187 research outputs found

    Ophthalmologic Manifestation of Inflammatory Bowel Disease: A Review

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    In patients with inflammatory bowel disease (IBD), ocular extraintestinal manifestations (EIM) are less common than EIM of other systems, but they are clinically important because they can lead to complications that can cause catastrophic damage to the visual acuity and ocular structure. Anterior uveitis and episcleritis are the most common ocular EIM. Involvement of the orbit, posterior segment, and optic nerve can also occur. A variety of treatments are available ranging from topical steroids to systemic immunosuppressive therapies. The treatment of IBD is also essential if the activity of inflammatory bowel disease affects the ocular symptoms.ope

    ๋ฏธ์šฉ ์•ˆ๋ฉด ํ•„๋Ÿฌ ์ฃผ์‚ฌ ์‹œ์ˆ  ํ›„ ๋ฐœ์ƒํ•œ ๋ง๋ง‰ํ•˜์ถœํ˜ˆ์„ ๋™๋ฐ˜ํ•œ ๋‹ค๋ฐœ์„ฑ ๋ง๋ง‰๋™๋งฅํ์‡„์˜ ์ฆ๋ก€ ๋ณด๊ณ 

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    Purpose: Retinal artery occlusion and ciliary artery occlusion (CAO) may occur as complications after cosmetic filler injections. However, submacular and subhyaloid hemorrhage have not been reported after cosmetic filler injection. Herein, we report the first case of subretinal hemorrhage after iatrogenic multifocal retinal and CAO following facial filler injection. Case summary: A 44-year-old woman with no relevant medical history presented with a sudden upper visual field defect of the right eye immediately after receiving hyaluronic acid cosmetic facial filler injection in the glabellar region. The patient was diagnosed with multiple branch retinal and posterior CAO of the right eye. On the fourth day of follow-up, submacular and subhyaloid hemorrhage was observed. Intravitreal injection of 1.25 mg bevacizumab and 0.2 mL pure C3F8 (octafluoropropane) gas was performed. At the 2-month follow-up, subretinal and subhyaloid hemorrhage at the macula had resolved. Without further treatment, the retina was stable with no further recurrence through the 1-year follow-up. Conclusions: Submacular and subhyaloid hemorrhage following branch retinal and posterior CAO immediately after cosmetic facial filler injection is a rare, but serious complication. Although the pathogenic mechanism for subretinal hemorrhage remains unclear, bevacizumab injection combined with 0.2 mL pure C3F8 gas injection may be a possible treatment option when faced with such complications.ope

    Optical coherence tomography findings predictive of response to treatment in diabetic macular edema

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    OBJECTIVE: To evaluate the short-term efficacy of intravitreal bevacizumab (IVB) and posterior sub-tenon triamcinolone injections (PSTI) on the basis of spectral-domain optical coherence tomography (SD-OCT) patterns in diabetic macular edema (DME). METHODS: We retrospectively reviewed 73 eyes of 73 patients with DME. Based on the presence of serous retinal detachment (SRD), eyes were categorized into two groups, and either IVB or PSTI treatment was performed. Central macular thickness (CMT) and the degree of SRD were assessed preoperatively and 1 month postoperatively. The severity of intraretinal edema was approximated based on the distance from the external limiting membrane to the internal limiting membrane. RESULTS: In eyes with SRD, reduction of SRD was greater with IVB than with PSTI. Moreover, reduction of intraretinal edema was greater with PSTI than with IVB. In eyes without SRD, PSTI achieved greater CMT reduction, compared with IVB. CONCLUSIONS: In DME patients with SRD, IVB achieved greater reduction of SRD, compared with PSTI; however, intraretinal edema responded more favorably to PSTI, regardless of the presence of SRD. Our results suggest that the classification of DME based on OCT findings may be useful to predict responses to IVB or PSTI treatments.ope

    ์ˆœ์œ„์˜์กด ํšจ์šฉํ•˜์—์„œ์˜ ์œ„ํ—˜๊ณต์œ 

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› ์‚ฌํšŒ๊ณผํ•™๋Œ€ํ•™ ๊ฒฝ์ œํ•™๋ถ€, 2017. 8. Yves Gueron.Risk-averse agents prefer to be fully insured against the fluctuations on their endowments. One way to avoid consumption risks is to agree upon endowment transfers among them. This kind of informal insurance is what we call a risk sharing. Over an infinite time horizon, the agents can be better off through risk sharing if they are sufficiently patient. We extend Mailath and Samuelson (2006) by allowing types of agents. A standard agent may benefit from having a pessimistic agent under rank-dependent utility as his risk sharing partner. Furthermore, it is much easier for them to have full insurance in equilibrium. We characterize a lower bound of the efficient frontier when the two agents are not patient enough. We also present our results with numerical examples.Introduction 1 1 Model 4 2 Risk sharing of two standard agents 5 2.1 Full insurance 6 2.2 Partial insurance 8 2.2.1 Characterization of the efficient frontier 10 2.2.2 MAX1 and MAX2 10 3 Risk sharing with a pessimistic agent 12 3.1 Full insurance 13 3.2 Partial insurance 16 3.2.1 Characterization of a lower bound for the efficient frontier 20 4 Numerical examples 21 Concluding remarks 23 References 24 Appendix 25 ์ดˆ๋ก (Abstract in Korean) 29Maste

    Clinical characteristics, risk factors, and surgical outcomes of secondary macular hole after vitrectomy

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    Secondary macular hole(MH) formation after vitrectomy is rare and its risk factors and pathogenesis are not clearly understood. This retrospective study was conducted to identify the risk factors of this complication and assess outcomes at 2 tertiary centres. The primary outcomes were the clinical characteristics associated with development of secondary MH, which included the primary diagnosis for initial vitrectomy, features on optical coherence tomography, and adjuvant surgical techniques used during the initial surgery. Secondary outcomes included the change in best-corrected visual acuity(BCVA), clinical factors associated with the need for re-operations for MH closure and prognostic factors for the visual outcomes. Thirty-eight eyes out of 6,354 cases (incidence 0.60%) developed secondary MH after undergoing vitrectomy for various vitreoretinal disorders over an 11-year period, most frequently after initial surgery for retinal detachment(RD) (9 eyes) and secondary epiretinal membrane (6 eyes). The mean age was 57.1 years (range: 17.8-76.7), and the mean follow-up was 51.1 months (range: 6.8 to 137.6). Prior to secondary MH formation, development of ERM was the most common OCT feature (19 eyes, 50%), and no cases of cystoid macular oedema (CME) were observed. A greater proportion of eyes with secondary MH had long axial lengths (32% โ‰ฅ26โ€‰mm vs 5% of eyes โ‰ค22โ€‰mm). MH closure surgery was performed in 36 eyes and closure was achieved in 34 (success rate 94%, final BCVA 20/86), with โ‰ฅ3-line visual gain in 18 cases. BCVA at MH onset (ORโ€‰=โ€‰0.056, Pโ€‰=โ€‰0.036), BCVA at post-MH surgery month 3 (ORโ€‰=โ€‰52.671, Pโ€‰=โ€‰0.011), and axial length โ‰ฅ28โ€‰mm (ORโ€‰=โ€‰28.487, Pโ€‰=โ€‰0.030) were associated with โ‰ฅ3-line visual loss; a history of macula-off RD (ORโ€‰=โ€‰27.158, Pโ€‰=โ€‰0.025) was associated with the need for multiple surgeries for MH closure. In conclusion, secondary MH occurs rarely but most commonly after vitrectomy for RD. Patients with axial length โ‰ฅ28โ€‰mm and poor BCVA at 3 months post-operation may have limited visual prognosis; those with a history of macula-off RD may require multiple surgeries for hole closure.ope

    ๋‚˜๊ฐ€์‚ฌํ‚ค(้•ทๅดŽ) ๋ฌด์—ญ๊ธˆ์œต์˜ ์„ฑ์žฅ๊ณผ ์กฐ์ผ๋ฌด์—ญ(ๆœๆ—ฅ่ฒฟๆ˜“)์˜ ๊ด€๊ณ„ : ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ์„ค๋ฆฝ๊ณผ ์กฐ์„  ์ง„์ถœ ๊ณผ์ •์„ ์ค‘์‹ฌ์œผ๋กœ

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์ธ๋ฌธ๋Œ€ํ•™ ๋™์–‘์‚ฌํ•™๊ณผ, 2018. 8. ๋ฐ•ํ›ˆ.์ œ18๊ตญ๋ฆฝ์€ํ–‰(็ฌฌๅๅ…ซๅœ‹็ซ‹้Š€่กŒ)์€ ์ผ๋ณธ ๋‚˜๊ฐ€์‚ฌํ‚ค ์ง€์—ญ์˜ ์ƒ์ธ๋“ค์ด 16๋งŒ ์—”์˜ ์ž๋ณธ์„ ์ถœ์žํ•˜์—ฌ 1877๋…„์— ์„ค๋ฆฝํ•œ ๋ฏผ๊ฐ„์€ํ–‰์ด๋‹ค. ์ด ์€ํ–‰์€ ๊ฐœ์—… ์งํ›„๋ถ€ํ„ฐ ์กฐ์„ ๊ณผ ์ผ๋ณธ ๊ฐ„์˜ ๋ฌด์—ญ์— ๊นŠ์ˆ™์ด ๊ด€์—ฌํ•˜๋ฉฐ ๋ฌด์—ญ์€ํ–‰์œผ๋กœ์„œ์˜ ์ž…์ง€๋ฅผ ๋‹ค์ ธ๋‚˜๊ฐ”๊ณ , ํŠนํžˆ 1880๋…„๋Œ€ ์ƒํ•˜์ด์—์„œ ๋‚˜๊ฐ€์‚ฌํ‚ค๋ฅผ ๊ฑฐ์ณ ์กฐ์„ ์œผ๋กœ ์žฌ์ˆ˜์ถœ๋˜๋Š” ๋ฉด์ œํ’ˆ์˜ ์œ ํ†ต์„ ์ค‘๊ฐœํ•˜๋ฉด์„œ ์กฐ์ผ๋ฌด์—ญ ํŒฝ์ฐฝ์— ๊ธฐ์—ฌํ•˜์˜€๋‹ค. ๋˜ํ•œ 1890๋…„์—๋Š” ์ธ์ฒœ์— ์ตœ์ดˆ์˜ ์ง€์ ์„ ์ถœ์ ํ•˜๊ธฐ๋„ ํ•˜์˜€๋‹ค. ๊ทธ๋Ÿฐ๋ฐ ์ด ์€ํ–‰์„ ์„ค๋ฆฝํ•œ ๋‚˜๊ฐ€์‚ฌํ‚ค ์ƒ์ธ๋“ค์€ ์—๋„์‹œ๋Œ€ ์กฐ์„ ๊ณผ์˜ ๋ฌด์—ญ์„ ๋…์ ํ•˜์˜€๋˜ ์“ฐ์‹œ๋งˆ ๋ฒˆ๊ณผ์˜ ๋ฐ€์ ‘ํ•œ ๊ด€๊ณ„ ์†์—์„œ ๊ทธ๋“ค์—๊ฒŒ ๋ฌด์—ญ ์ž๊ธˆ์„ ์ œ๊ณตํ•˜๋Š” ๋“ฑ ์ด๋ฏธ ์กฐ์ผ๋ฌด์—ญ์˜ ํ•œ ์ถ•์„ ๋‹ด๋‹นํ•˜๊ณ  ์žˆ์—ˆ๋‹ค. ๋ณธ ๋…ผ๋ฌธ์˜ ๊ณผ์ œ๋Š” ๋‚˜๊ฐ€์‚ฌํ‚ค ์ƒ์ธ๋“ค์ด ์ œ18๊ตญ๋ฆฝ์€ํ–‰์„ ์„ค๋ฆฝํ•˜๊ธฐ๊นŒ์ง€์˜ ๊ฒฝ์œ„์™€ ์กฐ์ผ๋ฌด์—ญ ์ฐธ์—ฌ ๊ณผ์ •์„ ๋ถ„์„ํ•˜์—ฌ ์กฐ์„ ๊ณผ ์ผ๋ณธ์„ ์˜ค๊ฐ€๋ฉฐ ์‹ค์ œ ๊ต์—ญ์„ ์ˆ˜ํ–‰ํ•˜๋Š” ํ–‰์œ„์ž๋กœ์„œ์˜ ์“ฐ์‹œ๋งˆ ์ƒ์ธ๋“ค๊ณผ, ์ˆ˜์ถœํ’ˆ์„ ์กฐ๋‹ฌํ•˜๊ณ  ์ˆ˜์ž…ํ’ˆ์„ ํŒ๋งคํ•  ์‹œ์žฅ์œผ๋กœ์„œ์˜ ๋‚˜๊ฐ€์‚ฌํ‚ค, ๊ทธ๋ฆฌ๊ณ  ์ด๋Ÿฌํ•œ ๋ฌด์—ญ์— ์ž๊ธˆ์„ ์ œ๊ณตํ•˜๋Š” ๋‚˜๊ฐ€์‚ฌํ‚ค ์ƒ์ธ์œผ๋กœ ๊ตฌ์„ฑ๋œ ์กฐ์ผ๋ฌด์—ญ์˜ ๊ตฌ์กฐ๊ฐ€ ์ด๋ฏธ 19์„ธ๊ธฐ ์ดˆ, ์ค‘์—ฝ๋ถ€ํ„ฐ ํ˜•์„ฑ๋˜์–ด ์กฐ์ผ์ˆ˜ํ˜ธ์กฐ๊ทœ ์ฒด๊ฒฐ ์ดํ›„๋กœ ์—ฐ์†๋˜์—ˆ์Œ์„ ์ž…์ฆํ•˜๋Š” ๊ฒƒ์ด๋‹ค. ์ œโ… ์žฅ์—์„œ๋Š” ์—๋„์‹œ๋Œ€ ์กฐ์ผ๋ฌด์—ญ์„ ๋…์ ํ•˜์˜€๋˜ ์“ฐ์‹œ๋งˆ ๋ฒˆ๊ณผ ๋‚˜๊ฐ€์‚ฌํ‚ค ์ƒ์ธ์˜ ๊ด€๊ณ„๋ฅผ ์ค‘์ ์ ์œผ๋กœ ์‚ดํŽด๋ณด์•˜๋‹ค. ์ œ18๊ตญ๋ฆฝ์€ํ–‰ ์„ค๋ฆฝ ๋‹น์‹œ ๊ฐ€์žฅ ๋งŽ์€ ์ž๋ณธ์„ ์ถœ์žํ•œ ๋‚˜๊ฐ€๋ฏธ ๊ฐ€(ๆฐธ่ฆ‹ๅฎถ)๋Š” ์—๋„์‹œ๋Œ€์— ๋‚˜๊ฐ€์‚ฌํ‚ค์˜ ํšŒ์†Œ๋ฌด์—ญ์— ์ฐธ์—ฌํ•  ์ˆ˜ ์žˆ์—ˆ๋˜ ๋ณธ์ƒ์ธ(ๆœฌๅ•†ไบบ) ๊ฐ€๋ฌธ์ด์—ˆ๋‹ค. ์ด๋“ค์€ 1800๋…„๋Œ€ ์ดˆ๋ถ€ํ„ฐ ๋Œ€๋ถ€์—…๊ณผ ๋ฌด์—ญ์—…์œผ๋กœ ์ž๋ณธ์„ ์ถ•์ ํ•˜์˜€๊ณ , 1850๋…„๋Œ€๋ถ€ํ„ฐ๋Š” ๋ฒˆ(่—ฉ)์„ ๋Œ€์ƒ์œผ๋กœ ํ•œ ๋Œ€๋ถ€์—…์ธ ๋‹ค์ด๋ฌ˜๊ฐ€์‹œ(ๅคงๅ่ฒธ)๋ฅผ ์‹œ์ž‘ํ•˜์˜€๋‹ค. ์—๋„์‹œ๋Œ€์— ์กฐ์ผ๋ฌด์—ญ์„ ๋…์ ํ•˜์˜€๋˜ ์“ฐ์‹œ๋งˆ ๋ฒˆ์ด ๋ฐ”๋กœ ๋‚˜๊ฐ€๋ฏธ ๊ฐ€์˜ ์ฃผ์š” ๋Œ€์ถœ ๋Œ€์ƒ ์ค‘ ํ•˜๋‚˜์˜€๋‹ค. ์“ฐ์‹œ๋งˆ ๋ฒˆ์€ ์กฐ์„ ์— ์ˆ˜์ถœํ•  ์ƒํ’ˆ์˜ ์กฐ๋‹ฌ์„ ์œ„ํ•ด์„œ ์„ ๋Œ€(ๅ…ˆ่ฒธ)๋ฅผ ๋ฐ›๋Š” ๋“ฑ ๋ฌด์—ญ์— ํ•„์š”ํ•œ ์ž๋ณธ์„ ๋‚˜๊ฐ€์‚ฌํ‚ค ์ƒ์ธ๋“ค์—๊ฒŒ์„œ ๋นŒ๋ฆฌ๊ณ  ์žˆ๋Š” ๋ชจ์Šต์ด ํ™•์ธ๋œ๋‹ค. ์“ฐ์‹œ๋งˆ ๋ฒˆ์ด ์ด์ฒ˜๋Ÿผ ๋‚˜๊ฐ€์‚ฌํ‚ค์˜ ์ƒ์ธ๋“ค๋กœ๋ถ€ํ„ฐ ์ž๊ธˆ์„ ์กฐ๋‹ฌํ•œ ๋ฐฐ๊ฒฝ์—๋Š”, ์กฐ์„ ์œผ๋กœ ์ˆ˜์ถœํ•  ์ฃผ์š” ์ƒํ’ˆ์ธ ๋‹จ๋ชฉ(ไธนๆœจ), ๋ฌผ์†Œ๋ฟ”[ๆฐด็‰›่ง’], ํ›„์ถ”, ๋ช…๋ฐ˜(ๆ˜Ž็คฌ) ๋“ฑ์˜ ์ƒํ’ˆ์„ ๋‚˜๊ฐ€์‚ฌํ‚ค์—์„œ ๊ตฌ์ž…ํ•˜๊ณ , ์กฐ์„ ์œผ๋กœ๋ถ€ํ„ฐ ์ˆ˜์ž…ํ•œ ํ•ด์‚ฐ๋ฌผ(์ฃผ๋กœ ํ•ด์‚ผ)์„ ์—ญ์‹œ ๋‚˜๊ฐ€์‚ฌํ‚ค๋ฅผ ํ†ตํ•ด ํŒ๋งคํ•˜๋Š” ๋ฌด์—ญ์˜ ๊ตฌ์กฐ๊ฐ€ ์žˆ์—ˆ๊ธฐ ๋•Œ๋ฌธ์ด๋‹ค. 1872๋…„ ์“ฐ์‹œ๋งˆ ๋ฒˆ์˜ ๋ฌด์—ญ์„œ(่ฒฟๆ˜“็ฝฒ)๊ฐ€ ํ•ด์ฒด๋  ๋‹น์‹œ ๋ถ€์ฑ„ 40,696์—” ์ค‘ 21,295์—”(์•ฝ 52.3%)์„ ๋‚˜๊ฐ€์‚ฌํ‚ค์˜ ์ƒ์ธ ๋ฐ ์‚ฌ์กฑ๋“ค์—๊ฒŒ์„œ ๋นŒ๋ฆฌ๊ณ  ์žˆ์—ˆ์Œ์ด ํ™•์ธ๋  ๋งŒํผ, ๋‚˜๊ฐ€์‚ฌํ‚ค ์ƒ์ธ๋“ค์˜ ์ž๋ณธ์€ ์ด๋ฏธ ์กฐ์ผ๋ฌด์—ญ์—์„œ ํฐ ๋น„์ค‘์„ ์ฐจ์ง€ํ•˜๊ณ  ์žˆ์—ˆ๋‹ค. ์ œโ…ก์žฅ์—์„œ๋Š” ์“ฐ์‹œ๋งˆ ๋ฒˆ์˜ ๋…์ ๋ฌด์—ญ์ฒด์ œ๊ฐ€ ํ•ด์ฒด๋˜๋Š” 1872๋…„๋ถ€ํ„ฐ ์กฐ์ผ์ˆ˜ํ˜ธ์กฐ๊ทœ๊ฐ€ ์ฒด๊ฒฐ๋˜๋Š” 1876๋…„๊นŒ์ง€์˜ ๊ณผ๋„๊ธฐ ๋™์•ˆ ์กฐ์„ ๊ณผ ์ผ๋ณธ ๊ฐ„์˜ ๋ฌด์—ญ์ด ์–ด๋–ค ํ–‰์œ„์ž๋“ค์— ์˜ํ•ด์„œ ์–ด๋–ป๊ฒŒ ์ „๊ฐœ๋˜์—ˆ๋Š”์ง€๋ฅผ ์‚ดํŽด๋ณด์•˜๋‹ค. 1859๋…„ ์ดํ›„ ์ผ๋ณธ์˜ ์—ฐ์ด์€ ๊ฐœํ•ญ์œผ๋กœ ๋‚˜๊ฐ€์‚ฌํ‚ค๋Š” ๋…์  ๋ฌด์—ญํ•ญ์œผ๋กœ์„œ์˜ ์œ„์น˜๋ฅผ ์ƒ์‹คํ•˜์˜€์ง€๋งŒ, ๊ธฐํƒ€ ์‚ฐ์—…์  ๊ธฐ๋ฐ˜์ด ์ทจ์•ฝํ•˜์˜€๋˜ ๋‚˜๊ฐ€์‚ฌํ‚ค์—์„œ ๋Œ€์™ธ ๋ฌด์—ญ์€ ์—ฌ์ „ํžˆ ์ง€์—ญ ๊ฒฝ์ œ์˜ ์ค‘์‹ฌ ์‚ฐ์—…์ด์—ˆ๋‹ค. ์ด๋Ÿฌํ•œ ์ง€์—ญ์  ํŠน์„ฑ์„ ๋ฐฐ๊ฒฝ์œผ๋กœ ๋‚˜๊ฐ€์‚ฌํ‚ค์˜ ํšŒ์†Œ๋ฌด์—ญ๊ณผ ๊ณ ๋ฆฌ๋Œ€์—…์œผ๋กœ ์„ฑ์žฅํ•œ ๋‚˜๊ฐ€๋ฏธ ๊ฐ€(ๆฐธ่ฆ‹ๅฎถ) ๋“ฑ์˜ ์ž์‚ฐ๊ฐ€๋“ค์€ ์ ์ฐจ ๋ฌด์—ญ๊ธˆ์œต์— ํŠนํ™”๋œ ๋…๋ฆฝ์  ๊ธˆ์œต๊ธฐ๊ด€์„ ์„ค๋ฆฝํ•˜๊ธฐ ์‹œ์ž‘ํ•œ๋‹ค. 1872๋…„ 1์›” ์„ค๋ฆฝ๋œ ๋‚˜๊ฐ€๋ฏธ๋งˆ์“ฐ๋‹ค์ƒ์‚ฌ(ๆฐธ่ฆ‹ๆพ็”ฐๅ•†็คพ)๋Š” ๋‚˜๊ฐ€์‚ฌํ‚ค ์ƒ์ธ๋“ค์ด ์„ธ์šด ์ตœ์ดˆ์˜ ๋…๋ฆฝ์  ๊ธˆ์œต๊ธฐ๊ด€์œผ๋กœ์„œ์˜ ์˜์˜๋ฅผ ๊ฐ€์ง€๋ฉฐ, ์ด ํšŒ์‚ฌ๋Š” 1872๋…„ ๋ง, ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ์ „์‹ (ๅ‰่บซ)์ด๋ผ๊ณ  ํ•  ์ˆ˜ ์žˆ๋Š” ๋ฆฟ์„ธ์ดํšŒ์‚ฌ(็ซ‹่ช ๆœƒ็คพ)๋ผ๋Š” ์ฃผ์‹ํšŒ์‚ฌ ํ˜•ํƒœ์˜ ๊ธฐ๊ด€์œผ๋กœ ์ „ํ™˜๋œ๋‹ค. ๋ฆฟ์„ธ์ดํšŒ์‚ฌ๋Š” ์˜ˆ๊ธˆ์—…๋ฌด, ์–ด์Œ์ทจ๊ธ‰์€ ๋ฌผ๋ก  ํƒ€ ๊ธˆ์œต๊ธฐ๊ด€๊ณผ์˜ ํ™˜๊ฑฐ๋ž˜์•ฝ์ •์„ ์ฒด๊ฒฐํ•˜๋Š” ๋“ฑ ์€ํ–‰์œผ๋กœ์„œ์˜ ์ฒด์ œ๋ฅผ ์ƒ๋‹นํžˆ ๊ฐ–์ถ”๊ณ  ์žˆ์—ˆ๋‹ค. ํ•œํŽธ ์ด ์‹œ๊ธฐ ์™ธ๋ฌด์„ฑ์˜ ์™ธ๊ต๋ฌธ์„œ์—์„œ ๋‚˜ํƒ€๋‚˜๋Š” ์กฐ์ผ๋ฌด์—ญ์˜ ๋™ํ–ฅ์„ ์‚ดํŽด๋ณด๋ฉด, ์“ฐ์‹œ๋งˆ์˜ ๋ฌด์—ญ์„œ ํ•ด์ฒด ์ดํ›„์—๋„ ์“ฐ์‹œ๋งˆ ์ƒ์ธ๋“ค์€ ์กฐ์„ ๊ณผ ๋ฌด์—ญ์„ ์ง€์†ํ•˜๊ณ  ์žˆ์—ˆ์œผ๋ฉฐ, ์ˆ˜์ถœ์ž…์„ธ๋„ ๋ฉด์ œ๋ฅผ ๋ฐ›๊ณ  ์žˆ์—ˆ๋‹ค. ์“ฐ์‹œ๋งˆ ์ƒ์ธ๋“ค์€ ์กฐ์„ ์—์„œ ์ผ๋ณธ์œผ๋กœ ์†Œ๊ฐ€์ฃฝ, ๋ชฉ๋ฉด(๋ฌด๋ช…), ํ•ด์‚ผ, ๋ฐฑ๋ฏธ, ์ธ์‚ผ ๋“ฑ์„ ์ˆ˜์ž…ํ•˜์˜€๊ณ  ์ผ๋ณธ์—์„œ ์กฐ์„ ์œผ๋กœ๋Š” ๋™(้Š…)๊ณผ ํ•จ๊ป˜ ๋‹น๋ชฉ๋ฉด, ๋น„๋‹จ, ์ฒœ์ถ•๋ชฉ๋ฉด ๋“ฑ ์ฃผ๋กœ ๋‚˜๊ฐ€์‚ฌํ‚ค๋ฅผ ํ†ตํ•ด ์ˆ˜์ž…๋˜๋˜ ์ง๋ฌผ๋ฅ˜๋ฅผ ์ˆ˜์ถœํ•˜์—ฌ ์“ฐ์‹œ๋งˆ ์ƒ์ธ๋“ค์ด ์—ฌ์ „ํžˆ ๋‚˜๊ฐ€์‚ฌํ‚ค์˜ ์ˆ˜์ž…ํ’ˆ์„ ์กฐ์„ ์— ์žฌ์ˆ˜์ถœ ํ•˜๊ณ  ์žˆ์—ˆ์Œ์ด ํ™•์ธ๋œ๋‹ค. ํŠนํžˆ 1880๋…„๋Œ€ ์กฐ์ผ๋ฌด์—ญ์˜ ํŒฝ์ฐฝ์„ ๊ฒฌ์ธํ•œ ์ผ๋ณธ ์ƒ์ธ๋“ค์˜ ๋ฉด์ง๋ฌผ ์ค‘๊ณ„๋ฌด์—ญ์˜ ๋‹จ์ดˆ๊ฐ€ ์ด๋ฏธ ์ด ์‹œ๊ธฐ์— ํ™•์ธ๋œ๋‹ค. ์ด๋Ÿฌํ•œ ๋ฌด์—ญ ๊ตฌ์กฐ๊ฐ€ ์œ ์ง€๋˜๋Š” ๊ฐ€์šด๋ฐ, 1872๋…„ ๋ฌด๋ ต๋ถ€ํ„ฐ ์ƒ์ธ๋“ค์˜ ๋…๋ฆฝ์  ๊ธˆ์œต๊ธฐ๊ด€์ด ํƒœ๋™ํ•œ ๋‚˜๊ฐ€์‚ฌํ‚ค์™€๋Š” ๋‹ฌ๋ฆฌ ์“ฐ์‹œ๋งˆ์—์„œ๋Š” 1879๋…„์—์•ผ ์˜› ์“ฐ์‹œ๋งˆ ๋ฒˆ ์ถœ์‹ ์˜ ์‚ฌ์กฑ๋“ค์„ ์ค‘์‹ฌ์œผ๋กœ ์ตœ์ดˆ์˜ ์€ํ–‰์ด ์„ค๋ฆฝ๋œ๋‹ค. ์ด ์‹œ๊ธฐ ์˜์„ธํ•œ ์“ฐ์‹œ๋งˆ ์ƒ์ธ๋“ค์— ๋Œ€ํ•œ ๋‚˜๊ฐ€์‚ฌํ‚ค ์ž๋ณธ์˜ ์˜ํ–ฅ๋ ฅ์€ ์ฆ๋Œ€ํ•˜์˜€๋‹ค. ์ œโ…ข์žฅ์—์„œ๋Š” ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ์˜์—…๋ณด๊ณ ์„œ์˜ ๋‚ด์šฉ์„ ๋ฐ”ํƒ•์œผ๋กœ ๋‚˜๊ฐ€์‚ฌํ‚ค ์ƒ์ธ๋“ค์ด ์ฃผ์ถ•์ด๋˜์–ด ์„ค๋ฆฝํ•œ ์ œ18๊ตญ๋ฆฝ์€ํ–‰์ด ์กฐ์ผ๋ฌด์—ญ์— ์ฐธ์—ฌํ•˜๋Š” ๊ณผ์ •์„ ์‚ดํŽด๋ณด๊ณ  ์—ฌ๊ธฐ์—์„œ ๋“œ๋Ÿฌ๋‚˜๋Š” ํŠน์ง•์„ ๋ถ„์„ํ•˜์˜€๋‹ค. 1877๋…„ 12์›”, ์ œ18๊ตญ๋ฆฝ์€ํ–‰์ด ๊ฐœ์—…ํ•˜์˜€๋‹ค. ์ด ์€ํ–‰์€ ์ฃผ์ฃผ์˜ 83%๊ฐ€ ํ‰๋ฏผ(๋Œ€๋ถ€๋ถ„ ์ƒ์ธ)์ด๊ณ , ์ด๋“ค์˜ ์ง€๋ถ„์œจ์ด 89%์— ์ด๋ฅด๋Š” ์ƒ์ธ ์€ํ–‰์ด์—ˆ๋‹ค. ์ด ์€ํ–‰์€ ๋‚˜๊ฐ€์‚ฌํ‚ค ํšŒ์†Œ๋ฌด์—ญ๊ณผ ๊ณ ๋ฆฌ๋Œ€์—…์œผ๋กœ ์„ฑ์žฅํ•œ ์ƒ์ธ์ž๋ณธ์ด ๋ฌด์—ญ๊ธˆ์œต์— ํŠนํ™”๋œ ์€ํ–‰์œผ๋กœ ๋ฐœ์ „ํ•œ ์‚ฌ๋ก€๋กœ ํ‰๊ฐ€ํ•  ์ˆ˜ ์žˆ๋‹ค. 1897๋…„ ๊ตญ๋ฆฝ์€ํ–‰์กฐ๋ก€์˜ ํ์ง€ ๋•Œ๊นŒ์ง€ ๋ชจ๋‘ 153๊ฐœ๊ฐ€ ์„ค๋ฆฝ๋œ ๊ตญ๋ฆฝ์€ํ–‰ ์ค‘ ์กฐ์„ ์— ์ง„์ถœํ•œ ๊ตญ๋ฆฝ์€ํ–‰์€ ์ œ1, ์ œ102, ์ œ18, ์ œ58๊ตญ๋ฆฝ์€ํ–‰ ๋“ฑ ๋ชจ๋‘ 4๊ฐœ์˜€๋‹ค. ์ด ์ค‘ ๋„์ฟ„์—์„œ ์„ค๋ฆฝ๋œ ์ œ1๊ตญ๋ฆฝ์€ํ–‰์€ 1878๋…„ ๋ถ€์‚ฐ์— ์ง€์ ์„ ์ถœ์ ํ•˜๋ฉด์„œ ๊ฐ€์žฅ ๋จผ์ € ์กฐ์„ ์— ์ง„์ถœํ•˜์˜€๋‹ค. ์˜› ์“ฐ์‹œ๋งˆ ๋ฒˆ์˜ ์‚ฌ์กฑ ์ถœ์‹ ๋“ค์ด 1879๋…„์— ์„ค๋ฆฝํ•œ ์ œ102๊ตญ๋ฆฝ์€ํ–‰๋„ 1881๋…„์„ ์ „ํ›„ํ•˜์—ฌ ๋ถ€์‚ฐ์— ์ถœ์žฅ์†Œ๋ฅผ ์„ธ์› ๋‹ค. ์ œ18๊ตญ๋ฆฝ์€ํ–‰์€ ์ด ๋‘ ์€ํ–‰์— ๋น„ํ•˜์—ฌ ์กฐ์„  ์ง„์ถœ ์‹œ๊ธฐ๊ฐ€ ๋Šฆ์ง€๋งŒ, ๋จผ์ € ์กฐ์„ ์— ์ง„์ถœํ•œ ๋‘ ์€ํ–‰๊ณผ ํ™˜๊ฑฐ๋ž˜์•ฝ์ •์„ ์ฒด๊ฒฐํ•˜์—ฌ ์กฐ์„  ๋‚ด์— ์ง€์ ์„ ์„ค์น˜ํ•˜์ง€ ์•Š๊ณ ๋„ ๋Œ€ ์กฐ์„  ์˜์—…์„ ์‹œ์ž‘ํ•  ์ˆ˜ ์žˆ์—ˆ๋‹ค. ํŠนํžˆ ์ „ํ†ต์ ์œผ๋กœ ๋ฐ€์ ‘ํ•œ ๊ด€๊ณ„์— ์žˆ๋˜ ์˜› ์“ฐ์‹œ๋งˆ ๋ฒˆ ์ถœ์‹  ์‚ฌ์กฑ๋“ค์ด ์„ธ์šด ์ œ102๊ตญ๋ฆฝ์€ํ–‰์˜ ์ง€์ ์€ ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ์—…๋ฌด๋ฅผ ๋Œ€ํ–‰ํ•˜๊ธฐ๋„ ํ•˜์˜€์œผ๋ฉฐ, ํ–ฅํ›„ ์ œ18๊ตญ๋ฆฝ์€ํ–‰ ์กฐ์„  ์ง„์ถœ์˜ ๊ต๋‘๋ณด๊ฐ€ ๋˜์—ˆ๋‹ค. 1877~1887๋…„๊นŒ์ง€ ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ์˜์—…๋ณด๊ณ ์„œ๋ฅผ ์‚ดํŽด๋ณด๋ฉด, ํ™”ํ™˜์–ด์Œ ์ทจ๊ธ‰์€ ๋™ ๊ธฐ๊ฐ„ 50๋ฐฐ ์ด์ƒ ํŒฝ์ฐฝํ•˜์˜€๋‹ค. ํŠนํžˆ ์กฐ์„ ๊ณผ์˜ ๊ฑฐ๋ž˜ ๋น„์ค‘์€ ํƒ€ ์ง€์—ญ์„ ์••๋„ํ•˜์˜€๋‹ค. ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ๋Œ€ ์กฐ์„  ๊ฑฐ๋ž˜๋Ÿ‰์˜ ๊ธ‰๊ฒฉํ•œ ์ฆ๊ฐ€๋ฅผ ๊ฒฌ์ธํ•œ ๊ฒƒ์€ ์ค‘๊ตญ์œผ๋กœ๋ถ€ํ„ฐ ๋“ค์–ด์˜จ ๊ธˆ๊ฑด(้‡‘ๅทพ), ํ•œ๋žญ์‚ฌ(ๅฏ’ๅ†ท็ด—) ๋“ฑ ๋ฉด์ œํ’ˆ์„ ์กฐ์„ ์— ์žฌ์ˆ˜์ถœํ•˜๊ณ , ์กฐ์„ ์œผ๋กœ๋ถ€ํ„ฐ ์ˆ˜์ž…ํ•œ ๋ฌผ๊ฑด์„ ์ผ๋ณธ ๊ตญ๋‚ด์— ์œ ํ†ตํ•˜๋Š” ํ˜•ํƒœ์˜ ์ค‘๊ณ„๋ฌด์—ญ์ด์—ˆ๋‹ค. 1880~1890๋…„๋Œ€ ์ดˆ๋ฐ˜๊นŒ์ง€๋Š” ์ƒํ•˜์ด์—์„œ ๋‚˜๊ฐ€์‚ฌํ‚ค๋กœ ์ˆ˜์ž…๋˜๋Š” ๊ธˆ๊ฑด์˜ 99%๊ฐ€ ์กฐ์„ ์œผ๋กœ ์žฌ์ˆ˜์ถœ๋˜์–ด, ๋‚˜๊ฐ€์‚ฌํ‚ค๋ฅผ ๊ฒฝ์œ ํ•˜์—ฌ ๋ถ€์‚ฐ์œผ๋กœ ์—ฐ๊ฒฐ๋˜๋Š” ์ด๋ฅธ๋ฐ” ์ƒํ•˜์ด ๋„คํŠธ์›Œํฌ์˜ ๋‚˜๊ฐ€์‚ฌํ‚ค-์กฐ์„  ๊ตฌ๊ฐ„์ด ์ตœ๋Œ€๋กœ ๊ธฐ๋Šฅํ•˜๋Š” ๋•Œ์˜€๋‹ค. ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ๊ฒฝ์˜ํ™œ๋™์€ ์ค‘๊ณ„๋ฌด์—ญ์ด๋ผ๋Š” ์‚ฐ์—…์— ํŠนํ™”๋˜์–ด ์žˆ๋˜ ๋‚˜๊ฐ€์‚ฌํ‚ค์™€ ๊ทธ๋Ÿฌํ•œ ์—ฌ๊ฑด ์†์—์„œ ๋ฌด์—ญ์—…๊ณผ ๊ณ ๋ฆฌ๋Œ€์—…์œผ๋กœ ์ž๋ณธ์„ ์ถ•์ ํ•œ ๋‚˜๊ฐ€์‚ฌํ‚ค ์ƒ์ธ๋“ค, ๊ทธ๋ฆฌ๊ณ  ์ด๋“ค๊ณผ ์กฐ์ผ๋ฌด์—ญ์— ์ข…์‚ฌํ•˜๋˜ ์“ฐ์‹œ๋งˆ ์ƒ์ธ๋“ค๊ณผ์˜ ๊ด€๊ณ„๊ฐ€ 19์„ธ๊ธฐ ํ›„๋ฐ˜์— ๊ตญ์ œ์ ์ธ ๋ฌด์—ญ ๋„คํŠธ์›Œํฌ์˜ ์ผ๋‹จ(ไธ€็ซฏ)์œผ๋กœ ์—ฐ์†๋˜์–ด 1880๋…„๋Œ€ ์ค‘๊ตญ, ์ผ๋ณธ, ์กฐ์„  ๊ฐ„์˜ ๋ฌด์—ญ ๊ทœ๋ชจ๋ฅผ ์‹ ์žฅ์‹œํ‚ค๋Š” ๊ธฐ๋Šฅ์„ ํ•˜์˜€์Œ์„ ์ฆ๋ช…ํ•œ๋‹ค.โ… . ์“ฐ์‹œ๋งˆ ๋ฒˆ์˜ ์กฐ์ผ๋ฌด์—ญ๊ณผ ๋‚˜๊ฐ€์‚ฌํ‚ค ์ƒ์ธ์˜ ๊ด€๊ณ„ 7 1. ๋‚˜๊ฐ€์‚ฌํ‚ค์˜ ํšŒ์†Œ๋ฌด์—ญ(ๆœƒๆ‰€่ฒฟๆ˜“)๊ณผ ์ƒ์ธ์ž๋ณธ์˜ ์„ฑ์žฅ 7 2. ๋‚˜๊ฐ€๋ฏธ ๊ฐ€(ๆฐธ่ฆ‹ๅฎถ)์˜ ๋‹ค์ด๋ฌ˜๊ฐ€์‹œ(ๅคงๅ่ฒธ)์™€ ์“ฐ์‹œ๋งˆ ๋ฒˆ 12 โ…ก. ๋‚˜๊ฐ€์‚ฌํ‚ค ์ง€์—ญ๊ธˆ์œต๊ธฐ๊ด€์˜ ํƒœ๋™๊ณผ ์กฐ์ผ๋ฌด์—ญ 26 1. ์ƒ์ธ์ž๋ณธ์— ์˜ํ•œ ๊ธˆ์œต๊ธฐ๊ด€์˜ ํƒœ๋™ 26 2. 1872๋…„~1876๋…„์˜ ์กฐ์ผ๋ฌด์—ญ๊ณผ ๋‚˜๊ฐ€์‚ฌํ‚ค์˜ ์ž๋ณธ 29 โ…ข. ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ์„ค๋ฆฝ๊ณผ ์กฐ์ผ๋ฌด์—ญ 40 1. ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ์„ค๋ฆฝ ๋ฐฐ๊ฒฝ๊ณผ ๊ทธ ํŠน์ง• 41 2. ์กฐ์„ ์— ์ง„์ถœํ•œ ๊ตญ๋ฆฝ์€ํ–‰ 46 3. ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ์กฐ์ผ๋ฌด์—ญ ์ฐธ์—ฌ ๊ณผ์ •๊ณผ ๊ทธ ํŠน์ง• 52 4. ์ œ18๊ตญ๋ฆฝ์€ํ–‰์˜ ๋ฌด์—ญ๊ธˆ์œต๊ณผ ์ƒํ•˜์ด ๋„คํŠธ์›Œํฌ 74 ๋งบ์Œ๋ง 79 ์ฐธ๊ณ ๋ฌธํ—Œ ๋ชฉ๋ก 82 ๆ—ฅๆ–‡่ฆๆ—จ 88Maste

    Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

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    AimsTo investigate the effect of intravitreal dexamethasone implant (IVD) on central foveal thickness (CFT), choroidal thickness (CT) and its correlation with visual acuity in eyes with refractory diabetic macular oedema (DMO).MethodsThis was a retrospective interventional case-series. Thirty-five eyes of 35 patients were treated with a single injection of IVD because of refractory DMO with CFT over 300?ฮผm, and persistent intraretinal and subretinal fluid despite of multiple intravitreal bevacizumab injections. Patients were followed-up for 6 months for the evaluation of CFT and subfoveal CT by spectral-domain optical coherence tomography.ResultsAll eyes (mean age: 59.4ยฑ12.35 years; 18 males, 17 females) had been previously treated with multiple bevacizumab injections and showed persistent DMO (mean number of injections 4.08ยฑ2.98) The preoperative logMAR BCVA was 0.49ยฑ0.24, which gradually improved to 0.46ยฑ0.32 at 6 months (P=0.652) and 26% gained two or more lines of Snellen visual acuity. At baseline, the mean CFT was 526.29ยฑ123.48?ฮผm, which significantly improved to 316.15ยฑ100.09?ฮผm at 3 months (P<0.001). However, CFT deteriorated to 457.07ยฑ136.53?ฮผm at 6 months (P=0.051). Similarly, the mean preoperative subfoveal CT was 288.91ยฑ36.47?ฮผm and it decreased to 266.85ยฑ30.93?ฮผm at 3 months (P<0.01), but increased to 278.63ยฑ32.55?ฮผm at 6 months (P=0.137). The reduction of CFT from baseline showed significant correlation with that of subfoveal CT at 3 months (P=0.041) and at 6 months (P=0.008).ConclusionsIn DMO refractory to multiple bevacizumab injections, IVD significantly reduced CFT and subfoveal CT, with BCVA improvement in one-fourth of the patients. The reduction of CFT showed significant correlation with reduction of subfoveal CT.ope

    A Rare Case of Breast Cancer Metastasis to the Optic Nerve Head

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    Purpose To report a case of metastatic breast cancer to the optic nerve with a favorable response to an increased dose of intravitreal bevacizumab injection. Case summary A 60-year-old female presented to our clinic with blurred vision in her left eye for 3 weeks. The patient had a history of intraductal breast cancer carcinoma, metastasized to the mediastinum lymph nodes, liver, and bone and had received palliative chemotherapy and radiotherapy for 16 months. At her first presentation, best-corrected visual acuity of the left eye was 20/50 and the intraocular pressure was 11 mmHg. A yellowish elevated mass with hemorrhage at the optic disc with peripapillary swelling was observed in the left eye. Fluid at the subperipapillary and subfoveal areas and choroidal thickening with folds were observed with optic coherence tomography. The patient was diagnosed as having breast cancer metastasis to the optic nerve head. Three monthly intravitreal bevacizumab injections (0.05 mL, 1.25 mg) were administered, but showed limited effect. Two more intravitreal bevacizumab injections having twice the concentration of the previous dose (0.1 mL, 2.50 mg) were given. Tumor infiltration of the optic nerve head decreased, and serous retinal detachment subsided. No malignant cancer cells were detected in the anterior chamber. Conclusions We report a rare case of breast cancer metastasis to the optic nerve. Administering intravitreal bevacizumab injections with twice the dosage concentration could be an alternative treatment option, to alleviate exudative retinal detachment associated with metastatic tumor progression to the optic nerve head.ope
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