국립장기이식센터 설립 전후의 각막이식 실태

조은영,김만수.Eun Young Cho. M.D.. Man Soo Kim. M.D. 대한안과학회 2006 대한안과학회지 Vol.47 No.4

Purpose: This study was performed to evaluate the status of corneal transplantation in Korea over the last 6 years. Methods: We evaluated the current status of domestic corneal transplantation using the data obtained from Korean Network for Organ Sharing (KONOS). We evaluated imported corneal transplantation by the number of corneal transplantations, the country of origin of imported cornea, the preserved state of corneas, the time from the death to transplantation and the result of corneal transplantation. The imported corneal transplantation data was obtained from the institution registered in KONOS and the institution recognized by the authers. Results: The number of domestic cornea donations has not increased since 2000, but the number of transplantations using imported corneas has increased year by year. The quality of imported corneas was good. There was no difference in operation results when domestic corneas were used compared to the use of imported corneas from the USA, Australia or Sri Lanka. Conclusions: The increased use of imported corneas results of a deficiency in the number of domestic cornea donations. Social motivation should be used to increase domestic donations of corneas.

Application of computational modeling to improve cornea transplant surgery

Joo Jongho,Kim Bongjoon,Chun Honggu 한국물리학회 2021 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.79 No.9

Cornea transplant involving applanation results in a deformation of the cornea. This deformation combined with a mismatch of dimensional and mechanical properties between donor and recipient corneas gives rise to tension on the transplanted cornea, astigmatism and vision difficulties. Therefore, accurate prediction of deformation of the incision plant during such operations is necessary to minimize complications. In this work, we employed a finite element simulation on a cornea with measured geometry and hyperelastic Mooney–Rivlin mechanical properties to analyze the intended incision plane’s change during corneal applanation. A simulation of the cornea transplant procedure assuming two different geometries to be the same was performed, and the transplanted cornea showed a 5.1% change in the exterior radius. When the proposed method was applied, no change in the radius after transplant was observed. Moreover, a precise matching of the incision plane can be selected for the corneas, and the corneal deformation after an IntraLase-Enabled Keratoplasty (ILEK) corneal transplant procedure is expected to be minimal.

국내공여각막과 해외공여각막의 전층각막이식술 후 임상 결과 비교

김동현(Dong Hyun Kim),이자영(Ja Young Lee),오주연(Joo Yeon Oh),최혁진(Hyuk Jin Choi),김미금(Mee Kum Kim),위원량(Won Ryang Wee) 대한안과학회 2015 대한안과학회지 Vol.56 No.5

목적: 국내공여각막과 해외공여각막을 이용한 전층 각막 이식술 후 생존율 및 각막내피세포 밀도 변화를 비교해 보고자 하였다. 대상과 방법: 서울대학교병원에서 2004년 11월부터 2011년 8월까지 전층각막이식술을 시행 받은 환자 중 백내장 제거술 이외의 다른 수술이 병행된 경우를 제외하고 최소 1년간 경과관찰이 가능하였던 211명 236안을 대상으로 국내공여각막군(108안)과 해외공여각막군(128안)으로 나누어 의무기록을 후향적으로 분석하였다. 각 그룹 간 나이, 성별, 수술 전 진단명, 기증자 연령, 공여자 사망부터 각막이식편 보존시간과 공여자 사망부터 이식시간, 수술 전후 교정시력, 수술 후 3, 6, 12개월째, 이후 1년 단위마다 각막내피세포 밀도 감소율 및 생존율 등을 비교 분석하였다. 결과: 수술 전 진단명으로 국내각막군에서는 재이식, 수입각막군에서는 각막혼탁이 가장 많았으나 통계적 차이는 없었다. 각막이식편 보존까지는 국내각막군에서 8.9시간, 수입각막군에서 8.0시간으로 유의한 차이가 없었으나, 이식까지는 국내각막군에서 2.18일, 수입각막군에서 4.98일로 통계적으로 유의하게 수입각막군에서 길었다. 수술 전후 교정시력과, 각막 내피세포 감소율은 3년까지 모든 시간대에서 두 군 간 유의한 차이가 없었으며, 생존율도 백내장 수술 동반 유무 또는 각막부종질환과는 상관없이 유의한 차이가 없었다. 결론: 본 결과는 해외공여각막을 이용한 전층각막이식술 후 임상결과가 국내공여각막을 이용한 전층각막이식술과 동등한 유효성을 보임을 시사한다. <대한안과학회지 2015;56(5):672-679> Purpose: To compare the survival of corneal grafts and the changes in endothelial cell density in penetrating keratoplasty using domestic or imported corneas. Methods: Medical records of 236 eyes of 211 patients who underwent penetrating keratoplasty from November 2004 to August 2011 in Seoul National University Hospital and were followedup at least 1 year were retrospectively reviewed. After excluding the patients who received the combined surgeries with other surgeries except cataract surgery, the eyes were divided into 2 groups depending on the origin of donor tissue resulting in a domestic cornea group (108 eyes) and an imported cornea group (128 eyes). Recipient demographics, preoperative diagnosis, donor age, death-to-preservation time, death-to-operation time and pre-and postoperative visual acuities were compared between the 2 groups. Kaplan-Meier survival and changes in endothelial cell den-sity were analyzed at 3, 6 and 12 months and then every year. Results: The most common preoperative diagnoses were regraft and corneal opacity in the domestic and imported cornea groups, respectively, without statistical difference. Death-to-preservation time was 8.9 hours and 8.0 hours in the domestic and imported cornea groups, respectively, without statistical difference. However, death-to-operation time was longer in the imported cornea group (4.98 days) than in the domestic cornea group (2.18 days). There were no differences in pre- and postoperative visual acuities, decrease in annual changes in endothelial densities and survival up to 3 years between the 2 groups. In addition, the survival and decreased annual changes in endothelial densities were not different from each other in penetrating kerato-plasty combined with cataract surgery or in penetrating keratoplasty for a corneal edema. Conclusions: Our study results suggest that clinical outcomes of the penetrating keratoplasty using imported corneas are com-parable in efficacy when compared with the clinical outcomes using domestic corneas. J Korean Ophthalmol Soc 2015;56(5):672-679

기증 각막 한 개로 두 가지 각막이식술을 실시한 4예

김효원(Hyo Won Kim),황호식(Ho Sik Hwang),임성아(Sung A Lim),김만수(Man Soo Kim) 대한안과학회 2016 대한안과학회지 Vol.57 No.6

목적: 기증 각막 한 개를 이용하여 두 명의 환자에게 내피층각막이식술(descemet membrane keratoplasty, DMEK)과 심부표층각막이 식술(deep anterior lamella keratoplasty, DALK)을 각각 실시한 4예를 보고하고자 한다. 증례요약: 기증각막 4개를 내피층과 나머지 조직으로 분리하였다. 내피층은 분리되는 즉시 4명의 수포성 각막병증 환자에게 각각 이식하였고, 나머지 조직은 각막보존액에 넣어서 보관하였다. 그 후 보존된 나머지 각막편으로 2명의 지질각막병증과 2명의 원추각막환자에게 각각 심부표층각막이식술을 시행하였다. 술 후 이식된 각막편은 8명의 환자에서 모두 안정적으로 관찰되었다. 결론: 기증 각막 한 개로 내피층은 내피층각막이식술을 실시하고 나머지 조직으로 심부표층각막이식술을 실시한 4예를 국내에서 처음으로 보고한다. 기증 각막이 부족한 우리나라에서 하나의 기증 각막으로 2명의 환자에게 시술함으로써 각막이식이 필요한 환자들에게 더 많은 혜택을 줄 수 있을 것으로 생각된다. 〈대한안과학회지 2016;57(6):988-993〉 Purpose: To report four cases of split cornea transplantation involving separate Descemet membrane keratoplasty and Deep anterior lamella keratoplasty from a single cornea. Case summary: Four donor corneas were separated into the endothelium and other layers. The endothelial layers were transplanted into 4 pseudophakic bullous keratopathy patients, and the other layers were stored in corneal storage media. Deep anterior lamella keratoplasties were performed with the stored corneas in 2 lipid keratopathy and 2 keratoconus patients. Postoperatively, all grafted corneas were stable. Conclusions: The authors report the first 4 cases of split cornea transplantation in Korea, which is experiencing a shortage of donated corneas. Split cornea transplantation will be of benefit to a large number of patients by separating a single cornea into separate layers to be implanted into two patients. J Korean Ophthalmol Soc 2016;57(6):988-993

세극등현미경에서 보존액에 담긴 기증각막을 관찰할 수 있는 장치의 개발

남가희,김다란,윤영채,양순원,황웅주,변용수,황형빈,나경선,이현수,정소향,김은철,조양경,김현승,황호식 대한안과학회 2024 대한안과학회지 Vol.65 No.2

목적: 각막이식수술 전 정확한 이식 적합성 평가를 위하여 기증각막이 담긴 보존액 병을 고정시킬 수 있는 장치를 개발하였으며, 국내기증각막을 대상으로 세극등현미경검사를 시행하여 고안된 장치의 효용성을 평가해보고자 한다. 대상과 방법: 2023년 2월부터 2023년 3월까지 여의도성모병원에서 기증받는 국내 기증각막 2안을 대상으로 하였다. 기증각막이 담긴보존액 병을 고안된 장치의 홀더에 장착하여 세극등현미경에 설치하면, 세극등현미경의 빔은 장치의 거울에 의해 반사되어 보존액내의 각막에 입사하고, 이를 세극등현미경에서 관찰할 수 있다. 각막내피가 보존액 병의 위를 향한 상태와 바닥을 향한 상태에서 세극등현미경검사를 시행하고 전안부 사진을 촬영하였다. 또한, 고안된 장치를 이용하여 기증각막에 경면현미경검사와 전안부 빛간섭단층촬영을 시행하였다. 결과: 기증각막이 담겨있는 보존액 병을 장치에 고정한 상태에서 세극등현미경을 이용하여 공막 변연부를 360° 관찰하여 버트닝 상태를 확인하고, 세극등현미경의 좁은 빔으로는 각막 단면을 확인할 수 있었다. 역조명법을 이용하여 각막상피세포를 관찰할 수 있었으며, 경면반사법을 통해 내피세포층이 확인되었다. 그러나 경면현미경검사 및 빛간섭단층촬영검사 시 내피세포밀도와 각막두께는 측정되지 않았다. 결론: 저자들이 고안한 기증각막검사용 장치는 국내 기증각막에 대한 세극등현미경검사를 쉽고 안정적으로 시행할 수 있게 하며, 각막내피나 두께에 대한 정성적인 평가가 가능하였다. Purpose: To evaluate the effectiveness of an instrument devised for slit-lamp examination of donor corneas suspended in preservation medium. Methods: The study examined two donor corneas received at Yeouido St. Mary's Hospital in February 2023 and March 2023. The instrument has three main components: a plastic holder to hold the preservation medium bottle, a cube with a mirror for reflecting the slit beam, and a stand to attach the device to the slit-lamp. Using the instrument, the donor corneas were examined via slit-lamp: microscopy with the endothelium facing upward and downward. Specular microscopy and anterior segment optical coherence tomography (OCT) were also performed on the preserved donor corneas. Results: Slit-lamp examination of donor corneas in preservation medium using the instrument showed overall corneal buttoning and optical sections of the donor cornea. Using specular reflection and retroillumination, the endothelial layer was partially visible. However, specular microscopy and anterior segment OCT could not examine the donor cornea in preservation medium using the instrument. Conclusions: The devised instrument facilitates slit-lamp examination of donor corneas in preservation medium, enabling a qualitative assessment of donor corneas before corneal transplantation surgery.

Comparative observation of freeze–thaw-induced damage in pig, rabbit, and human corneal stroma

Oh, Joo Youn,Kim, Mee Kum,Lee, Hyun Ju,Ko, Jung Hwa,Wee, Won Ryang,Lee, Jin Hak Blackwell Publishing Ltd 2009 Veterinary ophthalmology Vol.12 No.suppl1

<P>Abstract</P><P>Objective </P><P>Although variations exist between species with respect to outcomes after cryopreservation, little is known about the differences in the susceptibility of the corneal stroma to cryoinjury. We performed this study to investigate freeze–thaw-induced damage in keratocytes and collagen in rabbit, pig, and human corneas.</P><P>Animals studied </P><P>Rabbit, pig, and human.</P><P>Procedures </P><P>We prepared 250-&mgr;m-thick anterior stroma from rabbit, pig, and human corneas after scraping off the epithelium and endothelium. Each 250-&mgr;m-thick corneal stroma without epithelium was placed in a 50-mL tube, frozen with liquid N<SUB>2</SUB> for 15 min and taken out to thaw rapidly at 37 °C. This procedure of rapid freezing and thawing was repeated three times. Differences between the species with respect to cells and collagen structures were examined using hematoxylin–eosin (H&E) staining, terminal deoxynucleotidyl transferase-mediated nick end labeling (TUNEL) assay, and transmission electron microscopy (TEM). We orthotopically transplanted the pig and rabbit corneal transplants after the triple freeze–thaw cycle into rabbit eyes and evaluated graft survival.</P><P>Results </P><P>On gross examination, rabbit corneas became opaque after the triple freeze–thaw procedure, while pig and human corneas remained transparent. Histologically, keratocytes were apoptotic on TUNEL assay and TEM in rabbit, pig, and human corneas. Collagen fibrils were fragmented and the arrangement of collagen fibrils was severely disturbed in rabbit corneas on H&E staining and TEM; collagen was well preserved in pig and human corneas. Rabbit corneal stroma underwent autolysis after transplantation, whereas the pig corneal stroma remained clear for 1 month.</P><P>Conclusions </P><P>Our study showed that rabbit corneal stroma was more susceptible to freeze–thaw injury than pig and human corneas.</P>

각막저장용액에 의한 major histocompatability 항원의 변화

차흥원 최신의학사 1994 最新醫學 Vol.37 No.3

Influence of Temperature on the Bacterial Community in Substrate and Extracellular Enzyme Activity of Auricularia cornea

( Xiaoping Zhang ),( Bo Zhang ),( Renyun Miao ),( Jie Zhou ),( Lei Ye ),( Dinghong Jia ),( Weihong Peng ),( Lijuan Yan ),( Xiaoping Zhang ),( Wei Tan ),( Xiaolin Li ) 한국균학회 2018 Mycobiology Vol.46 No.3

Temperature is an important environmental factor that can greatly influence the cultivation of Auricularia cornea. In this study, lignin peroxidase, laccase, manganese peroxidase, and cellulose in A. cornea fruiting bodies were tested under five different temperatures (20℃, 25℃, 30℃, 35℃, and 40℃) in three different culture periods (10 days, 20 days and 30 days). In addition, the V4 region of bacterial 16S rRNA genes in the substrate of A. cornea cultivated for 30 days at different temperatures were sequenced using next-generation sequencing technology to explore the structure and diversity of bacterial communities in the substrate. Temperature and culture days had a significant effect on the activities of the four enzymes, and changes in activity were not synchronized with changes in temperature and culture days. Overall, we obtained 487,694 sequences from 15 samples and assigned them to 16 bacterial phyla. Bacterial community composition and structure in the substrate changed when the temperature was above 35℃. The relative abundances of some bacteria were significantly affected by temperature. A total of 35 genera at five temperatures in the substrate were correlated, and 41 functional pathways were predicted in the study. Bacterial genes associated with the membrane transport pathway had the highest average abundance (16.16%), and this increased at 35℃ and 40℃. Generally, different temperatures had impacts on the physiological activity of A. cornea and the bacterial community in the substrate; therefore, the data presented herein should facilitate cultivation of A. cornea.

약물 독성 평가용 생체외 각막 모델 제작 연구

김선화,박상혁 대한의용생체공학회 2019 의공학회지 Vol.40 No.5

To evaluate the toxicity of ophthalmic drug, the Draize test and Bovine Corneal Opacity and Permeability (BCOP) test commonly used. In Draize test, experimental animals were under stress and pain due to long-term exposure of drug. In addition, regarding physiological functions, animal model is not perfectly reflected a human eye condition. Although some models such as EpiOcularTM, HCE model, LabCyte Cornea-Model, and MCTT HCETM were already presented advanced cornea ex-vivo model to replace animal test. In this sense, cornea tissue structure mimicked ex-vivo toxicity model was fabricated in this study. The corneal epithelial cells (CECs) and keratocytes (CKs) isolated from rabbit eyeball were seeded on non-patterned silk film (n-pSF) and patterned silk film (pSF) at 32,500 cells/cm2 and 6,500 cells/cm2. Sequentially, n-pSF and pSF were stacked to mimic a multi-layered stroma structure. The thickness of films was about 15.63 μm and the distance of patterns was about 3 μm. H&E stain was performed to confirm the cell proliferation on silk film. F-actin of CKs was also stained with Phalloidin to observe the cytoskeletal alignment along with patterns of the pSF. In the results, CECs and CKs were shown the good cell attachment on the n-pSF and pSFs. Proliferated cells expressed the specific phenotype of cornea epithelium and stroma. In conclusion, we successfully established the ex-vivo cornea toxicity model to replace the eye irritation tests. In further study, we will set up the human ex-vivo cornea toxicity model and then will evaluate the drug screening efficacy.

수입공여각막과 각막보존액의 미생물학적 연구

나윤수,우성욱,강자헌,주명진,Yoon-Soo Na,Sung-Wook Woo,Ja-Heon Kang,Myung-Jin Joo 대한안과학회 2005 대한안과학회지 Vol.46 No.12

Purpose: To evaluate the prevalence of contamination of imported donor corneas and their preserved solutions, and to characterize the spectrum of contaminating microorganisms. Methods: Thirty-seven imported donor corneas and their preserved solutions imported between December 2003 and June 2005 were included in this study. Results: Five imported donor corneas (13.5%) had positive bacterial cultures, and none had positive fungal or mycobacterial cultures. On the other hand, the preserved solutions did not have positive bacterial, fungal, or mycobacterial cultures. One of the 5 imported donor corneas with positive bacterial culture had a mixed bacterial culture. There were 3 isolates of Staphylococcus epidermidis, 1 isolate of Streptococcus viridans, 1 isolate of Enterobacter cloacae, and 1 isolate of Pseudomonas aeruginosa. Conclusions: The prevalence of contamination of imported donor corneas is low; however, there is a risk of postkeratoplasty infection by contaminated donor corneas. Thus, careful management should be practiced during and after corneal transplant operations.