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모락셀라그룹균에 의한 각막궤양에서의 각막 콜라겐 교차결합술
우상언,이시형 대한안과학회 2020 대한안과학회지 Vol.61 No.2
Purpose: To report a case of corneal collagen cross-linking for corneal ulcer caused by the Moraxella group. Case summary: A 77-year-old male had decreased visual acuity for several days in his right eye. The patient showed severe stromal ring infiltrates with a corneal epithelial defect measuring (5.0 × 7.0 mm), a corneal endothelial plaque, and a hypopyon measuring less than 1.0 mm in height in the anterior chamber of the right eye. There was no abnormal finding in the right eye using B-scan ultrasonography. Before starting treatment, a corneal culture was conducted. The culture tests showed the presence of the Moraxella group. Because the patient was diagnosed with a corneal ulcer caused by the Moraxella group, corneal collagen cross-linking (CXL) was performed. The antimicrobial susceptibility test confirmed that this Moraxella group was sensitive to ceftazidime, so the patient was treated with 5% ceftazidime eye drops and 0.5% moxifloxacin eye drops every 2 hours for 9 months after corneal collagen CXL. The uncorrected visual acuity was 0.1 in the right eye, and there was almost no corneal stromal melting on anterior segment optical coherence tomography. Conclusions: This is the first known case of a corneal ulcer, in the Republic of Korea, caused by the Moraxella group and treated with corneal collagen CXL. Corneal collagen CXL should be considered as a surgical treatment for patients who have an impending corneal perforation due to a corneal ulcer because it is a simple procedure and causes fewer serious complications than other treatments. 목적: 모락셀라 그룹균에 의한 각막궤양에서의 각막 콜라겐 교차결합술 1예를 보고하고자 한다. 증례요약: 77세 남자 환자가 내원 수일 전 시작된 우안의 시력저하를 주소로 내원하였다. 세극등현미경검사상 우안 5.0 × 7.0 mm 크기의 각막상피결손, 심한 기질 고리 모양 침윤, 각막내피반, 높이 1.0 mm 미만의 전방축농이 보였고 안구초음파검사상 특이 소견은없었다. 치료 전 각막궤양 배양검사를 시행한 결과 모락셀라그룹균이 동정되어 이에 의한 각막궤양 진단하에 각막 콜라겐 교차결합술을 시행하였다. 항생제 감수성검사상 ceftazidime에 감수성이 확인되어 ceftazidime 5% 안약을 1시간마다, moxifloxacin 0.5% 안약을 2시간마다 점안하였다. 수술 후 9개월째 우안 시력 0.1이었고, 전안부 빛간섭단층촬영상 각막기질 융해가 거의 발생하지 않았다. 결론: 국내에서 최초로 모락셀라 그룹균에 의한 각막궤양 환자에게 각막 콜라겐 교차결합술을 시행함을 보고하는 바이며, 이 수술은 시술이 간단하며 심각한 합병증을 유발하지 않아 각막궤양으로 인한 각막천공 위험성이 있는 경우 시행하는 수술 방법 중 하나로 고려해야 한다.
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세 가지 기기를 이용하여 측정한 중심각막두께의 비교 및 반복성 비교
우상언(Sang Earn Woo),이시형(Si Hyung Lee) 대한안과학회 2021 대한안과학회지 Vol.62 No.2
목적: 전안부 빛간섭단층촬영, 초음파 각막두께측정계 및 이중샤임플러그 전안부사진기(Galilei G4??)를 이용하여 중심각막두께의 측정치를 비교하고 각 기기들의 반복성을 비교하고자 한다. 대상과 방법: 정상인 60명 120안을 대상으로 전안부 빛간섭단층촬영, 초음파 각막두께측정계 및 이중샤임플러그 전안부사진기로 측정된 중심각막두께 검사치의 상관관계를 알아보고, 기기별 반복성을 비교하였다. 결과: 전안부 빛간섭단층촬영, 초음파 각막두께측정계 및 이중샤임플러그 전안부사진기를 이용하여 측정한 중심각막두께는 각각 511.23 ± 37.16 μm, 525.78 ± 39.22 μm, 531.43 ± 41.57 μm로 이중샤임플러그 전안부사진기가 가장 두껍게 측정되었고, 전안부 빛간섭단층촬영이 가장 얇게 측정되었으며, 각 측정치 사이에 통계적으로 유의한 차이를 보였다(p<0.05). 세 검사는 유의한 상관관계를 보였다(r>0.900, p<0.001). 검사자 내 반복성은 세 기기 모두 높은 신뢰도를 보였다(급내상관계수 ≥0.996). 결론: 세 검사 사이에 유의한 상관관계가 있었으며 세 검사 모두 높은 반복성을 보였다. 전안부 빛간섭단층촬영에 의해 측정된 중심각막두께는 이중샤임플러그 전안부사진기에 의해 측정된 중심각막두께보다 유의하게 얇게 측정되었고, 또한 이중샤임플러그 전안부사진기로 측정한 중심각막두께가 초음파 각막두께측정계로 측정한 값에 조금 더 유사한 값을 나타내어 결과 해석 시 이에 대한 고려가 필요할 것으로 생각된다. Purpose: To compare and analyze central corneal thickness (CCT) measurements and measurement repeatability according to the corneal thickness obtained with anterior segment optical coherence tomography (AS-OCT), ultrasound pachymetry (USP), and dual Scheimpflug imaging (Galilei G4??). Methods: CCT measurements obtained using AS-OCT, USP, and a dual rotating Scheimpflug camera in 120 eyes of 60 healthy subjects were compared and the repeatability was analyzed. Results: The average CCT measurements using AS-OCT, USP, and a dual rotating Scheimpflug camera were 511.23 ± 37.16, 525.78 ± 39.22, and 531.43 ± 41.57 μm, respectively. The CCT measurement using dual rotating Scheimpflug imaging was statistically significantly thicker than that measured using AS-OCT (p < 0.05). A significant linear correlation was observed among OCT, USP, and dual rotating Scheimpflug measurements (r > 0.900, p < 0.001). All three methods showed high repeatability (intraclass correlation coefficient ≥ 0.996) for intra-examiner CCT measurements. Conclusions: The CCT measurement results using the three methods were significantly correlated and showed high repeatability. However, the AS-OCT measurement was significantly thinner than that obtained using a dual rotating Scheimpflug camera. CCT measurement with a dual rotating Scheimpflug camera is a better alternative for USP than AS-OCT. Therefore, CCT should be interpreted in the context of the instrument used.
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한정우,우상언,최은우,온영훈 한국망막학회 2020 Journal of Retina Vol.5 No.2
Purpose: We investigated the correlations between macular function recorded with a multifocal electroretinogram (mfERG) and macular structure evaluated by optical coherence tomography angiography (OCT-A) in patients with retinitis pigmentosa (RP). Methods: In total, 30 eyes of 15 RP patients and 40 eyes of 20 healthy subjects were enrolled in this study. OCT-A and mfERG were performed for all patients. The area and circularity of the foveal avascular zone (FAZ) were measured, and the vessel density (VD) and perfusion density (PD) of the superficial capillary plexus and deep capillary plexus (SCP and DCP, respectively) were estimated. The average amplitude and implicit time of N1, P1, and N2 in rings 1 and 2 were obtained from the mfERG findings. Correlation between the OCT-A results and mfERG parameters were analyzed in RP patients and normal subjects. Results: The mean FAZ area in RP patients increased significantly compared with that in normal subjects (p < 0.001). Both the PD and VD in the SCP and DCP were significantly reduced in RP patients compared with normal subjects (p < 0.001 and p < 0.001, respectively). The mean amplitude of N1, P1, and N2 from rings 1 and 2 were significantly reduced in RP patients compared with normal subjects. The superficial FAZ and deep FAZ area were significantly correlated with P1 amplitude (r = -0.682, p = 0.000 and r = -0.612, p = 0.000, respectively). Both the VD and PD of the superficial plexus were correlated with P1 amplitude on mfERG (r = 0.188, p = 0.021; r = 0.215, p = 0.013; r = 0.323, p = 0.002; and r = 0.362, p = 0.001, respectively). Conclusions: The P1 amplitude from mfERG was significantly correlated with FAZ area and the PD and VD of the SCP and DCP in RP patients. Together, these results suggest that OCT-A together with mfERG is a useful modality for evaluating macular structure and function in RP patients.
KCI
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