외사시 환아에서 사시 수술 전후 주의력결핍 과다활동의 양상

유수리나,장윤희,이종복,정승아 대한안과학회 2009 대한안과학회지 Vol.50 No.5

목적: 외사시 환아에서 사시 수술 전후 주의력결핍 과다활동 양상의 변화에 대해 알아보고자 하였다. 대상과 방법: 외사시 환아 67명을 대상으로 사시 수술 전과 수술 후 3개월에 주의력결핍 과다활동장애 평가설문을 작성하여 이를 전향 적으로 분석하였다. 수술 전 설문 점수 15점을 기준으로 두 군을 나누어 연령, 성별, 사시각, 항상성, 사시 발견 시기, 유병기간, 수술 결과를 조사하고 수술 전후 설문 점수의 변화 양상을 분석하였다. 결과: 15점 미만군은 43명, 15점 이상군은 24명이었고 남아에서 15점 이상의 비율이 유의하게 높았다(p=0.048). 수술 전후의 설문 점수는 15점 미만군에서 술 후 1.30점 증가, 15점 이상군에서 1.04점 감소하였으나 의미 있는 변화는 아니었다. 사시 수술 성공여부를 고려하였을 때 수술결과에 따른 설문점수의 유의한 변화는 없었다. 결론: 외사시 환아에서 부모 설문에 의한 주의력결핍 과다활동 양상은 사시 수술 후에도 의미 있는 변화가 없는 것으로 나타났다. Purpose: To evaluate the effect of strabismus surgery in exotropia patients suspected of attention deficit hyperactivity disorder (ADHD). Methods: Parents of 67 exotropia patients answered the Conner Teacher Rating Scale-Revised for suspecting ADHD before and after 3 months of surgery. Patients were divided into 2 groups by preoperative scale scores. Group 1 had scores under 15 and group 2 who were suspected to have ADHD had scores above 15. Characteristics of exotropia and scale score differences were evaluated. Results: Group 1 had 43 patients and group 2 had 24 patients. The ratio of group 2 was significantly higher in boys than in girls (P=0.048). The scale scores increased by 1.30 points in group 1 and decreased by 1.04 points in group 2 but there was no significant difference. Scale scores in each group showed no significant difference according to surgical outcome. Conclusions: In exotropia patients, there was no significant change in scale scores of ADHD after strabismus surgery.

Korean Version Self-testing Application for Reading Speed

유수리나,김모세,김재형,이혜진,임태형 대한안과학회 2017 Korean Journal of Ophthalmology Vol.31 No.3

Purpose: This study introduces a reading chart application for the iPad tablet in the Korean language and investigatesthe reading speed in a normal-sighted population according to age group. Methods: Sixty-three Korean sentences were selected from textbooks for second grade elementary schoolstudents. A commonly used typeface in everyday printed material, “BatangChe,” was used. Letter size waspresented in logarithm of the minimum angle of resolution (logMAR) 0.0 to 1.0 at 0.1 logMAR steps at a readingdistance of 40 cm. A third generation retina display iPad was used to present the chart, and the sentenceswere presented randomly for each size of letter. The subjects repeated the test silently (reading only) and outloud (reading and speaking) to prevent them from skipping reading words. Pilot testing followed in 65 normalvision adults under 60 years of age. Results: The mean reading only speed for logMAR 0.5 optotype (point 10) was 121.1 ± 47.2 words per minute(wpm) for people in their 20s (n = 21), 116.5 ± 38.3 in their 30s (n = 27), 93.8 ± 12.6 in their 40s (n = 9), and56.5 ± 42.7 (n = 8) in their 50s. There was a significant correlation between age and reading and speakingspeed (r = –0.48, p < 0.001). The mean reading only speed for logMAR 0.5 optotype (point 10) was 202.3 ±88.4 wpm and the mean reading and speaking speed was 129.7 ± 25.9 wpm, with significantly different (p <0.001). Conclusions: This Korean reading chart application could present a new standard when checking readingspeed according to age groups.

Phacoemulsification Alone versus Phacoemulsification Combined with Trabeculectomy for Primary Angle-Closure Glaucoma

유수리나,홍사민,성공제,김찬윤 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.5

Surgical outcomes of phacoemulsification only and phacoemulsification combined with trabeculectomy were compared in patients with primary angle-closure glaucoma (PACG). Clinical records of 41 consecutive patients were retrospectively reviewed, and there was no difference in best-corrected visual acuity and intraocular pressure preoperatively and at the final follow-up in both study groups. Regarding the number of anti-glaucoma medications, it was higher in the phacoemulsification combined with trabeculectomy group preoperatively than the phacoemulsification only group (p = 0.045), but both groups were taking similar quantities of medication at the final follow-up (p = 0.6). In addition, postoperative hypotony (two cases)occurred only after phacoemulsification combined with trabeculectomy, but not after phacoemulsification only. In one case after phacoemulsification only, a second operation was needed. There were no additional postoperative complications. In conclusion, both phacoemulsification only and phacoemulsification combined with trabeculectomy showed good surgical outcomes in PACG patients. Both procedures might be equally effective in treating patients with PACG.

Transient Inferior Oblique Muscle Palsy Following Transconjunctival Lower Lid Blepharoplasty

이혜진,유수리나,오동은,정진호 고신대학교(의대) 고신대학교 의과대학 학술지 2018 고신대학교 의과대학 학술지 Vol.33 No.2

Although the inferior oblique (IO) muscle is positioned considerably deep in the orbit, transconjunctival lower lid blepharoplasty may affect it and transient or permanent IO muscle palsy might result. Therefore diplopia should be explained before cosmetic blepharoplasty performed with transconjunctival approach.

각막반사를 이용한 수평사시 수술중 조정술

홍진표,유수리나,장윤희,장지호,이종복,"Jin Pyo Hong,Soo Lie Nah Rhiu,Yoon Hee Chang,Jee Ho Chang,Jong Bok Lee" 대한안과학회 2008 대한안과학회지 Vol.49 No.1

`Purpose: Using corneal reflex, we performed intraoperative adjustments in horizontal strabismus patients who had very poor visual acuities with good compliance and analyzed various aspects of intraoperative adjustment. Methods: We retrospectively reviewed the records of patients with horizontal strabismus who underwent intraoperative adjustment using corneal reflex from May 1997 to April 2005. We evaluated various aspects of intraoperative adjustment. Results: Fifty-five patients (40 exotropes, 15 esotropes) were included in our study. 11 of 40 extropes (27.5%) and 4 of 15 esotropes (26.7%) eventually underwent operations that were adjusted intraoperatively. Successful results were seen in 35 of 40 exotropes (87.5%) and 8 of 15 esotropes (53.3%). Fifteen patients (27.3%) received intraoperative adjustments, and of these patients 11 (20.0%) who had successful results would have experienced either undercorrection or overcorrection if their operation were performed as scheduled. Four patients underwent operation on one muscle rather than on the scheduled two muscles. All 4 of these patients (100%) would have experienced significantly large overcorrection had they not received intraoperative adjustment. Conclusions: Patients who would have had difficulty with fixation due to low visual acuity could avoid under- or overcorrection and are expected to have higher success rates because of intraoperative adjustment using corneal reflex.`

양상전근 마비의 임상 양상 및 수술 결과

박현주,이종복,유수리나.Hyun Ju Park. MD. Jong Bok Lee. MD. Soolienah Rhiu. MD 대한안과학회 2014 대한안과학회지 Vol.55 No.11

Purpose: To evaluate the clinical manifestations of double elevator palsy and describe the surgery outcomes in patients. Methods: We performed a retrospective chart review of all patients who were treated surgically for double elevator palsy between 1999 and 2012 at Yonsei University, Severance Hospital in Seoul, Korea. Results: Overall, 15 subjects (7 males and 8 females) with a mean age of 14.6 years (range, 3-40 years) underwent their first surgery during the study period. All patients received inferior rectus recession as a primary procedure. Nine patients (60.0%) underwent a secondary procedure which included 4 cases of horizontal muscle transposition, 2 cases of correction of exotropia, and 3 cases of correction of hypotropia and exotropia simultaneously. The mean preoperative hypotropia was decreased from 29.9 ± 8.4 prism diopter (PD) to 4.7 ± 5.3 PD postoperatively. Mean follow-up period was 40.9 ± 48.2 months. Seven patients (46.7%) underwent eyelid surgery for true ptosis. At last follow-up, a majority of patients showed mild or no amblyopia. Conclusions: Primary inferior rectus recession and additive secondary horizontal muscle transposition surgery was effective in treatment of double elevator palsy. The clinical manifestations and surgical outcomes of monocular elevation deficiency in the present study can help in the treatment of Korean patients. J Korean Ophthalmol Soc 2014;55(11):1674-1680

양이측반맹을 보인 에탐부톨 시신경병증

이혜진(Hye Jin Lee),유수리나(Soolienah Rhiu),이선호(Sun Ho Lee),정진호(Jin Ho Jeong) 대한안과학회 2015 대한안과학회지 Vol.56 No.12

목적: 폐결핵으로 에탐부톨을 복용한 후 시력저하가 발생한 환자의 시야검사에서 양이측반맹 소견을 보인 3예를 경험하였기에 이를 보고하고자 한다. 증례요약: 신장장애가 있었고, 3개월 전부터 늑막성 결핵으로 에탐부톨을 복용하였던 50세 남자 환자, 폐결핵으로 10개월간 에탐부톨을 복용한 57세 남자 환자, 폐결핵이 재발하여 4개월 전 동일 약제를 복용하고 있다가 2개월 전 중단한 59세 남자 환자가 시력저하로 내원하여 에탐부톨 시신경병증으로 진단 받았다. 세 명 모두 시력저하, 색각이상, 시유발전위 이상을 보였고, 시야검사에서 2명은 중심암점을 포함한 양이측반맹, 1명은 중심암점이 없는 양이측반맹 소견을 보였다. 뇌영상검사는 정상이었다. 약제 중단 후 2명에서 시력, 색각, 시야장애가 호전되었다. 결론: 에탐부톨에 의한 시신경병증은 시야검사에서 다양한 스펙트럼의 양이측반맹을 보일 수 있으므로 철저한 병력청취와 더불어증상 발생 시 신속한 약제 중단이 필요하다. Purpose: To report three cases with bitemporal hemianopsia after using ethambutol to treat tuberculosis. Case summary: A 50-year-old male with chronic renal failure and tuberculous pleurisy, a 57-year-old male with diabetic retinopathy and pulmonary tuberculosis, and a 59-year-old male with diabetes and pulmonary tuberculosis were referred for evaluation due to decreased visual acuity for several months after taking ethambutol to treat tuberculosis. All 3 patients had abnormal color vision and visual evoked potential in both eyes. Visual field showed bitemporal hemianopsia with or without central scotoma. Brain imaging tests were normal. Although ethambutol was discontinued in all three patients, one patient with renal disease showed further decrease in visual acuity and visual field worsened to total field defect. Conclusions: Ethambutol-induced optic neuropathy is a wide spectrum disorder and based on our cases, can present as bitemporal hemianopsia mimicking compressive chiasmal lesions. A thorough history should be taken and immediate discontinuation of ethambutol is recommended in cases when bitemporal hemianopia occurs.

Parent-Reported Symptoms of Attention Deficit Hyperactivity Disorder in Children with Intermittent Exotropia before and after Strabismus Surgery

정승아,이종복,장윤희,유수리나,유혜린 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.4

Purpose: To investigate the symptoms of attention deficit hyperactivity disorder (ADHD) as reported by parents in children with intermittent exotropia [X(T)] and to determine whether strabismus surgery for X(T) affects ADHD symptoms. Materials and Methods: Fifty-one consecutive children undergoing muscle surgery for X(T) were prospectively recruited. One parent of each child completed the ADHD rating scale IV (ADHD RS-IV) assessment consecutively before and one year after surgery. Patients whose preoperative scores were above the cut-off point, the 90th percentile based on a Korean sample, were regarded as demonstrating the ADHD trait. The impact of muscle surgery on ADHD symptoms was assessed by comparing the preoperative scores with the post-operative scores. Results: Eight (15.7%) of the 51 patients demonstrated the ADHD trait. ADHD RS-IV scores following strabismus surgery significantly decreased in patients with the ADHD trait (p=0.014), while they did not differ in patients without the ADHD trait. Seven (87.5%) of the 8 patients with the ADHD trait showed improvement in their ADHD RS-IV scores after surgery. There was no difference in surgical success rates between X(T) patients with and without the ADHD trait. Conclusion: The ADHD trait was relatively common in children with X(T), and the parent-reported symptoms of the children with the ADHD trait improved after strabismus surgery. These results suggest that childhood X(T) may be one contributing factor to ADHD-related symptoms.

갑상선 안병증 환자에서 점안 마취하 수술 중 조정사시수술의 효과와 예후 인자에 대한 평가

박현주,이종복,윤진숙,유수리나 대한안과학회 2015 대한안과학회지 Vol.56 No.4

목적: 갑상선 안병증에서 점안 마취하 수술 중 조정 사시수술의 효과와 예후 인자에 대해 분석하고자 한다. 대상과 방법: 2005년부터 2012년까지 갑상선 안병증으로 인한 사시로 수술 중 조정 사시수술을 시행 받은 30명의 의무기록을 후향적으로 조사하였다. 성공적인 수술은 술 후 1년째 평가에서 남은 사시각이 8 프리즘 디옵터 이내이며 제일 눈위치에서 복시가 없는것으로 정의하였다. 수술 성공과 실패의 두 군 간 유의한 차이를 보인 인자들에 대해 비교하였다. 결과: 수술 전 평균 수직 사시는 17.5 프리즘 디옵터였고, 수평 사시는 20.3 프리즘 디옵터였다. 평균 추적관찰 기간은 12.4개월이었다.총 30명 중 24명(80.0 %)이 성공적인 수술 결과를 보였다. 4명(13.3 %)은 사시의 재발로 인해 추가적 수술이 필요했고, 2명(6.7 %)은수술 후 남은 사시를 교정하기 위해 프리즘 안경의 착용이 필요했다. 안구돌출(p=0.02) 혹은 시신경병증(p=0.01)의 합병, 스테로이드정맥 주사술 기왕력(p=0.02), 고용량 스테로이드 정맥 주사술을 시행 받은 횟수(p=0.01), 그리고 안와 감압술 기왕력(p=0.03)이 수술성공과 실패의 두 군 사이에서 유의한 차이를 보였다. 결론: 갑상선 안병증에서 안구돌출이나 시신경병증, 스테로이드 정맥 주사술 기왕력, 그리고 안와 감압술 기왕력과 같은 더 진행된 임상 양상을 반영하는 인자를 가진 환자들에서 사시 수술의 성공률이 더 낮았다. 또한 저자들은 점안 마취하 수술 중 조정 사시수술을 시행하여 80.0%의 성공적인 결과를 얻었다. Purpose: To evaluate the prognostic factors that contribute to favorable surgical outcomes of single-stage adjustable strabismus surgery in thyroid eye disease. Methods: Retrospective review of clinical case notes were done of all patients who had surgical treatment for strabismus related to thyroid eye disease under the care of a single hospital between January 2005 and December 2012 (n = 30). Factors that possibly influenced the outcome were statistically analyzed for significance. “Successful” surgical outcome was defined as patients whose residual deviation was within 8 prism diopters and free from diplopia in the primary position on postoperative 1 year. Results: Mean preoperative vertical deviation was 17.5 prism diopters (PD) and horizontal deviation was 20.3 PD. Mean follow-up time was 12.4 months. Twenty-four patients (80.0%) had successful surgical results. Four patients (13.3%) needed further surgery due to recurrence of previous strabismus and two patients (6.7%) needed prism glasses due to remaining strabismus. Previous history of proptosis (p = 0.02), optic neuropathy (p = 0.01), intravenous (IV) steroid pulse therapy (p = 0.02),number of times of IV steroid pulse therapy (p = 0.01), and orbital decompression surgery (p = 0.03) were different between success and failure groups. Conclusions: Single-stage adjustable strabismus surgery under topical anesthesia showed a success rate of 80% for strabismus patients with thyroid eye disease. Patients who previously had proptosis, optic neuropathy, IV steroid pulse therapy, and orbital decompression surgery significantly showed unsuccessful results after strabismus surgery.