A Case of Acquired Brown Syndrome after Surgical Repair of a Medial Orbital Wall Fracture

Il Hun Seo,Jay Won Rhim,Young Woo Suh,Yoon Ae A. Cho 대한안과학회 2010 Korean Journal of Ophthalmology Vol.24 No.1

A case of acquired Brown syndrome caused by surgical repair of medial orbital wall fracture is reported in the present paper. A 23-year-old man presented at the hospital with right periorbital trauma. Although the patient did not complain of any diplopia, the imaging study revealed a blow-out fracture of the medial orbital wall. Surgical repair with a calvarial bone autograft was performed at the department of plastic surgery. The patient was referred to the ophthalmologic department due to diplopia that newly developed after surgery. The prism cover test at distant fixation showed hypotropia of the right eye, which was 4 prism diopters (PD) in primary gaze, 20 PD in left gaze, while orthophoric in right gaze. Eye movement of the right eye was markedly limited on elevation in adduction with normal elevation in abduction with intorsion in the right eye present. Forced duction test of the right eye showed restricted elevation in adduction. Computerized tomography scan of the orbits showed the right superior oblique muscle was entrapped between the autografted bone fragment and posterior margin of the fracture. When repairing medial orbital wall fracture that causes Brown syndrome, surgeons should always be careful of entrapment of the superior oblique muscle if the implant is inserted without identifying the superior and posterior margin of the orbital fracture site.

자동굴절검사기를 이용한 연령에 따른 객관적 조절력 평가

강동완(Dong Wan Kang),엄영섭(Young Sub Eom),임재원(Jay Won Rhim),강수연(Su Yeon Kang),김효명(Hyo Myung Kim),송종석(Jong Suk Song) 대한안과학회 2016 대한안과학회지 Vol.57 No.1

Purpose: To evaluate the objective amplitude of accommodation in various age groups using an autorefractometer and to compare the results with subjective assessments on accommodation. Objective accommodative amplitude of artificial lenses in post-operative cataract patients was also measured. Methods: In this study, 41 patients who visited Korea University Guro Hospital from July through August 2014 were categorized into 6 different age groups. Accommodative amplitude was measured using long-distance refraction at 5 m and short-distance refraction at 20 cm. In 20 patients, subjective amplitude of accommodation was measured using the minus lens technique and was compared with the measured objective accommodative amplitude. Accommodative amplitude was also measured in 8 patients who received cataract surgery. Results: The mean accommodative ability in normal people was 2.38 D. The age groups of 10-19, 20-29, 30-39, 40-49, 50-59, and over 60 years showed accommodative amplitudes of 3.31 ± 0.99 D, 3.25 ± 0.34 D, 3.78 ± 0.68 D, 1.00 ± 0.60 D, 0.22 ± 0.23 D, 0.00 ± 0.00 D, respectively. The results showed a rapid decrease in accommodative ability of patients older than 40 years and demonstrated a correlation between objective and subjective amplitude of accommodation (Pearson’s correlation coefficient 0.838). There was a significant difference between objective and subjective accommodative amplitudes in artificial lenses (p =0.015), with average objective and subjective measures of 0.10 ± 0.23 D and 0.59 ± 0.35 D, respectively. Conclusions: Measuring amplitude of accommodation using an autorefractometer can be useful in assessing results of presbyopia treatment.

온열마사지가 눈꺼풀 온도 및 눈물막 지방층 두께에 미치는 효과

강동완(Dong Wan Kang),엄영섭(Young Sub Eom),임재원(Jay Won Rhim),강수연(Su Yeon Kang),김효명(Hyo Myung Kim),송종석(Jong Suk Song) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 상품화된 온열패드를 이용한 온열마사지가 눈꺼풀 온도 및 눈물막 지방층 두께에 미치는 효과를 평가하고자 하였다. 대상과 방법: 건성안이나 마이봄샘 기능장애 등 특별한 안질환이 없는 13인 26안을 대상으로 LipiView 2Ⓡ System (TearscienceⓇ, Morrisville, NY, USA)을 이용, 각각 양안의 평균 눈물막 지방층 두께를 측정하였다. 온열마사지의 효과를 알아보기 위하여 양안 중우안에만 찜질을 시행하였고, 찜질 시작 직후와 3분, 5분의 우안 눈꺼풀 온도를 측정하여 찜질을 하지 않은 좌안과 비교하였다. 5분간의 온열마사지 후 다시 양안의 눈물막 지방층 두께를 측정하여 온열마사지가 눈물막 지방층 두께에 미치는 영향을 분석하였다. 결과: 13인 26안에서의 온열마사지 전 평균 눈물막 두께는 우안 55.1 ± 21.0 nm, 좌안 53.9 ± 13.9 nm로 측정되었다(p=0.474). 온열마사지 전 눈꺼풀 온도는 우안 35.9 ± 0.3℃, 좌안 35.9 ± 0.2℃로 측정되었고, 마사지 시작 직후, 3분, 5분 후 눈꺼풀 온도는 각각 40.3 ± 1.3℃, 40.3 ± 1.3℃, 40.3 ± 1.9℃로 마사지를 하는 동안 눈꺼풀의 온도가 비교적 일정하게 유지되었다. 온열마사지 후 눈물막 지방층 두께는 우안 83.5 ± 18.8 nm로 마사지 전에 비해 유의한 증가를 보였고(p=0.001), 좌안 65.5 ± 27.1 nm에 비해서도 유의하게 차이를 보였다(p=0.005). 결론: 온열마사지는 정상안에서 마사지 후 눈물막 지방층의 두께를 증가시켰고, 5분의 마사지 시간 동안 40.3oC 정도의 비교적 안정적인 온도의 증가를 보여 눈물막 지방층 유지에 도움이 될 것이라 생각된다. <대한안과학회지 2016;57(6):876-880> Purpose: Warm compression using a commercial heat pad was used to evaluate the effects of temperature on the eyelids and tear film lipid layer thickness. Methods: Targeting 13 patients (26 eyes) with non-specific eye disease such as dry eye syndrome or Meibomian gland dysfunction, we measured the average thickness of the tear film lipid layer in both eyes with the LipiView 2?? System (Tearscience??, Morrisville, NY, USA). We performed warm compression on the right eye only in order to evaluate the effectiveness of massage and measured the temperature of the right eye lid immediately, 3 minutes, and 5 minutes after compression in order to compare with the untreated left eye. After warm compression for 5 minutes, we measured tear film lipid layer thickness of both eyes and analyzed the effectiveness of warm compression. Results: The average tear film lipid layer thickness was 55.1 ± 21.0 nm in the right eyes and 53.9 ± 13.9 nm in the left eyes (p = 0.474). Before performing the warm compression, the temperature of the right eye lid was 53.9 ± 13.9 nm, and that of the left was 35.9 ± 0.2oC. The eye lid temperature of the right eye immediately, 3 minutes, and 5 minutes after warm compression was 40.3 ± 1.3oC, 40.3 ± 1.3oC, and 40.3 ± 1.9oC, respectively, and these temperatures were relatively constant during the massage. Tear film lipid layer thickness after warm compression in the right eye was 83.5 ± 18.8 nm, which was increased compared to the original temperature (p = 0.001) and showed significant difference compared with the 65.5 ± 27.1 nm in the left eye (p = 0.005). Conclusions: Warm compression increased the tear film lipid layer thickness and showed a relatively constant increased temperature of 40.3°C over 5 minutes. This technique will be helpful for maintaining tear film lipid layer thickness in patients with Meibomian gland dysfunction. J Korean Ophthalmol Soc 2016;57(6):876-880

수성 눈물 부족 건성안 환자에서 수술적 눈물점 폐쇄의 효과 평가

안소민(So Min Ahn),엄영섭(Young Sub Eom),임재원(Jay Won Rhim),강수연(Su Yeon Kang),김효명(Hyo Myung Kim),송종석(Jong Suk Song) 대한안과학회 2016 대한안과학회지 Vol.57 No.2

Purpose: To analyze the improvement of symptoms and signs of dry eye after surgical punctual occlusion and to evaluate the effects of secondary systemic disease in dry eye patients. Methods: From March 2011 to July 2014, 15 eyes of 8 dry eye patients with a history of punctal plug insertion underwent surgical punctal occlusion. Schirmer test was measured based on mean 2.9 mm. The patients consisted of 4 dry eye patients with Sjogren’s disease, 1 with rheumatoid arthritis, 1 with graft-versus-host disease (GVHD), and 2 with no secondary systemic disease. Preoperative and postoperative ophthalmic examinations of log MAR visual acuity, subjective symptoms, corneal staining(National Eye Institute [NEI] score), and tear break-up time (BUT) were performed and the effects of secondary systemic disease in dry eye patients were evaluated. The results of surgical punctual occlusion were analyzed. Results: All patients showed a statistically significant improvement of log MAR visual acuity, subjective symptoms, corneal staining (NEI score), and tear BUT. The patients with rheumatoid-related diseases showed improved symptoms after surgery, but the patient with GVHD showed no significant improvement after surgery. Among the study patients, 80.0% showed completely closed punctum and 20.0% showed partial recanalization. Conclusions: Surgical punctal occlusion is an effective alternative in patients with severe aqueous deficient dry eye who show recurrent punctal plug loss or complications associated with punctal plugs.

안내후방콘택트렌즈삽입술 7년 후 발생한 급격한 내피세포 감소 1예

강동완(Dong Wan Kang),엄영섭(Young Sub Eom),임재원(Jay Won Rhim),강수연(Su Yeon Kang),김효명(Hyo Myung Kim),송종석(Jong Suk Song) 대한안과학회 2015 대한안과학회지 Vol.56 No.5

목적: 안내후방콘택트렌즈(implantable Collamer Lens, ICL) 삽입술을 받은 환자에서 6년째까지 정상내피세포 밀도를 보이다가 7년째 급격한 내피세포 감소가 발생한 환자가 있어 이를 보고하고자 한다. 증례요약: 남자 45세, 난시를 동반한 고도근시 환자에서 Toric ICL 삽입술을 시행하였다. 환자는 수술 전 최대교정시력이 양안 모두 0.7이었으며, 수술 후에는 나안시력이 양안 모두 0.9, 교정시력이 양안 모두 1.0으로 시력향상을 보였다. 수술 전 각막내피세포 밀도는 우안 3,063 cells/mm2, 좌안 3,126 cells/mm2였고 수술 후 5년째의 각막내피세포 밀도는 우안 2,897 cells/mm2 좌안 2,974 cells/mm2로 별 변화가 없었으나 6년째에는 우안 2,198 cells/mm2 좌안 2,803 cells/mm2로 내피세포의 감소가 관찰되었다. 1년 후 다시 측정한 각막내피세포 밀도는 우안 1,272 cells/mm2 좌안 2,852 cells/mm2로 우안의 내피세포밀도가 급격히 감소한 것이 관찰되었고, 우안의 Toric ICL 렌즈를 제거하고 수정체유화술 및 인공수정체 삽입술을 시행하였다. 수술 후 두 달째 측정한 각막내피세포 밀도는 1,257 cells/mm2로 수술로 인한 각막내피세포의 손상은 심하지 않았다. 결론: ICL과 같은 유수정체인공수정체를 삽입한 환자에서는 수술 후 백내장은 물론 각막내피세포에 영향을 줄 수 있어 정기적이고 규칙적인 내피세포밀도 측정을 시행해야 한다. <대한안과학회지 2015;56(5):784-788 > Purpose: To report a case of decreased endothelial cell density 7 years after posterior chamber phakic intraocular lens implantation. Case summary: A 45-year-old man with high myopia combined with astigmatism was treated with Toric implantable Collamer Lens (ICL) implantation. The patient's best corrected visual acuity was 0.7 in both eyes before the operation. After the treatment, his uncorrected visual acuity was 0.9 and corrected visual acuity was 1.0 in both eyes, indicating an improvement in visual function. Preoperative endothelial cell density measured 3,063 cells/mm2 in the right eye and 3,126 cells/mm2 in the left eye. At 5 years postoperatively, measurements were 2,897 cells/mm2 in the right eye and 2,974 cells/mm2 in the left, showing little change. However, a 6-year postoperative measurement of 2,198 cells/mm2 in the right eye and 2,803 cells/mm2 in the left showed a slight decrease in endothelial cell density in the right eye, and a follow-up measurement one year later displayed a rap-id decline to 1,272 cells/mm2 in the right eye and 2,852 cells/mm2 in the left eye. The Toric ICL lens was removed from the right eye and phacoemulsification and posterior chamber intraocular lens implantation was performed. Two-month postoperative en-dothelial cell density was 1,257 cells/mm2 and endothelial cell damage from the operation itself was minimal. Conclusions: ICL implantation may cause complications related to corneal endothelial cells as well as glaucoma. Patients should receive regular follow-up examinations for endothelial cell density. J Korean Ophthalmol Soc 2015;56(5):784-788

익상편 절제술 후 익상편의 크기 지표에 따른 평균 각막 굴절력 변화량 예측

남기태,엄영섭,임재원,강수연,김효명,송종석,Ki Tae Nam,MD,Young Sub Eom,MD,Jay Won Rhim,MD,Su Yeon Kang,MD,Hyo Myung Kim,MD,PhD,Jong Suk Song,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.11

Purpose: To assess the changes in mean corneal refractive power (ΔK) following pterygium surgery and to predict ΔK in cases of combined cataract and pterygium surgery. Methods: Thirty-seven eyes of unilateral pterygium patients who underwent pterygium surgery were analyzed retrospectively with at least more than 1 month of follow-up. Preoperative and postoperative 1 month corneal refractive power was measured using auto-keratometer (RK-F1, Canon, Tokyo, Japan). Pterygium horizontal extension, width, and area were measured and correlation with ΔK before and after surgery analyzed. We also compared ΔK of the contralateral normal eye. Results: The mean corneal refractive (Km) power measured before and 1 month after surgery was 43.30 ± 1.66 D and 44.07 ± 1.42 D, respectively. The Km significantly increased at 4 weeks after surgery (<EM>p </EM>< 0.001). However, postoperative Km was not significantly different when compared with the contralateral normal eye (43.86 ± 1.34 D; p = 0.59). All parameters of pterygium size including horizontal extension, width, and area were positively correlated with the mean ΔK. Among parameters, horizontal extension was best correlated with mean ΔK (<EM>p</EM> < 0.001). The mean ΔK with horizontal extension was predicted using linear regression (2.5 mm to 1 D, 4.0 mm to 1.8 D). Conclusions: We recommend contralateral corneal refractive power or prediction of corneal refractive power using linear regression with pterygium horizontal extension for determining intraocular lens power in cases of combined cataract and pterygium surgery. J Korean Ophthalmol Soc 2014;55(11):1613-1617