Case of Epithelial Ingrowth After Cataract Surgery Treated with Argon Laser and Monitored by Fourier Domain Optical Coherence Tomography Jin Pyo Hong,MD1, Jae Lim Chung,MD1, Jung Won Park,MD2, Tae-im Kim,MD,PhD1, Kyoung Yul Seo,MD,PhD1, Eung Kweon Kim,MD,PhD1 연세대 안과 홍진표 입니다. 저희는 이번에 두가지 다른방식의 오씨티, 즉 시간도메인과 푸리에도메인 방식의 오씨티를 가지고 중심각막두께를 측정하고 그 차이를 비교해 보았습니다. 1Department of Ophthalmology, Yonsei University, College of Medicine, Seoul, Korea 2Daegu Yonsei Eye Clinic, Daegu, Korea Authors have no financial interest

Purpose To report the development of epithelial ingrowth after cataract surgery with simultaneous removal of persistent pupillary membrane and effectiveness of argon laser as treatment modality, RTVue-100® (Fourier domain optical coherence tomography) as monitoring tool. 중심각막의 두께를 정확히 알아야 되는 경우는 여러가지가 있는데 특히 굴절교정수술의 술전 검사, 각막질환의 평가, 정확한 안압의 측정 및 고안압증의 환자가 녹내장으로 진행할 가능성의 평가 등에서 중요하다고 하겠습니다.

Methods 54 year old female came to our clinic for decreased visual acutiy Examinations 20/200(OD), 20/400(OS) for uncorrected visual acuity (UCVA) 20/25(OD), 20/50(OS) for best corrected visual acuity (BCVA) Intraocular pressure(IOP) 13mmHg(OD), 14mmHg (OS) Slit lamp microcopy Persistent pupillary membrane with moderate cataract(OU) 오씨티는 비접촉 영상기구로 로우 코리어런스 인터페로메트리의 원리로 비침습성 고해상도의 이미지 측정장비이며 크게 타임도메인과 푸리에도메인 방식으로 나눌수 있겠습니다.

Methods Surgery of left eye Postoperative 1 day Postoperative 3 month Persistent pupillary membrane was removed with Banna scissors and Healon after 3mm temporal incision. Extraction of cataract was followed through 3mm incision. Postoperative 1 day 20/200(OS) for UCVA, 14 mmHg (OS) for IOP Ciprofloxacin and prednisolone 1% were used. Postoperative 3 month 0.8(OS) for BCVA, 20 mmHg(OS) for IOP 건강한 젋은 성인, 즉 저희 안과 전공의 20명 40안을 대상으로 각막질환 및 수술의 병력이 없는 눈을 대상으로 검사하였습니다.

Methods Postoperative 3 month IOP was increased to 56 mmHg (OS) Iris bombe and angle closure were found After peripheral iridectomy, IOP was decreased to 7 mmHg (OS) Even after first iridectomy, because the angle closure and high IOP was repeatedly observed, total 4 more iridectomies had been performed.

Methods Postoperative 8 month IOP was increased to 64 mmHg (OS), UCVA was less than 20/400 Epithelial ingrowth was observed at whole iris surface(arrows) and easily diagnosed with RTVue-100, Fourier domain OCT.

Methods Postoperative 8 month RTVue-100, Fourier domain OCT was performed Normal iris surface with hyperreflection(long arrow) Fibrotic membrane overlying the iris surface with less reflective than iris surface (short arrow)

Results After applying argon laser on the epithelial ingrowth to find size of epithelial ingrowth, fibrotic membrane was turned to white fluffy opaque appearance

Results After applying 4 more argon laser on the epithelial ingrowth, the regression of fibrotic membrane was found After 2 more argon laser treatment After 4 more argon laser treatment Fibrotic membrane was found to be seperated from iris surface(arrows)

Results After a few more argon laser treatment, the clearance of fibrotic membrane was found. No complications was reported during argon laser treatments, recurrence have not been found hereafter UCVA was increased to 20/40

Conclusion We inferred that Release of proinflammatory factors into anterior chamber from incised iris Epithelial ingrowth might be developed more easily by this factors RTVue-100® (Fourier domain optical coherence tomography) A good tool for diagnosis and monitoring for epithelial ingrowth Especially in case of ambiguous epithelial ingrowth Argon laser photocogluation Effective modality as not only to detect but also to treat the epithelial ingrowth in this case 결국 알티뷰와 비잔테 모두 리피티빌리티와 리프로듀서빌리티가 높았으며 울트라 소노의 값과 높은 상과관계를 보이고 있었습니다. 특히 알티뷰가 비잔테보다 리피니빌리티와 리프로듀서블한 것으로 나타났으며