두눈 고도원시 환아에서 연령에 따른 안축장과 원시 정도의 장기간의 변화 관찰

채수혜,김선아 대한안과학회 2018 대한안과학회지 Vol.59 No.4

Purpose: To explore changes in the spherical equivalent refractive error and axial length of both eyes of children with high hyperopia over time. Methods: Children with bilateral hyperopia ≥ 4.0 diopters (D) underwent visual acuity testing and comprehensive ophthalmic examinations. The mean age at the first visit was 6.5 years and spherical equivalent refractive error and axial length were measured at least three times over the following year. Axial length was measured using an intraocular lens Master instrument (Carl Zeiss Meditec, Jena, Germany). Results: The mean annual increase in axial length was +0.21 mm and the mean annual reduction in spherical equivalent refractive error was –0.39 D. Between the ages of 3 and 5 years, the mean annual increase in axial length was +0.36 ± 0.26 mm. In patients aged ≥ 9 years old, the mean annual increase was +0.12 ± 0.09 mm (p = 0.00). The mean annual reduction in spherical equivalent refractive error was –0.53 ± 1.00 D between the ages of 3 and 5 years, but became –0.32 ± 0.54 D at age ≥ 9 years old. This difference was not significant (p = 0.11). Conclusions: In children with bilateral hyperopia, the spherical equivalent refractive error decreased and the axial length increased with age. The rate of axial length growth was higher in younger children. 목적: 고도원시 환아에서 연령에 따른 원시 정도의 변화, 안축장의 변화를 장기간 추적 관찰하였다. 대상과 방법: 2008년 10월부터 2017년 9월까지 성모안과병원에서 평균 53.4개월 동안 추적 관찰이 가능했던 두눈 +4.0디옵터(D) 이상의 고도원시 30명, 60안을 대상으로 하였다. 초진 시 평균 연령은 6.5세였으며, 1년 단위로 3회 이상 측정된 원시 정도의 변화, 안축장 변화를 분석하였다. 또한 약시와 저교정 여부에 따른 원시 정도의 변화, 안축장 변화의 차이를 비교하였다. 안축장 측정은 IOL Master (Carl Zeiss Meditec, Jena, Germany)를 사용하여 시행하였다. 결과: 안축장의 변화속도를 분석한 결과, 평균 +0.21 mm/year였고, 원시 정도의 변화는 평균 -0.39 D/year였다. 연령에 따른 안축장 변화속도와 원시 정도의 변화속도를 확인해 본 결과 안축장 변화속도는 평균 3-5세에 +0.36 ± 0.26 mm/year로 가장 빨랐고 연령이 증가할수록 감소하여 9세에는 +0.12 ± 0.09 mm/year로 측정되었다(p=0.00). 3-5세에 원시 정도의 변화속도는 -0.53 ± 1.00 D/year로 가장 큰 변화를 보였고 9세 이상에서는 -0.32 ± 0.54 D/year로 가장 작은 속도로 줄어드는 것으로 관찰되었다. 각 구간에서 원시 정도는 모두 감소하였으며 각 군 간의 속도의 차이는 통계학적 유의성을 갖지 않았다(p=0.11). 결론: 고도원시 환자에서 연령이 증가함에 따른 장기간 변화를 비교해 본 결과 원시의 정도는 감소하였고 안축장은 증가하는 경향을 보였으며, 연령이 어릴 때 안축장의 증가가 의미있게 빠른 양상을 보였다.

중기 나이관련황반변성이 동반된 망막전막에서 유리체절제술과 막제거술 이후 수술의 영향

채수혜,이주헌,이민수,전혜민,윤희성 한국망막학회 2021 Journal of Retina Vol.6 No.1

Purpose: To evaluate the outcomes of pars plana vitrectomy with membrane peeling for intermediate stage dry age-related macular degeneration (AMD) coexisting epiretinal membrane and compare the result with the contralateral eye that has only intermediate stage dry AMD. Methods: This retrospective, observational study comprised 41 patients diagnosed with epiretinal membrane treated with vitrectomy and membrane peeling for coexisting intermediate stage dry AMD. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were studied by comparing the pre- and postoperative measurements. Thirty-four fellow eyes with intermediate stage dry AMD were compared as a control group. Preoperative and postoperative data of BCVA, CMT, development of choroidal neovascularization (CNV), and retinal atrophic change after the operation were evaluated. Results: Surgical treatment resulted in a significant improvement in BCVA and decrease in CMT at postoperative 12 months. In the surgery group, there was 1 eye with CNV development and 1 eye with new central retinal atrophic change. In the control group, there was 1 eye with new central retinal atrophic change. Conclusions: There was a significant improvement in visual acuity after vitrectomy and membrane peeling in eyes with intermediate stage dry AMD and epiretinal membrane. Future studies are needed to confirm the change of stage for dry AMD after surgical removal of the membrane. 목적: 중기 나이관련황반변성과 망막전막이 동시에 존재하는 눈에서 유리체절제술 후 결과를 확인하고, 중기 나이관련황반변성이 단독으로 존재하는 눈과 비교하여 유리체절제술이 황반변성의 진행에 어떤 영향을 미치는지 알아보고자 하였다. 대상과 방법: 중기 나이관련황반변성과 망막전막을 동시에 진단받고 유리체절제술과 막제거술을 시행받은 환자 41명 41안을 대상으로의무기록을 통한 후향적 분석을 실시하였다. 유리체수술 후 환자의 수술 전과 후 최대교정시력과 중심황반두께의 변화를 확인하였다. 환자군 중 반대안에 중기 나이관련황반변성을 진단받은 34명을 대조군으로 하여 수술 전후의 최대교정시력과 중심황반두께, 수술 후 맥락막신생혈관과 망막위축의 발생 여부에 대하여 분석하였다. 결과: 유리체절제술을 시행받은 환자군에서는 술 전과 술 후 12개월 결과를 비교해 보았을 때 유의한 시력호전을 보였다. 중심황반두께도 수술을 시행 받은 환자군에서 술 전과 비교하였을 때 술 후 12개월째 유의하게 감소되는 결과를 보였다. 환자군 중 1안에서 술 후 맥락막신생혈관이 발생하였으며, 수술을 시행 받은 군과 대조군에서 모두 각각 1안에서 지도모양위축이 발생하였다. 결론: 중기 나이관련황반변성이 동반된 망막전막 환자군에서도 유리체절제술 후 유의한 시력호전을 보였다. 망막전막의 제거가 중기 나이관련황반변성의 단계적 변화에 어떤 영향을 끼치는지에 대한 확인을 위하여는 추가적인 연구가 필요할 것으로 생각된다.

특발 망막앞막에서 빛간섭단층혈관조영을 통해 관찰된 특징에 대한 고찰

채수혜,최지원,김중엽,전혜민,윤희성 한국망막학회 2023 Journal of Retina Vol.8 No.2

Purpose: To investigate optical coherence tomography angiography (OCTA) findings in idiopathic epiretinal membrane (ERM) compared with normal controls and analyze postoperative changes. Methods: This retrospective and observational study included 54 eyes with idiopathic ERM and 134 normal control eyes. Foveal avascular zone (FAZ) area, perimeter, and circularity were measured and vascular parameters including vessel density and perfusion density in the superficial capillary plexus (SCP) were determined by OCTA. Results: FAZ area was significantly smaller in the ERM group compared with the normal control group (p = 0.02). Vessel density and perfusion density in the SCP were significantly greater in the ERM group (p < 0.01, for both). Six months after surgery, FAZ area had not significantly changed compared with before surgery (p = 1.00). Central vessel density and perfusion density in the SCP had decreased significantly 6 months after surgery (p < 0.01, for both). Conclusions: OCTA provides a useful display of the retinal vascular network in ERM patients. In the center foveal area, vessel density and perfusion density parameters were decreased 6 months postoperative, and in parafoveal area, vessel density and perfusion density parameters were increased 6 months postoperative.

삼출 나이관련황반변성에 의한 황반하출혈에서 유리체강내 애플리버셉트 단독요법의 임상적 효과

채수혜(Sue Hey Chae), 안소은(Soh Eun Ahn), 윤희성(Hee Seong Yoon) 대한안과학회 2018 대한안과학회지 Vol.59 No.5

Purpose: To evaluate the effects of intravitreal aflibercept injection in the treatment of submacular hemorrhage secondary to neovascular age-related macular degeneration (nAMD). Methods: This retrospective, observational study included patients diagnosed with nAMD with submacular hemorrhage treated with intravitreal aflibercept monotherapy. A total of 54 eyes of 54 patients were treated with an initial series of three monthly intravitreal aflibercept injections followed by as-needed injections. At the 6 month follow-up, changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and submacular hemorrhage area (SMH) were evaluated. Results: The mean preoperative BCVA was 0.79 ± 0.59 logMAR, which improved significantly to 0.53 ± 0.46 logMAR at 3 months and 0.48 ± 0.50 logMAR at 6 months (p < 0.001, in both). The CMT significantly decreased in all eyes: preoperative, 454.4 ± 131.5 μm, to 242.6 ± 39.7 μm at 6 months. The SMH was also reduced in all eyes: preoperative, 6.4 ± 4.8 disc areas (DAs) to 0.8 ± 1.4 DAs at 6 months. Ten eyes were diagnosed with typical nAMD (18.5%) and 44 eyes were diagnosed polypoidal choroidal vasculopathy (81.5%). There was no significant difference at 6 months in the visual outcomes of the subgroups. Conclusions: Intravitreal aflibercept monotherapy is well-tolerated as a treatment in maintaining or improving vision in patients with SMH secondary to nAMD. J Korean Ophthalmol Soc 2018;59(5):437-443

한국인 원발개방각녹내장에서 iStent를 사용한 최소 침습 수술의 효과와 안정성

채수혜(Sue Hey Chae),이태헌(Tae Heon Lee),이경헌(Kyung Heon Lee),류진영(Jin Young Rhew) 대한검안학회 2019 Annals of optometry and contact lens Vol.18 No.3

Purpose: To evaluate efficacy and safety of the iStent Trabecular Micro-Bypass stent used as the sole procedure in patients with primary open-angle glaucoma (POAG). Methods: Retrospective, consecutive case series involving 12 Korean patients, 12 eyes with POAG that were implanted with 1 iStent trabecular micro-bypass stent. Data were collected preoperatively, and at 1, 3, and 6 months, 12 months, postoperatively. Data included intraocular pressure (IOP), visual acuity test and slit lamp examination. Results: Mean preoperative IOP was 20.6 ± 4.4 mmHg and significantly decreased in 16.3 ± 2.5 mmHg at three months (p < 0.05), in 16.6 ± 3.6 mmHg at 12 months postoperatively (p < 0.05). The mean number of glaucoma medications was 1.83 ± 0.25 preoperatively and 1.58 ± 0.30 (p < 0.05) at 12 months postoperatively. No significant changes in visual acuity were noted. The most common complications comprised mild hyphema in 3 eyes, mild uveitis in 4 eyes and transient IOP spike in 3 eyes on postoperative day 1 and all instances were medically well controlled. Conclusions: The significat IOP reduction after iStent insertion in Korean patients occurred after one week of operation. An IOP reduction from baseline occurred at 12 months after implantation of iStent.

유리체절제술과 백내장 병합수술에서 공기충전술을 시행한 경우 후낭절제술이 굴절력에 미치는 영향

채수혜(Sue Hey Chae), 김상원(Sang Won Kim), 윤희성(Hee Seong Yoon) 대한안과학회 2018 대한안과학회지 Vol.59 No.9

Purpose: To evaluate the postoperative refractive errors after air tamponade with posterior capsulectomy during combined vitrectomy and cataract surgery. Methods: Patients who underwent combined vitrectomy, cataract surgery, and air tamponade with or without posterior capsulectomy were reviewed. All patients were followed for 4 months after surgery. Preoperative characteristics such as anterior chamber depth, axial length, and refractive error were analyzed and refractive errors after the surgery were evaluated. The difference between the target refractions and final refractive errors after the surgery according to the biometry method, and intraocular lens power calculations, were observed. Results: Fourteen eyes of 14 patients who had combined vitrectomy and cataract surgery with posterior capsulectomy and air tamponade were classified as group A, and 10 eyes of 10 patients who had combined vitrectomy and cataract surgery with only air tamponade were classified as group B. The target refraction of group A measured with A-scan biometry using the Sanders-Retzlaff-Kraff/Theoretical (SRK/T) calculation was -0.21 ± 0.22 diopters (D), and the final refractive error at 9.5 (± 2.20) months after the surgery was -0.52 ± 0.54 D. The mean difference between the two was -0.32 ± 0.44 D. The target refraction of group B measured with A-scan biometry using the SRK/T calculation was -0.33 ± 0.29 D, and the final refractive error at 9.5 (± 2.20) months after the surgery was -0.27± 0.39 D. The mean difference between the two was 0.06 ± 0.53 D. Conclusions: Posterior capsulectomy during combined vitrectomy and cataract surgery with air tamponade led to myopic shifts compared with no posterior capsulectomy with air tamponade during combined vitrectomy and cataract surgery. Performing posterior capsulectomy with air tamponade during combined vitrectomy and cataract surgery should, therefore, be carefully considered. J Korean Ophthalmol Soc 2018;59(9):819-826

당뇨망막병증 환자에서 패턴 범망막광응고술 후 중심와아래 맥락막두께의 변화

전혜민(Hye Min Jeon), 채수혜(Sue Hey Chae), 안소은(Soh Eun Ahn), 김상원(Sang Won Kim), 윤희성(Hee Seong Yoon) 대한안과학회 2016 대한안과학회지 Vol.57 No.8

Purpose: To evaluate changes in subfoveal choroidal thickness (SFCT) after patterned panretinal photocoagulation (PRP) using pattern scan laser (PASCAL) in patients with diabetic retinopathy. Methods: This study included 39 patients (50 eyes) treated with patterned PRP using PASCAL and who were followed for at least 3 months. Patients were classified into 2 groups according to severity: severe non-proliferative diabetic retinopathy and proliferative diabetic retinopathy. SFCT was measured by enhanced depth imaging of spectral-domain optical coherence tomography. The change in SFCT was analyzed at 1 and 3 months after PRP. Results: SFCT was 270.42 ± 61.44 μm before PRP, 264.52 ± 60.78 μm at 1 month, and 255.74 ± 56.89 μm at 3 months after PRP. Significant change of SFCT was found at 3 months after PRP. Central macular thickness was 275.56 ± 50.61 μm before PRP and increased to 295.18 ± 52.80 μm and 293.10 ± 57.24 μm at 1 and 3 months post-treatment, respectively. There were no significant differences between groups in SFCT at baseline or in the amount of change in SFCT after PRP. Conclusions: SFCT significantly decreased after patterned PRP using PASCAL.

Cloninger의 이론을 활용한 사상체질 생리심리 지표 연구

채한,전은상,임수혜,이수진 사상체질면역의학회 2019 사상체질의학회지 Vol.31 No.3

Introduction Cloninger’s Novelty-Seeking (NS) and Harm-Avoidance (HA) were found to be the biopsychological characteristic of Sasang typology, and the So-Yang type has high NS and low HA however the So-Eum type as contrary. The purpose of this study was to show the clinical usefulness of these measures as objective clinical index of Sasang typology in foreign countries lacking validated measures. Methods The Sasang type of 103 university students was diagnosed using Questionnaire for Sasang Constitution Classification (QSCC) II and clinical specialist, and biopsychological and physical features with NS, HA, Sasang Personality Questionnaire (SPQ) and BMI. These measures were normalized to make a noble index of ‘NS(100-HA)’, and the correlation among these were examined with Pearson’s correlation. The differences of biopsychological and physical features between Sasang type groups were attested with ANCOVA, and the comparison of clinical usefulness of SPQ and NS(100-HA) were examined with discriminant analysis. Results SPQ and BMI were clinically useful for Sasang typology as shown in previous studies, and the substitution of SPQ with normalized NS(100-HA) was found acceptable. The NS(100-HA) is significantly correlated with SPQ (r=0.466, p<0.01), however not with BMI (r=0.079, ns). The SPQ and NS(100-HA) scores were found to be distinctive between Sasang type groups, and these were found to predict Sasang type of participants with similar correctness. Discussion and Conclusion The current study reviewed the theoretical backgrounds and confirmed the clinical usefulness of Cloninger’s biopsychological theory in Sasang typology. These might provide foundations for integrative medicine and cross-cultural biopsychology of the East and West.

Pharmacognostic outlooks on medical herbs of Sasang typology

임수혜,전은상,이미숙,한상윤,채한 한국한의학연구원 2017 Integrative Medicine Research Vol.6 No.3

The purpose of this study was to review the pharmacognostic characteristics of Sasang type-specific medical herbs and suggest biological mechanisms that might be related to the personalized treatment of the East. Major compounds and their pharmacological activities of medical herbs for each Sasang types were systematically reviewed. The pharmacognostic characteristics of its main compounds were systematically analyzed with previous studies and three web-based databases. Sasang type-specific medical herbs were selected, and biological effects of their phytochemicals were reviewed from the pathophysiological features of each Sasang types. Phenolics were dominant in Tae-Yang type-specific herbs, iridoids and triterpenes with antipyretic and diuretic effects were in So-Yang type-specific, saponins (triterpene saponins and steroidal saponins) with antitussive effects were in Tae-Eum type-specific, and monoterpene and sesquiterpenes with stomachic effect were in So-Eum type-specific herbs. Pharmacognostic understandings on Sasang type-specific medical herbs with consideration of type-specific pathophysiological features were provided for the first time. This study would contribute to in-depth understandings on the pathophysiology of Sasang typology and integration of East-Asian and Western personalized medicine.

특발 망막앞막에서 막제거술 과정 중 발생하는 중심와 견인

전혜민,채수혜,방찬우,이민수,윤희성 대한안과학회 2018 대한안과학회지 Vol.59 No.8

Purpose: To determine influences of intraoperative foveal traction during membrane peeling in idiopathic epiretinal membrane (ERM) surgery. Methods: This retrospective observational study included 46 eyes of 46 patients with idiopathic ERM who underwent pars plana vitrectomy with ERM and internal limiting membrane peeling from February 2015 to September 2015. The presence of intraoperative foveal traction during membrane peeling was reviewed using video records. The main outcome measures were best-corrected visual acuity (BCVA), central foveal thickness (CFT), foveal contour, and photoreceptor inner segment/outer segment junction disruption using optical coherence tomography at baseline and at 1, 3, 6, and 12 months after surgery. Results: Group 1 (ERM with intraoperative foveal traction) included 22 eyes, and group 2 (ERM without intraoperative foveal traction) included 24 eyes. Preoperatively, convex pattern ERM was observed more often in group 1. Group 1 had a significantly thicker CFT and a lower BCVA compared to group 2 at baseline and during the first 6 months, but the final postoperative BCVA and CFT were not significantly different between the groups at 12 months. Among 22 eyes, 12 eyes (54.5%) were restored to flat or concave ERM patterns at an average of 5.4 months after surgery in group 1, and 18 out of 24 eyes (75%) recovered at 2.4 months (p < 0.01) in group 2. Conclusions: Preoperative thick CFT and convex pattern ERM indicated a high possibility of intraoperative foveal traction in idiopathic ERM surgery. There were no differences in long-term BCVA and restoration of foveal configuration according to foveal traction during membrane peeling. 목적: 특발 망막앞막 환자에서 막제거술을 시행하는 과정에서 발생한 중심와 견인이 수술 결과에 미치는 영향에 대해 분석해 보고자 하였다. 대상과 방법: 2015년 2월부터 9월까지 본원에서 특발 망막앞막으로 진단받고 유리체절제술 및 막제거술을 시행받은 환자 46명 46안을 대상으로 후향적으로 분석하였다. 수술영상을 판독하여 막제거술 과정에서 중심와에 견인이 발생하였는지를 확인하였고, 술 전, 술 후 1개월, 3개월, 6개월, 12개월에 최대교정시력 및 빛간섭단층촬영상에서 중심망막두께, 중심오목형태, 시세포 내절/외절 상태의 변화를 조사하였다. 결과: 술 중 중심와 견인이 발생한 22안은 견인이 발생하지 않은 24안에 비해 술 전 볼록형 형태가 많았고 중심망막두께가 두꺼웠으며 술 전 시력이 낮았다. 술 후 6개월까지 견인이 발생했던 군에서 시력이 낮고 중심망막두께가 두꺼웠으나 12개월에는 두 군의 차이가 없었다. 술 후 황반의 형태가 편평형 또는 오목형으로 회복되는 기간은 견인이 발생한 군에서 5.4개월, 견인이 발생하지 않은 군에서 2.4개월이었다(p<0.01). 결론: 특발 망막앞막 환자에서 수술 전 중심망막두께가 두껍고 볼록형 형태일수록 막제거술 과정 중 중심와 견인이 발생할 가능성이 높으며, 막제거술 과정 중 중심와 견인의 발생 유무에 따른 장기적 시력 및 해부학적 결과는 차이가 없었다.