蕭裕泉醫師眼科筆記

August 2010‧EyeWorld Challenging refractive cases Pharmaceutical corner Balancing risks and benefits   by Vanessa Caceres EyeWorld Contributing Editor Treating pregnant patients not an easy task Managing ophthalmic medications in pregnant patients is a challenging team effort between ophthalmologists and OB/GYNs, said Louis B. Cantor, M.D., Jay C. and Lucile L. Kahn Professor of Glaucoma Research and Education and vice chairman, Education, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis. "It's important to make decisions with the patient and their obstetrician," Dr. Cantor said. Most specialists are vigilant about contacting patients' obstetricians as they want to protect the health of the mother and unborn baby and avoid dangerous side effects, said Jennifer R. Niebyl, M.D., professor and Residency Program Director, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa Cit

August 2010‧EyeWorld Challenging refractive cases Dodgy DLK diagnosis by Maxine Lipner Senior EyeWorld Contributing Editor                                                        Eye with diffuse interface fluid syndrome Source: Richard L. Lindstrom, M.D. It must have seemed like an easy diagnosis, a no-brainer even. Following bilateral LASIK for high myopia, a 31-year-old man returned a few days later complaining of blurry vision with his eyes showing mild irritation. Initially the patient had acuity of 20/30 in both eyes, with an intraocular pressure of 18mmHg. The surgeon here concluded that this was yet another case of DLK and treated the patient with intense steroids, placing him initially on 1 percent prednisolone acetate to be taken every two hours. At the 3-week post-op mark, however, no improvement was seen in the DLK appearance. The patient's vision was not checked, but his pressure had climbed to 23 mmHg in both eyes. His physician

 August 2010‧EyeWorld Challenging refractive cases A case of isolated epithelial ingrowth nests? by Michelle Dalton EyeWorld Contributing Editor Frustration mounts as a recurrent epithelial ingrowth is evasive to treat    It all seems to go according to plan—the patient is evaluated for LASIK, is determined to be a good candidate, the surgery scheduled, the microkeratome-created flap and subsequent laser correction are completely uneventful, immediate post-op indicates this is yet another successful surgery. But then the woman returns a couple of months later with an epithelial ingrowth. Instinct tells the surgeon to lift and scrape and that will be that. About 6 weeks later, however, the woman returns with an epithelial ingrowth in just about the same spot as the original. Again, the surgeon presumes he might have missed a cell or two the first time, so he lifts, scrapes, replaces one more time. He notes the epithelial cells seem to be very central, with no visible trail. Yet w

 August 2010‧EyeWorld What shallow really means by Matt Young EyeWorld Contributing Editor T raditionally, factors such as high ultrasound energy, advanced age, and high nucleus grade have increased the risk for endothelial cell loss, but researchers may have hit on something a little different.    A shallow anterior chamber has not been associated with endothelial cell loss, according to some research, but now ophthalmologists have found that shallow anterior chamber depth (ACD) combined with certain surgical scenarios, like a long corneal tunnel, could indeed increase one's risk for endothelial cell loss.  " shallow ACD leads to phacoemulsification being performed closer to the endothelium and may therefore be associated with an increased risk of endothelial cell loss," according to study co-author Man Soo Kim, M.D. , Ph.D., Department of Ophthalmology, Catholic University of Korea, Seoul St. Mary Hospital, Seoul, Korea. The study was published online in February