry eye syndrome including Sjögren syndrome. The level correlates with disease severity and tear surface parameters. J Korean Ophthalmol Soc 2008;49(10):1565-1571

칸디다와 세균의 복합 각막염 5예

양영훈,유인천,Young Hoon Yang,In Cheon You 대한안과학회 2013 대한안과학회지 Vol.54 No.5

Purpose: To report the clinical manifestations and prognoses in 5 cases of mixed Candida and bacterial keratitis and present a literature review on mixed fungal and bacterial keratitis. Case summary: Five eyes of 5 patients (1 male, 4 female) diagnosed as mixed Candida and bacterial keratitis by corneal smear and culture were included in the present study. Patient mean age was 62.80 years. All patients had preexisting ocular or systemic conditions as predisposing factors for mixed Candida and bacterial keratitis. The most common Candida species isolated was Candida albicans (3 eyes, 60%), while Staphylococcus (3 eyes, 60%) was the most common mixed bacterial species. The average size of ulceration was 7.02 mm2. In 2 eyes (40%), the lesions were located at the corneal center. The depth of the infiltration was significant in all cases, and hypopyon was present in 2 eyes (40%). On the initial visit, the visual acuity was counting fingers or worse in all cases. Four eyes (80%) unresponsive to the topical and systemic treatment underwent surgical intervention but only 1 eye (20%), which had responded to the topical and systemic treatment, showed acuity improvement of more than 1 line on the final visit. Conclusions: In managing chronically compromised cornea, the possibility of mixed infections with Candida and bacterial organisms should be considered as keratitis shows poor prognosis.

단순포진각막염 환자에서 발생한 진균각막염 3예

문귀형,박영걸,유인천,윤경철,Gui Hyeong Mun,Yeoung Geol Park,In Cheon You,Kyung Chul Yoon 대한안과학회 2010 대한안과학회지 Vol.51 No.9

Purpose: To report several cases of secondary infection by fungus in herpes simplex keratitis. Case summary: A retrospective chart review was performed on 3 eyes of 3 patients who were without improvement and diagnosed with fungal keratitis by smear and culture on prior presentation with herpetic keratitis. Two cases were diagnosed with fungal keratitis, based on the results of culture. Fungal keratitis by Candida albicans was improved with antifungal agents, but a case caused by Fusarium species was more aggravated, regardless of antifungal agents. One case was improved by antifungal medications, which was diagnosed with fungal keratitis by the fungal hyphae manifestation on KOH preparation. Conclusions: Secondary microbial infection should be considered, when the lesion had no improvement with antiviral agents in herpetic keratitis. J Korean Ophthalmol Soc 2010;51(9):1271-1275