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A Case of Congenital Orbital Malignant Rhabdoid Tumor: Systemic Metastasis following Exenteration
Kook, Koung Hoon,Park, Moon Sung,Yim, Hyunee,Lee, Sang Yeul,Jang, Jae Woo,Grossniklaus, Hans E. S. Karger AG 2009 Ophthalmologica Vol.223 No.4
<P>A newborn girl presented with massive proptosis of the right eye. Physical and radiologic examination disclosed that the primary orbital mass was confined to the site. A diagnosis of malignant rhabdoid tumor was made by histopathologic examination of an incisional biopsy specimen. Exenteration was performed, and the resection margins were free from tumor cells. However, distant metastasis developed in the liver 1 month after surgery. Despite chemotherapy, the patient died 2 months later due to tumor invasion into the central nervous system, which was confirmed by autopsy. To the best of our knowledge, this is the first case of congenital orbital malignant rhabdoid tumor showing systemic metastasis after exenteration, which suggests the need for aggressive systemic treatment rather than exenteration, even in a case of locally confined tumor.</P><P>Copyright © 2009 S. Karger AG, Basel</P>
Use of the Bispectral Index to Predict Eye Position of Children during General Anesthesia
Koung Hoon Kook,Seung Ah Chung,Suyoun Park,Dae Hee Kim 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.3
Purpose: To assess the relationship between eye position and anesthesia depth using the bispectral index (BIS) value, a parameter derived from electroencephalography data. Methods: We investigated the relationship between BIS value and eye position in 32 children who underwent surgery for epiblepharon under general anesthesia. BIS values were recorded continuously throughout the procedure (from induction to awakening). Eye positions were video-recorded and analyzed after surgery. The vertical position of each eye was scored according to its height in relation to the medial canthus. An eye position in which the upper eyelid covered one-third of the cornea was defined as a significant ocular elevation. Results: The BIS value correlated inversely with the end-tidal concentration of each anesthetic agent, whereas it correlated positively with the eye elevation score (eye position = 0.014 × BIS + 0.699, p = 0.011). The mean eye position score was significantly greater in patients whose BIS values were over 65. Eleven patients (34.4%) had significant ocular elevation; their mean concurrent BIS value was 61.6. Two of these patients had elevation during surgery and 9 had elevation during emergence from anesthesia. Conclusions: We found that high BIS values were correlated with low levels of anesthetic concentration and high eye position, suggesting that BIS monitoring may be useful for predicting eye position during anesthesia. Particular attention must be given to eye position during ophthalmic surgery. Anesthesia depth can be maintained by assuring that the BIS value remains below 65.
경계골 소실이 동반된 안와내하벽골절에서 생체흡수성 코폴리머의 겹치기 방법을 이용한 정복술
최아영,박수연,국경훈,Ah Young Choi,Su Youn Park,Koung Hoon Kook 대한안과학회 2013 대한안과학회지 Vol.54 No.9
Purpose: To report the results of surgical repairing of inferomedial orbital wall fractures accompanied with loss of bony strut by an overlapping method using Resorb X<sup>® plates (poly(D,L)-lactic acid). Methods: To repair inferomedial orbital wall fractures with loss of bony strut, we bent the medial aspect of the plate for floor fracture according to the anatomical structure and then inserted the floor implant, which was supported by anterior, posterior and lateral margins of the floor fracture. Then, the medial implant, which was supported by the bent medial edge of the floor implant, was inserted. Postoperatively, we analyzed the outcomes of 21 patients regarding postoperative enophthalmos, limitation of eye movement (LOM) and diplopia. The diagonal lengths of the orbit in the operated side were compared with the non-traumatized side based on the coronal view of the postoperative CT scans to determine the success or failure of the reconstruction. Results: The average postoperative enophthalmic value was 0.5 mm, and no significant differences between the orbital diagonal lengths of the operated and non-operated eyes were observed. The LOM shown in 7 out of 8 patients was completely resolved during the postoperative follow-up period. All patients with diplopia, including one patient who showed partial remission of LOM, experienced complete symptom resolution. No other complications related to the implant were recorded. Conclusions: Inferomedial orbital wall fractures with the loss of bony strut can be successfully repaired by the overlapping method using Resorb X<sup>® implants.
안와섬유모세포의 지방세포 분화에 대한 혼합 갱글리오사이드의 영향
최윤희,조은형,국경훈,Youn-Hee Choi,Eun Hyung Cho,Koung Hoon Kook 대한안과학회 2011 대한안과학회지 Vol.52 No.3
Purpose: To investigate the role of gangliosides in the differentiation of orbital fibroblasts into adipocytes, a component in the pathogenesis of Graves’ ophthalmopathy. Methods: Orbital tissues were obtained during orbital surgery for subjects without Graves’ ophthalmopathy or other inflammatory orbital disease, and orbital fibroblasts were primarily cultured from each obtained tissue. Morphological examination of orbital fibroblasts was performed after treatment with commercially available gangliosides mixture (Gmix) comprised of several subtypes. To determine the effect of Gmix on the differentiation of orbital fibroblasts into adipocytes and the differentiation-related genes, Oil Red-O staining and RT-PCR were performed. Results: The treatment with Gmix induced the morphological changes, which at least in part were explained with the differentiation of orbital fibroblasts into adipocytes in accordance with the increase of mRNA level of genes known to be related to adipogenesis, whereas dermal fibroblasts and preadipocytes were irresponsive to the same treatment. Conclusions: The results from the present study suggest gangliosides may have a role in pathologic mechanisms of Graves’ ophthalmopathy by the induction of differentiation of orbital fibroblasts into adipocytes. J Korean Ophthalmol Soc 2011;52(3):338-344
원발성 군날개 수술 시 양막이식을 동반한 자가결막이식술 후 재발률
김종완,안재홍,국경훈,양홍석,Jong Wan Kim,Jaehong Ahn,Koung Hoon Kook,Hongseok Yang 대한안과학회 2011 대한안과학회지 Vol.52 No.2
Purpose: To compare postoperative recurrence rates between conjunctival autograft transplantation alone and conjunctival autograft transplantation with amniotic membrane transplantation in primary pterygium surgery. Methods: The authors conducted a retrospective analysis of 66 eyes from 62 patients who underwent primary pterygium surgery from January 2001 to May 2009. Twenty three eyes underwent conjunctival autograft transplantation alone, 43 eyes underwent conjunctival autograft transplantation with amniotic membrane transplantation. Results: Recurrence of pterygium was observed in 5 of 23 eyes that received conjunctival autograft transplantation alone. There were 2 cases of recurrence of 43 eyes that received conjunctival autograft transplantation and amniotic membrane transplantation. No major complications such as necrotizing scleritis, sclera ulcer, or corneal perforation were observed in either group after surgery. Conclusions: The present study showed that receiving both conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery has a lower recurrence rate than conjunctival autograft transplantation alone. J Korean Ophthalmol Soc 2011;52(2):163-168
Choi, Kyungsun,Lee, Kihwang,Ryu, Seung-Wook,Im, Minju,Kook, Koung Hoon,Choi, Chulhee Molecular Vision 2012 Molecular vision Vol.18 No.-
<P><B>Purpose</B></P><P>Transforming growth factor-β (TGF-β) plays a key role in transforming retinal pigment epithelial (RPE) cells into mesenchymal fibroblastic cells, which are implicated in proliferative vitreoretinopathy. Herein, we tested the effect of pirfenidone, a novel antifibrotic agent, on TGF-β1-mediated fibrogenesis in the human RPE cell line ARPE-19.</P><P><B>Methods</B></P><P>The effect of pirfenidone on the TGF-β1-induced phenotype in ARPE-19 cells was measured with immunocytochemistry as the change in F-actin. Fibronectin and collagen production was measured with enzyme-linked immunosorbent assay, and cell migration activity was investigated using a scratch assay. Immunoblot analyses of cofilin, sma and mad protein (smad) 2/3, p38 mitogen-activated protein kinase, c-Jun N-terminal kinase, and extracellular signal-related kinase expression were conducted to elucidate the cell signaling networks that contribute to the antifibrotic effect of pirfenidone.</P><P><B>Results</B></P><P>Treatment with TGF-β1 induced typical phenotypic changes such as formation of stress fiber running parallel to the long axis of cells and enhanced migration and production of extracellular matrix components such as collagen type I and fibronectin. This fibroblast-like phenotype induced by TGF-β1 was significantly inhibited by pretreatment with pirfenidone in a dose-dependent manner. We also elucidated the TGF-β signaling pathways as the target of the inhibitory effect of pirfenidone. Pirfenidone inhibited TGF-β signaling by preventing nuclear accumulation of active Smad2/3 complexes rather than phosphorylation of Smad2/3.</P><P><B>Conclusions</B></P><P>These results collectively provide a rational background for future evaluation of pirfenidone as a potential antifibrotic agent for treating proliferative vitreoretinopathy and other fibrotic retinal disorders.</P>
선천성 눈꺼풀처짐 환자에서 보존대퇴근막을 전두근과 검판에 직접 고정한 전두근걸기술의 결과
이기황,장윤희,국경훈,장재우,Ki Hwang Lee,Yoon Hee Chang,Koung Hoon Kook,Jae Woo Jang 대한안과학회 2007 대한안과학회지 Vol.48 No.2
Purpose: To investigate the outcome of frontalis suspension surgery congenital blepharoptosis with poor levator palpebral muscle function using preserved fascia lata with direct tarsal and frontalis fixation method. Methods: Twelve congenital ptosis patients (fourteen eyes) who underwent frontalis suspension using preserved fascia lata with direct tarsal and frontalis fixation method between July 1999 and June 2002 with the mean follow-up time of 54.8 months (31 months~78 months) included. And the postoperative results were obtained from medical records retrospectively. Results: The desired lid height was achieved in eight out of twelve patients (71.4%) after surgery. In four patients (4 eyes) (28.6%), adjustment was required due to under-correction within one month postoperatively. At a mean follow-up period of 54.8 months, all twelve patients had good final results with no postoperative complications. Conclusions: Frontalis suspension using preserved fascia lata with direct tarsal and frontalis fixation method provided cosmetically pleasing results with a low rate of ptosis recurrence and complication related to procedures. This method using preserved facia lata could be considered as alternative to the use of autogenous facia lata for the repair of ptosis.