蕭裕泉醫師眼科筆記

Patient satisfaction is a two-way street by Rich Daly EyeWorld Contributing Editor Many of today's ophthalmologists want patients to perceive their practice as "premium." What is a premium practice? The surgeon and patient may view this differently. The surgeon may feel offering the latest technology and perhaps having a nice office surrounding embraces the concept of a "premium practice." Patients may have an entirely different idea. To a patient, a premium practice might mean being seen on time for a scheduled appointment. It might mean the staff and physicians are completely in tune with each other, with uncanny communication. More than likely, expectations for visual outcomes are going to be high, perhaps too high. The art of medicine is to provide the customer service a patient expects, diagnose and treat each clinical issue correctly, and take the time to answer all of the patients' questions. It's equally important to provide all of the

Complicated cataract cases Vitrectomy prior to cataract removal for the "crowded anterior segment" by Samuel Masket, M.D., Basak Bostanci Ceran, M.D., and Nicole R. Fram, M.D. E yes with very shallow anterior chambers come along every now and then. Most are anatomically small in the anteroposterior dimension and carry hyperopic refractive errors. The central anterior chambers of these eyes may be only a few corneal thicknesses deep, and their irises may be in apposition to the peripheral posterior cornea. Often they have had a peripheral iridectomy already because they are anatomically predisposed to phakic pupillary block and angle closure glaucoma. Despite these obstacles, most of these eyes can undergo fairly routine cataract surgery with a few extra considerations—a little pre-op digital massage, the administration of a hyperosmotic agent, a carefully constructed cataract incision that prevents iris prolapse, and the judicious use of a highly retentive OVD. Ever

1.高度近視-8.0以上，cupping larger and 拉長 2.Disc hemorrhage:有青光眼的要懷疑進行，沒青光眼要懷疑青光眼。 3.也可以斜斜的cupping 4.青光眼的惡化進行跟ocular circulation 及含氧量有關，以後可能會有doppler儀器。 5.Red-free photo:RNFL看起來是 白-黑@-白 6.RNFL 的loss比VF loss早出現 7.SITA:可以大幅減少VF做的時間，選30,24度，end-stage用10。才不會黑媽媽一片。 8.眼鏡鏡框的Rim effect:黑圈不是從blind spot發出 9.如果眼壓不高且VF正常，只是disc或RNFL不正常，是不需要治療的。