蕭裕泉醫師眼科筆記

by Meenakashi Gupta, M.D.,  Jessica Rankin, M.D., Athanasios Papakostas, M.D., Justin Kanoff, M.D., Laurence Rand, M.D., John Lowenstein, M.D. Residency program director, Massachusetts Eye and Ear Infirmary This month I asked the residents of the Massachusetts Eye and Ear Infirmary to review this interesting article on phaco in diabetic patients from the November issue of the Journal of Cataract and Refractive Surgery (see abstract on page 33.) — David F. Chang, M.D., chief medical editor I n their article published this month, "Phacoemulsification cataract surgery in a large cohort of diabetes patients" Ostri et al. evaluated cataract surgery outcomes among diabetic patients using data from the Danish National Patient Registry. The authors conducted a retrospective cohort study to assess changes in visual acuity and degree of diabetic retinopathy in 285 type 1 and 2 diabetic patients who underwent cataract surgery from 1999 to 2008. Best corrected vis...

Cataract tips from the teachers What is the best way to practice a continuous curvilinear capsulorhexis? Sherleen Chen, M.D. Instructor in ophthalmology Harvard Medical School Director of Cataract and Comprehensive Ophthalmology Massachusetts Eye and Ear Infirmary Roberto Pineda, M.D. Assistant professor of ophthalmology Harvard Medical School Director of Refractive Surgery Massachusetts Eye and Ear Infirmary What is the best way to practice a continuous curvilinear capsulorhexis? Perhaps one of the most challenging and anxiety-provoking steps for beginning cataract surgeons is learning how to proficiently and consistently perform the capsulorhexis. From initiating the capsulorhexis, to controlling the tear, its size, to successful completion, the capsulorhexis is composed of many separate components. Our instructors share their experience on how to perform and, more importantly, practice this essential part of phacoemulsification. Sherleen Chen, M.D., and Roberto Pine...

Uncovering the mystery of negative dysphotopsia by Faith A. Hayden EyeWorld Staff Writer What we know, what we don't know, and what we can do about it   It's always concerning to hear surgeons say, "I don't know; it's a mystery," when speaking about a medical phenomenon. Physicians live and breathe facts and data on who develops a condition and why and what can be done to treat it. But with negative dysphotopsia, the answers to many of those questions are puzzling. "We don't really know what it is, and we don't understand it very well," said James Davison, M.D., cataract and refractive specialist, Wolfe Eye Clinic, which has locations throughout Iowa. "It only seems to happen in people who have perfect surgery. Everything else looks absolutely perfect and then they have this difficulty." This difficulty, or negative dysphotopsia (ND), comes in the form of a black line, a parenthesis out of the patient's peripheral v...

Complicated cataract cases Cornea editor's corner of the world Pterygium surgery trends and pearls by Vanessa Caceres EyeWorld Contributing Editor Pterygium is a common problem that, if managed incorrectly, can lead to a more significant clinical condition post-op. A recurrent pterygium is a different disease than a primary pterygium. Recurrences are more inflamed, progress more rapidly, lead to more conjunctival scarring, are more difficult to surgically remove, and are more likely to lead to loss of vision. Therefore surgeons need to use an operative technique that first and foremost reduces the recurrence rate and leads to the best outcome. Clinical trials have definitively shown that the bare sclera technique has a very high recurrence rate (25-90%) and should never be used as the sole procedure. Excision with some adjunct therapy is the treatment of choice. Surgeons have many options available to them and have to make surgical decisions that they feel are the correc...