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실데나필 시트르산염 과다복용 후 발생한 색각이상 및 시야감소 1예
김패트릭,김소영 대한안과학회 2015 대한안과학회지 Vol.56 No.9
Purpose: Sildenafil citrate, is an oral tablet demonstrating efficacy for maintaining an erection in males with erectile dysfunction by inhibiting phosphodiesterase type 5 (PDE5). In the present study, we report 1 case of a transient color anomaly with visual field defect after an overdose of sildenafil citrate. Case summary: One patient, a 39-year-old female, with no significant medical history other than previous major depressive disorder,visited an outpatient department due to the visual field defect that began after taking 30 tablets of sildenafil citrate (50 mg)3 days earlier. A number of ophthalmologic tests were administered including visual acuity test, color vision test, fundus photography and the measurement of retinal structure with optical coherent tomography and her condition was monitored. The best corrected visual acuity was 1.0 in both right and left eyes in her first visit. The color anomaly and a central scotoma of both eyes were detected in the visual field test, while significant signs were not observed after evaluation using optical coherent tomography and fundus photography. After 5 weeks, the visual acuity was not affected, the color anomaly symptom disappeared and the focal visual field defect was present although improved. Conclusions: Transient color anomaly and persistent central scotoma caused by an overdose ingestion of sildenafil has not been reported in Korea, The related mechanisms may involve the inhibition of PDE5 on ganglion cells and bipolar cells in the retina and interruption of phosphodiesterase type 6 (PDE6) function in both rods and cones. 목적: Sildenafil citrate는 선택적으로 phosphodiesterase type 5 (PDE5)를 억제하여 발기를 지속시키는 경구용 발기부전 치료제로 널리 사용되는 약제이다. 본 저자는 sildenafil citrate 과다복용 이후에 발생한 색각이상 및 시야감소 1예를 보고하고자 한다. 증례요약: 특이 전신 질환이 없던 39세 여자 환자가 내원 3일 전 자살 목적으로 sildenafil citrate 50 mg 30알을 복용 후 시작된 시야감소를 주소로 내원하였다. 교정시력 우안(1.0), 좌안(1.0)이었으며 빛간섭단층촬영 및 안저검사상 특이소견은 발견되지 않았으나, 색각이상 및 시야검사에서 중심 암점이 관찰되었다. 경과관찰 5주간 시력변화는 없었으며 색각이상은 소실되었으나, 시야는 호전되는양상이지만 결손은 남아있었다. 결론: Sildenafil의 추천용량을 넘어서는 고용량을 한 번에 복용할 경우 일시적인 색각이상과 지속되는 중심 암점과 같은 시기능 저하가 나타날 수 있다.
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망막앞막 환자의 정량화된 변시증의 정도와 빛간섭단층촬영 소견과의 연관성
김패트릭(Patrick Kim),박성용(Sung Yong Park) 대한안과학회 2016 대한안과학회지 Vol.57 No.4
목적: 망막앞막 환자에서 새로 고안된 Monpack One 변시증 검사로 변시증의 정량화를 시도하고, 그 정도와 빛간섭단층촬영 소견과의 연관성을 비교하였다. 대상과 방법: 특발성 망막앞막 환자 35명 37안을 대상으로 하였다. 모든 대상에서 빛간섭단층촬영 및 Monpack One을 이용하여 변시증 검사를 시행하였다. 빛간섭단층촬영은 Early Treatment Diabetic Retinopathy (ETDRS) 격자의 중심오목 및 중심오목 부근 4방향의 망막두께(1 mm, 3 mm)를 측정하였으며 각 인자 간에 유의한 관련이 있는지 알아보았다. 변시증 검사의 재현성 및 신뢰도를 평가하기 위해 정상 11명 22안을 대상으로 변시증 검사를 2회 반복 시행하였다. 결과: ETDRS 격자의 중심 및 상측, 하측, 비측, 이측 구역에서의 두께는 각각 495 ± 102 μm, 428 ± 98 μm, 454 ± 78 μm, 434 ± 83 μm, 463 ± 95 μm였다. 변시증의 전체 점수는 24.8 ± 13.9였고, 상측, 하측, 비측, 이측 점수는 14.7 ± 9.1, 15.1 ± 8.6, 15.9 ± 8.9, 14.6 ± 8.6이었다. 변시증의 전체 점수는 중심부 망막의 평균두께와 유의한 상관 관계를 보였으며, 상측, 하측, 비측, 이측 점수가 각각 하측, 상측, 이측, 비측 구역의 평균 두께와 유의한 상관 관계를 보였다. 정상안에서 변시증 정도의 검사 간 급내상관계수는 모든 구역에서 0.9 이상이었다. 결론: 망막앞막에서 Monpack One 변시증 검사를 이용해 구역별로 변시증의 정도를 평가할 수 있었고, 그 정도는 빛간섭단층촬영의 수치와 유의한 상관관계를 보였다. Purpose: To investigate the quantification of metamorphopsia with a novel method that uses Monpack One (Metrovision, Perenchies, France) and to compare the relationship between metamorphopsia score and spectral-domain optical coherencetomography (SD-OCT) findings in patients with epiretinal membrane (ERM). Methods: This study included 37 eyes of 35 patients with idiopathic ERM. We examined the patients using SD-OCT and quantified the degree of metamorphopsia using the Monpack One. On the topographic map of the Early Treatment Diabetic Retinopathy (ETDRS) grid, central retinal thickness at the fovea (1 mm), and parafovea (3 mm) was measured with the SD-OCT software. The correlation between these factors was analyzed. We repeated the metamorphopsia test twice in 22 eyes of 11 healthy subjects in order to calculate intraclass correlation coefficients (ICCs) and evaluate the reproducibility and reliability of the new metamorphopsia test. Results: On the ETDRS grid, the retinal thickness (μm) of the central, superior, inferior, nasal, and temporal subfields was 495 ± 102, 428 ± 98, 454 ± 78, 434 ± 83, and 463 ± 95, respectively. The mean total metamorphopsia score was 24.8 ± 13.9, while those for the superior, inferior, nasal, and temporal subfields were 14.7 ± 9.1, 15.1 ± 8.6, 15.9 ± 8.9, and 14.6 ± 8.6, respectively. Linear regression analysis revealed that total metamorphopsia score was significantly related to central retinal thickness (p = 0.01). Moreover, each subfield of parafoveal retinal thickness positively correlated with metamorphopsia subfield score (p < 0.01-0.023). The ICCs for the metamorphopsia tests of the healthy individuals showed almost perfect repeatability (>0.9) in all subfields. Conclusions: The degree of metamorphopsia in ERM could be quantified objectively on each subfield using the Monpack One metamorphopsia test. The degree of metamorphopsia significantly correlated with retinal thickness measurements based on SD-OCT.
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백내장수술 전 각막내피세포의 상태가 수술 후 각막내피세포의 감소에 미치는 영향
김패트릭(Patrick Kim),정문선(Moon Sun Jung) 대한안과학회 2017 대한안과학회지 Vol.58 No.2
Purpose: To analyze the influence of preoperative corneal endothelial status on postoperative corneal endothelium density after cataract surgery. Methods: We evaluated 228 eyes of 158 patients who underwent cataract surgery. Corneal endothelial status and central corneal thickness were measured before surgery and 1 day, 1 month, 3 months and 6 months after surgery. Patients were classified by preoperative endothelial cell density (three groups) and their coefficients of variation and hexagonality (two groups). Clinical parameters, including corneal endothelial cell losses, visual acuity, intraocular pressure, spherical equivalent refraction and central corneal thickness were measured to compare the intergroup indices. Results: There were no significant differences in corneal endothelial cell losses at 1 day, 1 month, 3 months and 6 months after surgery in any of the groups based on corneal endothelial cell density. There were increases in corneal thickness at 1 day and 1 month after surgery that were significantly higher in the low-endothelial cell density group than the 2,000−2,500 cells/mm2 cell density group (p < 0.05), but there were no differences after the 3-month time point. There were no significant differences in clinical parameters for the coefficient of variation and hexagonality groups until 6 months after surgery. Conclusions: We observed reversible corneal edema in the low endothelial group; however, there were no significant intergroup differences in corneal endothelial cell loss due to preoperative corneal endothelial status. Our results suggest that cataract surgery is relatively safe for patients with morphologically abnormal corneal endothelium and/or low endothelial density; the safety is primarily due to improved equipment and surgery techniques.
KCI
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