불명열 환자에서 동반된 급성 일과성 근시성 굴절력 변화 1예

장선영,이현준,정문선,김소영 대한안과학회 2009 대한안과학회지 Vol.50 No.8

Purpose: To report a case of acute transient myopic shift in a patient with fever of unknown origin. Case summary: A 31-year-old woman without a history of any ophthalmic problems presented with a sudden onset of bilateral blurred vision. She was admitted with the diagnosis of fever of unknown origin (FUO). Ophthalmic examination revealed a visual acuity of 0.06 in the right eye and 0.1 in the left eye. A myopic shift of 3.12 diopters (D) and 2.25D was noted in the right and left eyes, respectively. Retinal folds and choroidal thickening accompanied the myopic shift. On the third day after onset, visual acuity had decreased even more. Myopic shift increased to 4.87D in the right eye and 4.50D in the left eye. At the same time, the depth of the anterior chamber maximally decreased and the thickness of the lens was maximally increased. One week later, the myopic shift was normalized to emmetropia. The depth of the anterior chamber and the thickness of the lens also normalized as the fever subsided. 목적: 불명열 환자에서 동반된 급격한 근시성 굴절력 변화 1예를 경험하여 이를 보고하고자 한다. 증례요약: 안과적 과거력이 없는 31세 여자가 불명열로 치료하던 중 갑자기 발생한 양안의 시력저하를 주소로 안과에 의뢰되었다. 처음 검사에서 나안시력은 우안 0.06, 좌안 0.1이었으며 현성굴절검사에서 우안 -3.12Diopters(D), 좌안 -2.25D의 근시성 굴절이상을 보였다. 안저검사에서 망막 주름, 초음파 검사에서 맥락막 부종의 소견이 동반되었다. Pentacam과 A-scan을 이용하여 전방깊이, 수 정체 두께 및 안축장을 측정하였고 매 검사 시마다 추적 관찰했다. 증상 발생 3일째에 시력은 더욱 감소하였으며 우안-4.87D, 좌안 -4.50D로 근시성 굴절이상이 증가하였고 전방 깊이는 더욱 감소되었고 수정체 두께는 증가되었다. 증상 발생 1주일 후 내과적인 증상 이 호전되면서 굴절이상은 정시화되었고 전방 깊이 및 수정체의 두께도 정상화 되었으며 나안시력은 양안 1.0으로 호전되었다.

Comparison of the Long-term Clinical Results of Hydrophilic and Hydrophobic Acrylic Intraocular Lenses

( Young Woo Suh ),( Chung Hoon Oh ),( Hyo Myung Kim ) 대한안과학회 2005 Korean Journal of Ophthalmology Vol.19 No.1

This study was performed to compare the incidence of posterior capsular opacity (PCO) and refractive errors between hydrophilic (ACR6D, Corneal®) and hydrophobic (MA60BM, AcrySof®) acrylic intraocular lenses (IOLs) over a 3-year follow-up after phacoemulsification surgery. The patients with AcrySof® implanted in one eye and Corneal® in the other eye were categorized as Group 1 (n=28), while those with one or both eyes implanted with IOLs of the same kind were categorized as Group 2 (AcrySof®, n=90; Corneal®, n=95). Refractive errors were evaluated at 3months and 3 years postoperatively. The incidence of visually significant PCO was investigated 3years postoperatively. Postoperative refractive values at 3 months were not significantly different between the two groups. However, refractive values at 3 years were significantly different between two IOLs in both groups [AcrySof® -0.37±0.43D, Corneal® -0.62±0.58D in Group 1 (p=0.04); AcrySof® -0.38±0.52, Corneal® -0.68±0.54 in Group 2 (p<0.01)]. The incidence of visually significant PCO was 14% and 32% in Group 1, and 13% and 28% in Group 2, for the AcrySof® and Corneal® implants, respectively. The incidence of visually significant PCO of hydrophilic acrylic IOLs was higher than that of hydrophobic acrylic IOLs in the 3-year follow-up. The postoperative 3-year refractive value of Corneal® showed myopic shift.

서울 일부지역 안경원 방문자의 연령에 따른 굴절상태 변화

유선아,이군자 대한시과학회 2014 대한시과학회지 Vol.16 No.3

목 적: 안경원 방문자를 대상으로 연령군에 따른 굴절이상의 분포와 굴절상태의 변화를 분석하고자 하였다. 방 법: 2007년부터 2013년까지 서울 서초동 소재 안경원에 내원한 922명(1,844안)을 대상으로 연령군에 따라 10대군(10∼19세), 20대군(20∼29세), 30대군(30∼39세), 40대군(40∼49세), 50대군(50∼59세), 60대 이상군(≥60세)으로 분류하고 타각적 굴절검사와 자각적 굴절검사를 시행하였다. 굴절이상은 등가구면굴절 력을 이용하여, 근시군(SE≥-0.75 D), 원시군(SE≥+0.75 D) 및 난시군(Cyl≥-1.00 D)으로 나누고, 난시는 (-) 원주축 방향에 따라 직난시(180°±15°), 도난시(90°±15°), 사난시(16°∼74° 또는 106°∼164°)로 구분 하였다. 통계분석은 SPSS version 18 (SPSS INC., Chicago, IL, USA)을 이용하여 각 요인을 독립표본검 정(independent T-test), 선형회귀분석(linear regression analysis), 일원배치분산분석(one way anova)을 통해 조사하였으며, 유의 수준은 p<0.05로 하였다. 결 과: 전체 대상안의 굴절이상 분포는 근시 84.4%, 원시 5.7%, 정시 9.9%그리고 난시는 46.1%로 나타 났다. 평균 등가구면굴절력은 10대 -3.77±2.06 D, 20대 -4.44±2.61 D, 30대 -3.85±2.61 D, 40대 -3.48± 2.70 D, 50대 -1.92±2.65 D, 60대 -0.56±2.58 D로 연령이 증가함에 따라 근시에서 원시로 유의 하게 변하였다(p<0.05). 난시는 직난시 54.8%, 사난시 30.4%, 도난시 14.9% 로 나타났고 10대에서는 직난 시가 월등히 높았으며, 도난시는 60대에서 45.3%로 가장 높았다. 결 론: 청소년기에는 근시와 직난시의 유병률이 높지만, 연령이 증가하면서 굴절상태는 변하여 노년층에 서는 원시와 도난시의 유병률이 높았다. 굴절상태는 연령에 따라 청소년기에 근시화가 진행되고, 근시안과 정시안의 경우에는 40대 이후에 원시화가 나타나며, 근시화와 원시화 정도는 근시안이 정시안보다 더 많은 것으로 사료된다. Purpose: To characterize refractive changes in ametropic eyes with age, all records from clinical patients at an KE optician's clinic in the year of 2007~2013 were used for the study. Methods: Refractive errors were decomposed into spherical-equivalent refractive error (SE), (myopia, SE≤-0.75 D; hyperopia, SE≥+0.75 D). Astigmatic groups were categorized by the cyl≥ -1.00 D and were classified by the with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism. Subjects were divided into six age group by decade(10s, 20s, 30s, 40s, 50s, and 60s). Statistical analysis were performed with the SPSS/win programs (version 18.0; SPSS, Inc.) and Origin 8.0. P-value of less than 0.05 was considered to be statistically significant. Results: Among the subjects, 84.4.% had myopia, 5.7% had hyperopia, and 46.1% had astigmatism. Average of SE was -3.55±2.83 D and the mean of SE of the six age group by decade were 10s, -3.77±2.06 D; 20s, -4.44±2.61 D; 30s, -3.85±2.61 D; 40s, -3.48±2.70 D; 50s, -1.92±2.65 D; 60s, -0.56±2.58 D that progressively shift from myopia to hyperopia as age progresses. The prevalence of WTR astigmatism is 54.8% and oblique astigmatism is 30.4% and ATR astigmatism is 14.9%. And WTR astigmatism was highly dominant in teen age group, while 45.3% of the 60s were ATR astigmatism. Conclusions: In adolescence, a prevalence rates of both myopia and WTR astigmatism is increased during the first decades. Majority of the elderly (over 60s) had hyperopia and ATR astigmatism. Age-related refractive changes in eyes showed myopic shift in adolescence, however showed an age-related hyperopic shift after 40s in both myopic and emmetropic eyes. In myopic eyes myopic and hyperopic shift are larger than emmetropic eyes.

서울 일부지역 안경원 방문자의 연령에 따른 굴절상태 변화

유선아,이군자 대한시과학회 2014 대한시과학회지 Vol.16 No.3

Purpose: To characterize refractive changes in ametropic eyes with age, all records from clinical patients at an KE optician's clinic in the year of 2007~2013 were used for the study. Methods: Refractive errors were decomposed into spherical-equivalent refractive error (SE), (myopia, SE≤-0.75D; hyperopia, SE≥+0.75D). Astigmatic groups were categorized by the cyl≥-1.00D and were classified by the with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism. Subjects were divided into six age group by decade(10s, 20s, 30s, 40s, 50s, and 60s). Statistical analysis were performed with the SPSS/win programs (version 18.0; SPSS, Inc.) and Origin 8.0. P-value of less than 0.05 was considered to be statistically significant. Results: Among the subjects, 84.4.% had myopia, 5.7% had hyperopia, and 46.1% had astigmatism. Average of SE was -3.55±2.83D and the mean of SE of the six age group by decade were 10s, -3.77±2.06D; 20s, -4.44±2.61D; 30s, -3.85±2.61D; 40s, -3.48±2.70D; 50s, -1.92±2.65D; 60s, -0.56±2.58D that progressively shift from myopia to hyperopia as age progresses. The prevalence of WTR astigmatism is 54.8% and oblique astigmatism is 30.4% and ATR astigmatism is 14.9%. And WTR astigmatism was highly dominant in teen age group, while 45.3% of the 60s were ATR astigmatism. Conclusions: In adolescence, a prevalence rates of both myopia and WTR astigmatism is increased during the first decades. Majority of the elderly (over 60s) had hyperopia and ATR astigmatism. Age-related refractive changes in eyes showed myopic shift in adolescence, however showed an age-related hyperopic shift after 40s in both myopic and emmetropic eyes. In myopic eyes myopic and hyperopic shift are larger than emmetropic eyes. 목 적: 안경원 방문자를 대상으로 연령군에 따른 굴절이상의 분포와 굴절상태의 변화를 분석하고자 하였다. 방 법: 2007년부터 2013년까지 서울 서초동 소재 안경원에 내원한 922명(1,844안)을 대상으로 연령군에 따라 10대군(10∼19세), 20대군(20∼29세), 30대군(30∼39세), 40대군(40∼49세), 50대군(50∼59세), 60대 이상군(≥60세)으로 분류하고 타각적 굴절검사와 자각적 굴절검사를 시행하였다. 굴절이상은 등가구면굴절력을 이용하여, 근시군(SE≥-0.75D), 원시군(SE≥+0.75D) 및 난시군(Cyl≥-1.00D)으로 나누고, 난시는 (-) 원주축 방향에 따라 직난시(180°±15°), 도난시(90°±15°), 사난시(16°∼74° 또는 106°∼164°)로 구분하였다. 통계분석은 SPSS version 18 (SPSS INC., Chicago, IL, USA)을 이용하여 각 요인을 독립표본검정(independent T-test), 선형회귀분석(linear regression analysis), 일원배치분산분석(one way anova)을 통해 조사하였으며, 유의 수준은 p<0.05로 하였다. 결 과: 전체 대상안의 굴절이상 분포는 근시 84.4%, 원시 5.7%, 정시 9.9%그리고 난시는 46.1%로 나타났다. 평균 등가구면굴절력은 10대 -3.77±2.06D, 20대 -4.44±2.61D, 30대 -3.85±2.61D, 40대 -3.48± 2.70D, 50대 -1.92±2.65D, 60대 -0.56±2.58D로 연령이 증가함에 따라 근시에서 원시로 유의하게 변하였다(p<0.05). 난시는 직난시 54.8%, 사난시 30.4%, 도난시 14.9% 로 나타났고 10대에서는 직난시가 월등히 높았으며, 도난시는 60대에서 45.3%로 가장 높았다. 결 론: 청소년기에는 근시와 직난시의 유병률이 높지만, 연령이 증가하면서 굴절상태는 변하여 노년층에서는 원시와 도난시의 유병률이 높았다. 굴절상태는 연령에 따라 청소년기에 근시화가 진행되고, 근시안과 정시안의 경우에는 40대 이후에 원시화가 나타나며, 근시화와 원시화 정도는 근시안이 정시안보다 더 많은 것으로 사료된다.

라섹 후 잠복조절량 증가로 인한 일시적인 근시 편위

김규아,안지민,정우석.Gyu Ah Kim. MD. Ji Min Ahn. MD. Woo Suk Chung. MD 대한안과학회 2014 대한안과학회지 Vol.55 No.1

Purpose: To investigate accommodation and progress of patients who showed myopia on manifest refraction in the early postoperative period after LASEK. Methods: Forty-one eyes were included in the present study which had undergone LASEK surgery from February to March 2012. Seven eyes showed myopia over -0.25 D on manifest refraction at 1 month postoperatively, but showed decreased amount of myopia at 2 months postoperatively and were classified as group 1. The other 34 eyes were classified as group 2. The differences between cycloplegic and manifest refraction (CRSE-MRSE) were defined as the amount of latent accommodation and compared between the 2 groups. Results: Amount of latent accommodation was 0.179 ± 0.426 D in group 1 (7 eyes), 0.265 ± 0.303 D in group 2 (34 eyes) preoperatively, 1.286 ± 0.664 D in group 1, 0.368 ± 0.536 D in group 2 at 1 month postoperatively, and 0.500 ± 0.520 D in group 1, and 0.489 ± 0.546 D in group 2 at 2 months postoperatively. The amount of latent accommodation in group 1 was significantly greater than that of group 2 one month postoperatively. As the amount of latent accommodation decreased, the amount of myopic shift decreased gradually over 2 months in group 1 after surgery. Conclusions: Transient myopic shift due to increased latent accommodation was observed in several patients one month postoperatively and the amount of myopic shift decreased with time without treatment. Thus, surgeons should consider cycloplegic refraction when planning treatment for patients with myopic regression. J Korean Ophthalmol Soc 2014;55(1):40-46

Myopic Shift after Implantation of a Novel Diffractive Trifocal Intraocular Lens in Korean Eyes

황성순,임동휘,현 주,김명준,정태영 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.1

To evaluate the clinical outcomes of cataract surgery using novel diffractive trifocal intraocular lenses(IOLs) in Koreans. Methods: This was a retrospective, consecutive, interventional study of cataract surgery using POD FineVisionIOL implantation. Complete ophthalmologic examinations were performed preoperatively and postoperatively. Defocus curves were assessed over a range of +1.5 to -4.0 diopters in 0.5-diopter steps at one month postoperatively. Uncorrected distant visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity,corrected distant visual acuity, distant-corrected intermediate visual acuity, and distant-corrected near visual acuitywere assessed one month postoperatively, and manifest refraction was performed during every visit. Results: The study analyzed 31 eyes in 20 patients. There were statistically significant improvements in uncorrecteddistance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distancevisual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity (p <0.001). The final postoperative refractive outcomes showed statistically significant myopic shifts compared to thetarget refraction based on SRK/T, SRK-II, Haigis, and Hoffer Q formulas (p < 0.001). Conclusions: POD FineVision IOLs provide stable visual restoration with improvements of near and intermediatevision in presbyopic eyes. POD FineVision IOLs show myopic shift in

유리체절제술과 함께 시행한 백내장수술에서 굴절오차 분석

이여진(Yeo Jin Lee),곽재혁(Jae Hyuck Kwak),박영근(Young-Gun Park),박영훈(Young-Hoon Park),김미리내(Mirinae Kim) 대한검안학회 2021 Annals of optometry and contact lens Vol.20 No.2

Purpose: To evaluate the tendency of refractive prediction error and to examine factors that affect the refractive changes after combined vitrectomy and cataract surgery. Methods: We retrospectively reviewed demographic and clinical data, including axial length, intraocular pressure (IOP), preoperative anterior chamber depth, target refraction, preoperative refraction, postoperative refraction, keratometry, and refractive prediction error (the difference between postoperative and target refraction) of a retinal detachment (RD) group (28 eyes) and an epiretinal membrane (ERM) group (82 eyes). Both groups underwent combined vitrectomy and cataract surgery. Results: The refractive prediction error with myopic shift was evident in total patients (-0.85 ± 0.85 D, p < 0.001), the RD group(-0.92 ± 1.13 D, p = 0.007), and the ERM group (-0.83 ± 0.78 D, p < 0.001). There was no significant difference between preoperative and postoperative keratometry in the two groups (p = 0.742 and 0.500, respectively). The preoperative IOP of the affected eye was significantly lower than that of the unaffected eye in the RD group (p = 0.012). In multivariate regression analysis, preoperative axial length was significantly correlated with the refractive prediction error in both the RD (β = 0.189, p = 0.036) and ERM (β = 0.689, p < 0.001) groups. Age, IOP, and preoperative visual acuity were not significantly associated with the refractive prediction error. Conclusions: A significant myopic shift was observed in the RD and ERM groups after combined vitrectomy and cataract surgery with gas tamponade. The preoperative axial length was significantly correlated with the refractive prediction error in both groups.

외편위 환자에서 3D TV 시청이 사시각 및 굴절이상에 미치는 영향

서혜진,김승현,서영우,최용민,유은주,한지윤,남기태,조윤애,Hye Jin Seo,MD,Seung Hyun Kim,MD,PhD,Young Woo Suh,MD,PhD,Yong Min Choi,MD,Eun Joo Yoo,MD,Ji Yun Han,MD,Ki Tae Nam,MD,Yoon Ae Cho,MD,PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.10

Purpose: To investigate the effects of watching three-dimensional (3D) television (TV) on the angle of deviation and refractive error in children with exodeviation. Methods: Twenty-three volunteers with exodeviation, aged 6 to 12 years, without any ocular abnormalities other than refractive error and exodeviation were recruited for this study. The subjects watched 3D TV for 50 minutes at a viewing distance of 2.8 meters. The image disparity of 3D contents was -1 to 1 degree. Refractive errors were measured before and immediately after watching TV and after a 10-minute rest. The changes in angle of deviation were also obtained. Refractive errors and angle of deviation before and after watching 3D TV were compared. Results: The mean age of the subjects was 9.30 ± 1.58 years. The mean baseline angle of deviation was 13.04 ± 5.25 (6-30) prism diopters (PD), which did not change significantly immediately after watching 3D TV and after a 10-minute rest (<EM>p</EM> = 0.452). The mean refractive errors were -2.15 ± 1.55 D in the right eye and -2.06 ± 1.55 D in the left eye before and changed to -2.14 ± 1.57 D and -2.11 ± 1.45 D, respectively, immediately after watching 3D TV. After a 10 minute rest, the mean refractive errors were 2.14 ± 1.53 D in the right eye and -2.07 ± 1.53 D in the left eye. All changes in refractive errors were not statistically significant (<EM>p </EM>= 0.991 in right eye, 0.495 in left eye). The amount of myopic shift in both eyes immediately after watching 3D TV was correlated with the angle of exodeviation (r = 0.468, p = 0.024). However, the correlation disappeared after a 10-minute rest (r = 0.345, <EM>p </EM>= 0.107). Conclusions: Watching properly made 3D contents on 3D TV for 50 minutes at more than 2.8 meters of viewing distance did not affect the refractive error in children with exodeviation. Further studies on the relationship between the amount of myopic shift and the angle of exodeviation are necessary. J Korean Ophthalmol Soc 2014;55(10):1525-1529

3가지 친수성 아크릴 인공수정체의 안정성 비교

변석호,김완수,Suk Ho Byeun,M,D,Wan Soo Kim,M,D,Ph,D 대한안과학회 2006 대한안과학회지 Vol.47 No.10

Purpose: To evaluate the stability of three different hydrophilic acrylic intraocular lenses (IOLs), which have different shapes. IOLs included in this study are three-piece acrylic IOL with PMMA (Polymethylmethacrylate) haptics (Hydroview? H60M, Bausch &Lomb, U.S.A), one-piece acrylic IOL with broad optic-haptic junction (Centerflex?570H, RAYNER, UK), and one-piece acrylic IOL with narrow optic-haptic junction (Aquasens, Ophthalmic Innovations International, U.S.A). Methods: We evaluated 69 patients (100 eyes) who had undergone cataract surgeries and who had hydrophilic acrylic IOLs implanted from September, 2003 to March, 2004. Forty eyes implanted with three-piece acrylic IOL with PMMA haptics, 40 eyes implanted with one-piece acrylic IOL with broad optic-haptic junction, and 20 eyes implanted with one-piece acrylic IOL with narrow optic-haptic junction were included. Slit lamp examination, best corrected visual acuity (BCVA), anterior chamber depth (ACD), refraction, and IOL decentration were evaluated at one week and at one, three, and six months postoperatively. Results: There was no statistically significant difference in BCVA, ACD, mean SE or decentration between patients implanted with three different types of hydrophilic acrylic IOL during the 6 month follow-up period (P>0.05). However, Postoperative myopic shift was discovered in 4 eyes (4/20) with Aquasens. Conclusions: There were no statistically significant difference in the Stabilities of the 3-different hydrophilic acrylic IOLs. However, patients who were implanted Aquasens shold be observed carefully because Aquasense has the posibilitiy to have myopic shift more than 1 Dioptor.

유리체절제술과 백내장 동시수술에서 네지지부인공수정체의 안정성

김재우,양지욱,지동현,Jae Woo Kim,Ji Wook Yang,Dong Hyun Jee 대한안과학회 2010 대한안과학회지 Vol.51 No.6

Purpose: To evaluate the stability of intraocular lenses (IOLs) according to the haptic design in combined surgery (phacoemulsification, intraocular lens insertion, and vitrectomy) by comparing early IOP elevation and the accuracy of IOL power. Methods: A retrospective study was conducted for 85 eyes of 85 patients who had undergone combined surgery. IOP elevation one week postoperatively and the difference between target refraction and postoperative refraction after two months were evaluated in all patients. All eyes were allocated to either a 2-haptic IOL group or a 4-haptic IOL group, and then each group was divided into three subgroups: gas-filled, silicone oil-filled, or balanced salt solution-filled. Results: In the balanced salt solution-filled group, the early IOP increase was significantly less in the 4-haptic IOL group than it was in the 2-haptic IOL group (3.24 mmHg vs. 6.15 mm Hg, p=0.025). The myopic shifts of the 2-haptic IOL group were significantly greater than those of the 4-haptic IOL group for all of the subgroups (gas subgroup -0.71D vs. -0.31D, p=0.045; balanced salt solution subgroup -0.66D vs. -0.16D, p=0.018). Conclusions: In combined surgery, 4-haptic IOL implantation showed significantly less early IOP elevation and less myopic shift than those of 2-haptic IOL implantation. J Korean Ophthalmol Soc 2010;51(6):829-834