혼탁한 각막 후부에 숨겨져 있던 나무 가시에 의한 각막염 치료 사례

김성미(Seongmi Kim),이혜진(Hye Jin Lee),하아늘(Ahnul Ha),이종영(Jong Young Lee),정진호(Jinho Jeong) 대한안과학회 2021 대한안과학회지 Vol.62 No.12

목적: 전안부빛간섭단층촬영과 전방각경검사를 통해 혼탁한 각막 후부에서 발견된 나무 가시를 제거하고 각막염이 호전된 증례를 보고하고자 한다. 증례요약: 79세 여성이 농사 중 좌안을 가시에 찔린 후 발생한 각막염으로 한 달간 항생제 치료에도 호전이 없어 의뢰되었다. 좌안 시력은 안전수동이었고, 중심부에 각막혼탁과 함께 전방축농이 동반되었으며, 강화 항생제 점안치료에도 전방축농은 호전과 악화를 반복하였다. 각막병변부에 전안부빛간섭단층촬영 및 전방각경검사를 통해 후부 각막 및 전방 내로 돌출된 미세 이물을 확인하였으며, 수술적으로 제거하였다. 이물 제거 후 좌안 전방축농은 소실되었고, 각막혼탁과 상피결손이 호전되었다. 결론: 통상적인 치료로 호전되지 않는 감염각막염에서 외상의 병력이 있고 혼탁으로 인해 각막 후면이 관찰되지 않을 때, 각막내 이물의 잔존 가능성을 의심하여야 하며, 전안부빛간섭단층촬영 및 전방각경검사가 유용한 진단 도구로 활용될 수 있다. Purpose: We report a case of keratitis that improved after removal of a causative plant foreign body from below the posterior surface of an opaque cornea. The foreign body was revealed by anterior segment optical coherence tomography (AS-OCT) and gonioscopy. Case summary: A 79-year-old woman was referred with an impression of left-eye keratitis; the eye had been injured by a branch of a tangerine tree 1 month prior. She had been given the usual topical antibiotics by a local clinic, but they were ineffective. At her initial visit, her visual acuity was only hand motion in the left eye; slit-lamp examination revealed a 3 × 3-mm corneal infiltration with a hypopyon in the anterior chamber. Despite administration of strong topical antibiotics on an hourly basis, the corneal lesion worsened. AS-OCT and gonioscopy revealed a small foreign body below the posterior surface of the cornea; this was surgically removed. The corneal opacity and corneal epithelial defects dramatically improved, and the hypopyon disappeared. Conclusions: The possibility of a residual foreign body should be considered if trauma precedes infectious keratitis that does not improve with conventional treatment and the posterior surface of the cornea is not visible because of corneal opacity. In such a case, AS-OCT and gonioscopy can be useful.

녹내장환자에서 백내장수술 후 안압하강에 영향을 미치는 전방각경 점수 및 술 전 인자

박율리,김영빈,조경진 대한안과학회 2019 대한안과학회지 Vol.60 No.5

Purpose: To evaluate a new gonioscopy score and preoperative factors as a potential predictor for intraocular pressure (IOP) reduction after phacoemulsification. Methods: This is a retrospective review of 182 eyes with glaucoma of either open or narrow angles that underwent phacoemulsification. Preoperative variables such as age, IOP, refractive errors, anterior chamber depth (ACD), axial length, and lens position were evaluated at 6 months after surgery. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants. To determine variables associated with IOP change at 6 months, univariate and multivariate linear regression analysis was performed. Results: The mean age of the patients was 72.8 ± 9.5 years and the average preoperative IOP was 16.4 ± 3.7 mmHg with 1.2 glaucoma medications. The mean IOP reduction after phacoemulsification was 2.7 ± 2.2 mmHg at postoperative 6 months. Preoperative IOP (β = 0.55, p < 0.001), gonioscopy score (β = -0.29, p < 0.001), ACD (β = -0.67, p = 0.02), and IOP/ACD ratio (β = 0.58, p = 0.01) were associated with IOP reduction at 6 months. Conclusions: Preoperative predictors for IOP reduction after phacoemulsification were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio in patients with glaucoma. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification. 목적: 녹내장환자에서 수정체유화술 후 안압에 영향을 주는 전방각경 점수를 포함한 술 전 인자에 대해 알아보고자 하였다. 대상과 방법: 녹내장환자 중 백내장수술을 받은 182안을 대상으로 후향적 의무기록 분석을 시행하였다. 나이, 안압, 안축장, 전방 깊이, 수정체 위치, 굴절력을 술 후 6개월째에 비교 분석하였다. 술 전 전방격경 점수는 4사분면의 Shaffer 전방각경 grading을 합하여 계산하였다. 단변량 및 다변량 회귀분석을 이용하여 위 인자들과 술 후 안압의 관계를 분석하였다. 결과: 환자들의 평균 나이는 72.8 ± 9.5세, 평균 술 전 안압은 16.4 ± 3.7 mmHg로 측정되었으며, 평균 1.2개의 안압하강제를 사용하고 있었다. 술 후 6개월째에 평균 2.7 ± 2.2 mmHg의 안압하강을 보였다. 다변량 분석상 술 전 안압(β=0.55, p<0.001). 전방 깊이(β=-0.67, p=0.02), 전방각경 점수(β=-0.29, p<0.001) 및 intraocular pressure/anterior chamber depth (IOP/ACD)비(β=0.58, p=0.01)가 통계적으로 유의하게 술 후 6개월의 안압하강과 연관성을 보였다. 결론: 녹내장환자에서 수정체유화술 후 안압하강과 관련된 술 전 인자는 술 전 안압, 전방 깊이, 전방각경 점수 그리고 IOP/ACD비였다. IOP/ACD비와 전방각경 점수는 백내장수술 후 안압하강을 예측하는 데에 도움이 될 것으로 생각된다.

안내렌즈삽입술 후 안압과 전방각의 변화

전연숙,이종호,이제명,박인기,Yeoun Sook Chun,Jong Ho Lee,Jae Myung Lee,In Ki Park 대한안과학회 2005 대한안과학회지 Vol.46 No.2

Purpose: To evaluate the effects of ICL implantation on angle structures, intraocular pressure (IOP) and pupil diameter. Methods: A Staar implantable contact lens (ICL) was implanted in 81 eyes of 43 patients with spherical equivalent over -6D. Gonioscopy was done 1 day after laser iridotomy and 6 months after ICL implantation and postoperative changes in gonioscopic findings were evaluated. Also IOP and pupil diameter were examined. Results: There were occlusion or narrowing of the LI opening site in 10 eyes (12.3%). Width of angle was wide over 30° in all cases but that was narrowed under 20° in 16 eyes (19.8%) at postoperative 6 months. The mean pigmentation was 2.11 in inferior, 0.47 in nasal, 0.22 in temporal and 0.18 in superior angle at 6 months postoperatively by semiquantitative method (Grade 0~4). There was decrease of pigmentation in nasal and temporal angle but no change in inferior and superior angle after ICL implantation. There was temporary increase of IOP at 1 week and 1 month postoperatively due to steroid eye drops but returned to preoperative level and maintained until the 6 months postoperatively. There was significant decrease of pupil diameter at postoperative 1 and 3 months but returned to the preoperative level at postoperative 6 months. There was no evidence of pigment dispersion syndrome and pigmentary glaucoma. Conclusions: ICL implantation caused the narrowing of width of angle but did not increase trabecular pigmentation. We expect that ICL implantation is safe about pigment dispersion syndrome and pigmentary glaucoma.

외상섬모체해리에서 시행한 부분 공막편을 이용한 경공막 섬모체유착술 1예

박한석,최신영,장효주,안재홍 대한안과학회 2019 대한안과학회지 Vol.60 No.4

Purpose: To report a case of a cyclodialysis cleft that was successfully managed with gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap. Case summary: A 44-year-old man complaining of blurred vision in the left eye after blunt trauma was referred to our hospital. The intraocular pressure (IOP) was 4 mmHg and the visual acuity was counting finger. Gonioscopy examination revealed cyclodialysis cleft from 3 to 6 o’clock and fundus examination revealed macular folds. After the failure of conservative medical therapy and laser photocoagulation, gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap was performed. Four months later, the IOP was 18 mmHg, the visual acuity was 0.8, and fundus examination showed the disappearance of the macular folds. Conclusions: Transscleral cyclopexy using partial-thickness scleral flap is a safe and effective method to treat hypotony maculopathy due to cyclodialysis and to minimize pupil distortion. 목적: 보존적 약물 치료와 레이저광응고술에 반응하지 않았던 외상섬모체해리로 인하여 저안압 황반병증이 발생한 환자에서 부분 공막편을 이용하여 경공막섬모체유착술을 시행하여 성공적으로 치료된 1예를 보고하고자 한다. 증례요약: 44세 남자가 좌안에 둔상을 입은 후 발생한 시력저하를 주소로 내원하였다. 시력은 안전수지, 안압은 4 mmHg, 전방각경검사에서 3시에서 6시까지 이어지는 섬모체해리가 관찰되었고, 안저검사에서 맥락망막주름이 관찰되었다. 보존적 약물 치료와 레이저광응고술에 반응하지 않아 전방각경으로 확인하며 부분 공막편을 통한 경공막섬모체유착술을 시행하였다. 수술 4개월 후 시력은 0.8, 안압은 18 mmHg로 안정적으로 유지되었으며, 안저검사에서 맥락망막주름이 소실되고 동공의 모양은 잘 유지되었다. 결론: 부분 공막편을 통해 시행한 경공막섬모체유착술은 섬모체해리로 인한 저안압 황반병증의 치료에 안전하고 효과적이며 동공 변형을 최소화할 수 있는 방법이다.

Primary Angle-Closure Glaucoma in a Maltipoo Dog

Manbok Jeong 한국임상수의학회 2023 한국임상수의학회지 Vol.40 No.3

A two-year-old spayed female Maltipoo dog was presented with a two-month duration of glaucoma in the right eye. On the first presentation, menace response and dazzle reflex were absent in the right eye, but it was pres- ent in the left eye. Slit-lamp biomicroscopy showed buphthalmia, mild corneal edema, and conjunctival and episcleral hyperemia in the right eye. The intraoc- ular pressures were 70 mmHg and 30 mmHg in the right and left eyes, respec- tively. On the gonioscopic and high-resolution ultrasound examinations, both the iridocorneal angle and ciliary cleft were completely closed in the right eye. However, gonioscopy revealed an opened iridocorneal angle even with some broader base of pectinate ligament fiber, but high-resolution ultrasound showed a narrowed ciliary cleft and increased contact of the iris base with the limbal cor- nea in the left eye. Based on these results, a diagnosis of primary angle-closure glaucoma was made in both eyes. This case report highlighted the importance of evaluating the ciliary cleft with high-resolution ultrasound as a critical diag- nostic and prognostic role in canine glaucoma.

Distribution and Characteristics of Peripheral Anterior Synechiae in Primary Angle-Closure Glaucoma

( Jong Yun Lee ),( Yong Yeon Kim ),( Hai Ryun Jung ) 대한안과학회 2006 Korean Journal of Ophthalmology Vol.20 No.2