백내장 수술 후 난시교정용 인공수정체를 이용한 난시 교정 효과

차용재(Yong Jae Cha, MD),김미금(Mee Kum Kim, MD, PhD),위원량(Won Ryang Wee, MD, PhD) 대한안과학회 2015 대한안과학회지 Vol.56 No.10

목적: 난시를 동반한 백내장 환자에서 백내장 수술 시 테크니스 토릭 인공수정체 삽입술의 난시교정 효과 및 안정성을 분석하고자 하였다. 대상과 방법: 1D에서 4D의 각막 난시를 동반한 백내장 환자 중 2013년 6월부터 2014년 5월까지 서울대학교병원에서 임상시험 동의하에 백내장 제거술 및 테크니스 토릭 인공수정체 삽입술을 받은 14명 17안을 전향적으로 관찰하여 분석하였다. 수술 전과 후의 시력, 굴절력, 난시, 인공수정체 축, 고위수차의 변화를 술후 3개월까지 관찰하였다. 난시 분석에는 power vector analysis가 사용되었다. 결과: 나안시력(logMAR)은 술 전 평균 0.58 ± 0.34에서 3개월에 0.26 ± 0.43으로 유의하게 향상되었다. 평균 굴절난시는 술 전 -2.67 ± 0.89D였고, 술후 3개월에 -0.59 ± 0.48D로 최종 77.9%의 유의한 감소 효과를 보였다. 난시벡터 분석 시 M, B, J0, J45 모두 술 전과 비교하여 유의하게 감소하였다. 수술 전 의도한 축과 술 후 3개월째 실제 인공수정체 축 간의 평균 차이는 3.26도만큼 시계 방향으로 회전하였지만 통계적으로 유의하지 않았고, 회전은 대부분 술 후 한 달 이내에 발생하였다. 결론: 난시를 동반한 백내장 환자에서 초음파 유화술 및 테크니스 토릭 인공수정체 삽입술은 우수한 난시교정 효과 및 회전 안정성을 보였다. Purpose: To evaluate the efficacy of Tecnis?? toric intraocular lens (IOL) implantation for the correction of astigmatism and rotational stability during cataract surgery in patients with cataract and astigmatism. Methods: We prospectively analyzed 17 eyes of 14 patients with 1 to 4 diopters (D) of corneal astigmatism who underwent phacoemulsification and Tecnis?? toric IOL implantation at Seoul National University Hospital from June 2013 to May 2014. Informed consent was obtained from all participants before the clinical trial. We evaluated the changes in visual acuity, refraction, astigmatism, IOL axis and higher order aberration for 3 months postoperatively. Power vector analysis was used to analyze astigmatism. Results: The mean uncorrected visual acuity (log MAR) significantly improved from 0.58 ± 0.34 to 0.26 ± 0.43 at 3 months postoperatively. The mean refractive astigmatism was significantly decreased by 77.9% from a mean value of -2.67 ± 0.89 D to -0.59 ± 0.48 D at 3 months postoperatively. According to power vector analysis, M, B, J0, and J45 were significantly reduced after the surgery. The mean difference between achieved and intended IOL axis was 3.26 degrees clockwise at postoperative 3 months, which was statistically insignificant. Most of the rotational changes were observed within a month after the surgery. Conclusions: Phacoemulsification and Tecnis?? toric IOL implantation in patients with cataracts and astigmatism showed efficacy for the correction of astigmatism and rotational stability.

Post-Transfusion Prupura 1 례

차용재(YJ Cha),김준길(JK Kim),김준태(JT Kim),김태수(TS Kim),신영관(YK Shin),김동진(DJ Kim) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.10

Post-transfusionpurpura(PTP) is believed to be a rare clinical syndrome characterized by the acute occurrence of severe purpura with thrombocytopenia approximately 1 week after blood transfusion. This syndrome occurs predominantly in patients who lack the platelet-specific alloantigen, and has been previously sensitized by prior transfusion or pregnancy. The typical patient is a middle-aged, multiparous white woman. Diagnosis may be suspected by normal clotting studies, bone marrow biopsy showing increased megakaryocytes, and demonstration of a potent antibody reactive against platelets by appropriate serologic tests. Treatment with corticosteroid and platelet transfusion is ineffective. Exchange trasfusion or plasmapheresis has led to improved survival in this disease. Recent reports indicate that IV IgG may become a effective treatment. We exprienced a case of PTP in a multiparous woman received first blood transfusion during Cesarean section. Here we report this case with brief review of literature.

스펙트럼영역과 시간영역 빛간섭단층촬영기로 측정한 망막신경섬유층 두께 비교

이주향,송인석,김유정,차용재,엄기방,Juhyang Lee,MD,In Seok Song,MD,Yu-Jeong Kim,MD,Yong Jae Cha,MD,Ki Bang Uhm,MD,PhD 대한안과학회 2012 대한안과학회지 Vol.53 No.1

Purpose: To compare retinal nerve fiber layer (RNFL) thickness measured by time domain (Stratus) and spectral domain (3D) optical coherence tomography (OCT). Methods: Sixty-nine normal subjects and 92 glaucoma patients were included in the present study. Peripapillary RNFL thickness was measured with Stratus fast RNFL scan and 3D optic disc cube scan on the same day. The relationship between RNFL thickness measurements of the two OCTs were evaluated using a Pearson’s correlation analysis. A Bland-Altman plot was used for the comparison of Stratus-OCT and 3D-OCT. Results: In all subjects, average, superior, and inferior quadrant RNFL thicknesses measured by Stratus-OCT were thicker than those measured by 3D-OCT. In contrast, temporal and nasal quadrant RNFL thicknesses measured by 3D-OCT were thicker than those measured by Stratus-OCT. Although there were absolute value differences in RNFL thicknesses, high correlation was observed between Stratus-OCT and 3D-OCT (average: r = 0.897, temporal quadrant: r = 0.728, superior quadrant: r = 0.811, nasal quadrant: r = 0.678, and inferior quadrant: r = 0.905). Bland-Altman plots showed that Stratus-OCT values were greater than 3D-OCT values with relatively high RNFL thickness and the opposite with low RNFL thickness. Conclusions: For thicker RNFL, Stratus-OCT measurements tend to be greater than 3D-OCT, while for thinner RNFL, 3D-OCT measurements tend to be greater than Stratus-OCT. This difference must be taken into account if comparing measurements made with a Stratus-OCT to the measurements of a 3D-OCT. J Korean Ophthalmol Soc 2012;53(1):103-110

Methotrexate로 치유한 자궁경관임신 1 례

김준길(JK Kim),차용재(YJ Cha),윤미림(MR Yoon),황호민(HM Hwang),김동진(DJ Kim) 대한산부인과학회 1994 Obstetrics & Gynecology Science Vol.37 No.10

Cervical pregnancy is one of the most rare but life-threatening form of ectopic pregnancy. Most cervical pregnancies result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervical tissue. Until recently they usually resuulted in abdominal hysterectomy as a life-saving procedure. But efforts for reserving childbearing capacity in the past decade have led to several successful attempts at conservative managements that include cervical cerclage, tamponade of the cervical canal, ligation of internal iliac arteries, insertion of Foley catheter into the cervical canal, and uterine artery embolization. We report a case in which a cervical pregnancy was diagnosed in a 6 weeks and in which the patient was successfully treated with methotrexate without surgical intervention.

자궁탈에 관한 임상적 관찰

김태웅(TW Kim),이석환(SH Lee),김준길(JK Kim),차용재(YJ Cha),김준태(JT Kim),윤미림(MR Yoon),진건(K Jin),김동진(DJ Kim) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.10

This clinical and statistical study was attempted to analyze 168 cases of uterine prolapse(13 cases-not oeprated, 155 cases-operated) at the Department of Obstertrics and Gynecology, KangNamGeneral Hospital during the perilod from Jan 1981 to Dec. 1992. The results are as follows: 1. The incidence of the uterine prolapse found at the Department of Obstetrics and Gynecology during the past 12 years was 0.09% 2. The highest group of age distribution at the time of admission was 50 to 59 years(36.3%)and the mean age was 54.5 years old 3. The highest group of the degree of uterine prolapse was the 3 rd degree(48.8%) 4. The parity showed that 118 cases(70.3%) was over 4 and I case(0.6%)was nullipara 5. The delivery place was home in 151 cases(89.8%) and the urban area(89.3%)had a higher incidence than rural area(10.7%) 6.The age distribution at the time of development of uterine prolapse showed that 48 cases (28.5%) were 50 to 59years 33cases(19.6%) were 30 to 39years and mean age was 46.5years. 7. 96 cases(47.2%)was those cases who had suffered from the uterine prolapse for more than 10years and mean duration was 15.3years. 8. The feeling of a prolapsed mass was the most common symptom (95.25)and dysuria and urinary frequency were the next common symptoms(20.2%) 9. In 7 cases out of 168 cases(4.1%), previous treatment such as vaginal hysterectomy abdominal hysterectomy chemical cauterization was done 10. Out of 155 cases of uterine prolapse, 106 cases(68.4%)were treated by the vaginal hysterectomy with either anterior and posterior repair and/or posterior repair 11. Recurrence was 4 cases(2.5%) 12. The fever was the most common postoperative complication(6.4%)and urinary tract infection was the next common symptom(5.1%) 13 Pathologic findings were as follows: Chronic cervicitis 102 cases(65.8%) squamous metaplasisa of cervical gland 99 cases(63.8%), associated ovarian cyst 7 cases (4.4.%) Leiomyoma 5 cases (3.2%)etc.