蕭裕泉醫師眼科筆記

Ocular allergies Calming allergic conjunctivitis by Faith A. Hayden EyeWorld Staff Writer     A patient with SAC Source: Ira J. Udell, M.D. April showers bring May flowers and endless misery to those suffering from seasonal and perennial conjunctivitis caused by pollen, mold, and grasses. 'Tis the season for red, itchy eyes, so EyeWorld spoke with two experts about diagnosing and treating patients with these ocular issues. Seasonal or perennial? The differences between seasonal and perennial allergies are limited, said Leonard Bielory, M.D., Springfield, N.J. Other than their frequency, primary differences are severity of symptoms and root cause. Seasonal allergies occur during the spring and fall months and are typically caused by pollen, grass, and ragweed. The intensity of seasonal allergic conjunctivitis (SAC) can be explosive for a number of weeks, depending on the level of exposure to the specific allergen circulating. "Tree pollen counts can go u...

Corneal diagnoses and systemic disease Ophthalmologists can diagnose deadly disease at slit lamp by Jena Passut EyeWorld Staff Writer A patient with Fabry's disease and a characteristic cornea verticillata Amiodarone deposition in the cornea Source (all): W. Barry Lee, M.D. Fabry's disease presents with corneal verticillata Imagine looking into the slit lamp and seeing something that, without a doubt, tells you the patient sitting there is suffering from a debilitating disease that will kill him. Now, imagine he has no idea. The patient has several seemingly unrelated symptoms, including a strange skin rash, nausea, unexplained pain, and hypertension. When an ophthalmologist spots a characteristic cornea verticillata, the patient most likely is suffering from Fabry's disease, also known as Anderson-Fabry disease, angiokeratoma corporis diffusum, and alpha-galactosidase A deficiency. Fabry's disease patients lack an enzyme called alpha galac...

Corneal diagnoses and systemic disease Mooren's ulcer vs. PUK: The difference can mean life or death by Enette Ngoei EyeWorld Contributing Editor An example of Mooren's ulcer PUK with scleritis in a patient with RA Source (all): Virender S. Sangwan, M.D. Telling the difference between Mooren's ulcer and early signs of something deadly While Mooren's ulcer is by definition not associated with any systemic autoimmune disorder, it can be confused with corneal ulcers that are early warning signs of life-threatening diseases, said C. Stephen Foster, M.D., founder and president, Massachusetts Eye Research and Surgery Institute, Cambridge, and clinical professor of ophthalmology, Harvard Medical School, Boston. Therefore, the general ophthalmologist ought to hear alarm bells ring if the peripheral corneal disease has the following characteristics: It is a real ulcer, that is, the epithelium is not intact, there is some loss of stroma, it is a rea...

Corneal diagnoses and systemic disease PUK and systemic autoimmune disease by Michelle Dalton EyeWorld Contributing Editor   PUK is clearly identifiable in this patient Source: Sophie X. Deng, M.D. An example of marginal (limbal) herpes simplex keratitis (mimicking PUK) Source: Vincent P. de Luise, M.D. Mooren's ulcer caused this patient's PUK Source: Vincent P. de Luise, M.D. Usually considered an ocular manifestation of a systemic autoimmune disorder, peripheral ulcerative keratitis can result in devastating outcomes—including permanent loss of vision Peripheral ulcerative keratitis (PUK) is typically associated with poorly managed systemic conditions such as rheumatoid arthritis (RA accounts for almost one-third of non-infectious PUK), among others. What can cause it? "VAST CRIMES," said Vincent P. de Luise, M.D., assistant clinical professor of ophthalmology, Yale University School of Medicine, New Haven, Conn. PUK can be caused by ...

Linking keratoconus and floppy eyelid syndrome to sleep apnea by Faith A. Hayden EyeWorld Staff Writer An example of FES Source: Francis S. Mah, M.D. A patient with keratoconus Source: Uday Devgan, M.D. Does your patient need a sleep study? Has a patient ever nodded off in the exam chair or perhaps mentioned problems sleeping? Does that patient have keratoconus or floppy eyelid syndrome (FES)? If so, pay attention. Keratoconus and FES are linked to sleep apnea, a dangerous sleep disorder characterized by breaks in breathing that's associated with heart disease, stroke, hypertension, atrial fibrillation, congestive heart failure, and other deadly vascular diseases. Keratoconus, FES, and sleep apnea exist independently of each other. For example, many keratoconus patients don't have sleep apnea, and many sleep apnea patients don't have keratoconus. But it's not unusual to find a keratoconus or FES patient with sleep apnea. What are the signs and sympt...

Going around the capsular block in femtosecond cataract surgery by Maxine Lipner Senior EyeWorld Contributing Editor An example of posterior capsule rupture Source: David Allen, F.R.C.Ophth. Understanding how the laser cataract environment differs from the traditional It happened without warning—two cases of the very rare capsular block syndrome occurring among the first 50 femtosecond laser-assisted cataract surgeries performed at an Australian center, according to Tim V. Roberts, M.D., consultant ophthalmic surgeon, Vision Eye Institute and Royal North Shore Hospital, Sydney. "We were doing phaco the same way that we [typically] had," Dr. Roberts said. The practitioners, who had only just begun to adapt to the femtosecond-assisted procedure, immediately stopped to take a closer at what was occurring. After uneventful combined laser fragmentation, capsulotomy, and corneal incision procedures, things had suddenly gone awry in both cases, resulting in pos...

Negative still rules by Enette Ngoei EyeWorld Contributing Editor The Tecnis aspheric lens Source: Abbott Medical Optics The AcrySof aspheric lens Source: Alcon The ReSTOR lens Source: Alcon Aspheric IOLs remain popular choice among physicians Despite the loss of the NTIOL (new technology IOL) Medicare reimbursement, negative aspheric IOLs are still a valuable offering in refractive cataract practices. "I think it became the conventional wisdom at a certain point that aspheric lenses are superior, you get better image quality and better patient satisfaction, so especially for multifocal lenses, I think they made a huge improvement in results with the ReSTOR [Alcon, Fort Worth, Texas] in particular," said Mark Packer, M.D., clinical associate professor of ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland. He continued: "I think the market stayed there, but the prices fell in response to the loss of the new tec...

"Inside-out" approach to posterior polar cataracts by Abhay R. Vasavada, M.S., F.R.C.S., and Shetal M. Raj, M.S. Although most posterior polar cataracts tend to be on the softer side at the time of their removal, they can still be some of the more complex cataract extractions. The thinned and weakened posterior capsule has been reported to rupture in 26-36% of these cases. Certain precautions can be taken such as avoiding downward pressure on the capsule, avoiding hydrodissection, avoiding excessive rotation of the endonucleus, and working within the safety of an epinuclear shell. In this month's column, one of the world's most experienced surgeons, Abhay Vasavada, M.S., F.R.C.S., gives tips and pearls for dealing with the posterior polar cataract. His inside-out hydrodelineation technique is a useful method for insuring safe creation of an epinuclear shell while placing minimal stress on the posterior capsule. His step-by-step instructions should help us...

AOC 20120624 在Taipei W Hotel Acry-sof IQ ReSTOR multifocal TORIC IOL 有 10% 的人散光＞ -2.0 裝多焦點人工水晶體注意 -3.0 的病人 注意散光是 Regular or irregular? Topography 每個病人都要做，再做 A –scan 前 , 而且要趁角膜很好的時候先做。 如果 Topography 與電腦驗光 K readings 不合？是不規則？ tear film ？ corneal   scar ？。 就不放 toric IOL 了！ 裝 Restor IOL 有 65% 有 glare or halo vision ，但 65% 沒關係 IQ 遠 100 ，中 0 近 0 Restor IOL 遠 80 ，中 8o 近 8O ， biIateral 植入會更佳 NTG, 的 risk factor:female,migraine headache, disc hemorrhage Set target pressure: 也要考慮角膜厚度！ 用薬：用效果好的，注意： CME ， uveitis ， herpes ， sulfa drug 過敏 Dry eye : 注意 meibomian gland 的功能 多焦 CL ：看遠可以，光線要良好 ，或只有單眼開白內障。 dominant 看遠， non-dominant 看近 提醒病人是多看到了什麼，而不是看不到什麼。 tear film breakup time 対乾眼症的診斷比Schirmer test較準，視力會 fluctuation也是乾眼症的症狀