蕭裕泉醫師眼科筆記

Refractive challenges and innovations A toric challenge: Surgeons review a complicated case -------------------------------------------------------------------------------- by Jena Passut EyeWorld Editor Figure 1 Figure 2 From selection to insertion, toric lenses may present challenges to the best of surgeons. EyeWorld presented a complicated toric case from Kerry D. Solomon, M.D., EyeWorld refractive editor, and director, Carolina Eyecare Research Institute, Carolina Eyecare Physicians, Charleston, S.C., and asked surgeons to comment on how they would handle it. A 77-year-old man complained of worsening vision, trouble with glare and haloes, and difficulty driving at night after having toric lenses implanted. Pre-op, his manifest refraction (MRx) was –0.50 +0.50 x 15 in the right eye and –2.00 +2.00 x 165 in the left. Slit lamp evaluation on both eyes was given a score of 2+ with nuclear sclerotic and cortical changes. Corneal topog...

Glaucoma editor's corner of the worldGlaucoma on the cutting edge -------------------------------------------------------------------------------- by Maxine Lipner Senior EyeWorld Contributing Writer The much-anticipated revolution in glaucoma surgery may have finally arrived with the recent FDA approval of the iStent—the first available trabecular bypass device. Other new devices—the Hydrus and the CyPass—are in FDA trials and may be up for approval in the near future. These new glaucoma implants may lower IOP and reduce the burden of medical therapy through procedures that are much faster and safer than trabeculectomies or tube shunts. But with new technology comes the need for new terminology. Filling this void is MIGS—micro-invasive glaucoma surgery. This term was developed by Ike Ahmed, M.D.—the surgeon with perhaps the most experience with all the MIGS procedures. But this has become a controversial area as many other procedures and devices seek to claim MI...

Complicated cataract cases Cataract surgery in patients with Fuchs' dystrophy -------------------------------------------------------------------------------- by Brian Alder, M.D., and Terry Kim, M.D. Fuchs' dystrophy is the most common endothelial dystrophy affecting human corneas. Cataract is the most common ailment affecting the eye of older adults. The intersection of these two problems in the same eye is not uncommon. Many patients with cataract have mild to moderate guttata and stromal thickening at the time of cataract evaluation. In many cases it is not clear whether cataract or Fuchs' dystrophy contributes more to the decline in vision. Clinical judgment and experience are necessary to distinguish between the contributions. Sometimes it isn't known until after surgical intervention. In recent years, endothelial keratoplasty (DSAEK, DSEK, DMEK) replaced penetrating keratoplasty as the most common surgical procedure for treating adva...

Review of "Effects of tamsulosin and silodosin on isolated albino and pigmented rabbit iris dilators: Possible mechanism of intraoperative floppy-iris syndrome" -------------------------------------------------------------------------------- by Daniel L. Chao, M.D., Yasha S. Modi, M.D., Bradford Lee, M.D., Jayanth Sridhar, M.D., Ajay E. Kuriyan M.D., and Steven J. Gedde, M.D., Bascom Palmer Eye Institute, Miami, Fla. Steven J. Gedde, M.D. This month, an important paper on the mechanism of IFIS appears in JCRS. I invited the Bascom Palmer residents to review it, and their analysis will help our clinician readers to better understand the findings and their significance. —David F. Chang, M.D., EyeWorld chief medical editor The residents from Bascom Palmer Eye Institute Source: Steven J. Gedde, M.D.  Intraoperative floppy iris syndrome (IFIS) is a recently described condition that may present significant challenges during cataract surger...

Pharmaceutical focus Weekends are overrated -------------------------------------------------------------------------------- by Jena Passut EyeWorld Editor The busiest cataract surgeon in Japan is also one of the most innovative. Takayuki Akahoshi, M.D., has been the director of ophthalmology at the Mitsui Memorial Hospital in Tokyo for 20 years. Internationally, he is best known for developing the prechop technique and instrumentation—a method that he has traveled worldwide to teach. He is also a pioneer of microcoaxial phaco, which has supplanted biaxial phaco as the most popular method of reducing incision size. When you meet him, he is incredibly humble and unassuming, and certainly does not have the ego that one might expect of such a brilliant surgeon. However, what has always amazed me the most is the grueling schedule that Taka keeps. It wasn't until I recruited him to write a textbook chapter that I learned that Taka literally works 7 days a week. Furth...

International techniques and technology Expanding indications for the use of anti-VEGF drugs -------------------------------------------------------------------------------- by Maxine Lipner Senior EyeWorld Contributing Editor Anti-VEGF agents provide a good option for conditions such as retinal vein occlusion, which were otherwise very limited Patients with diabetic retinopathy are among the expanding group that can benefit from anti-VEGF agents Source (all): Amar Agarwal, M.D. Looking beyond the obvious Growing applications Practitioners here and abroad have adopted these neovascular wonder drugs for a host of ocular problems well beyond FDA-approved macular degeneration. "Many people use them for choroidal neovascularization of any etiology, pathological myopia, ocular histoplasmosis, idiopathic choroidal rupture, any inflammatory disease, and android streaks," said Susan B. Bressler, M.D., professor of ophthalmology, Wilme...

Pharmaceutical focus The next wave of novel dry eye therapies -------------------------------------------------------------------------------- by Maxine Lipner Senior EyeWorld Contributing Editor Novel therapies are in development they may help patients with dry eye (pictured here) Source: Alan N. Carlson, M.D. New agents poised for takeoff Let's face it: Dry eye is everywhere, with many patients suffering from this all- too-common condition. EyeWorld looked at some novel therapies working their way through the pipeline that could help bring additional relief to some of these dry eye sufferers. New T-cell modulator Mention T-cell modulator to practitioners and Restasis (cyclosporine, Allergan, Irvine, Calif.) immediately comes to mind. Now a new T-cell modulator, SAR 1118 (lifitegrast, SARcode Bioscience, Brisbane, Calif.), is winding its way through channels. Eric D. Donnenfeld, M.D., co-chairman, Cornea, Nassau University Medical Center, East Mead...

Cornea editor's corner of the world Treating ocular surface squamous neoplasia -------------------------------------------------------------------------------- by Michelle Dalton EyeWorld Contributing Editor Ocular surface squamous neoplasia (OSSN) is not a common condition but is one that all clinicians need to be able to recognize. An early diagnosis with a small lesion results in a very good prognosis. However, a delay in diagnosis can lead to a lesion that involves a large area of epithelium including a significant amount of the limbal stem cells and conjunctival. Treating these larger lesions is more difficult and has a higher recurrence rate. All clinicians should be aware of the clinical findings of OSSN: irregular, thickened limbal, corneal and conjunctival epithelium, and neovascularization. The abnormal epithelium typically arises from the limbus and can progress centrally over the cornea or posteriorly over the conjunctiva or in both directions. An atypica...

Screen potential AMD patients before cataract surgery -------------------------------------------------------------------------------- by Jena Passut EyeWorld Staff Writer Although there doesn't seem to be a correlation between cataract surgery and the advancement of age-related macular degeneration (AMD), two physicians who spoke to EyeWorld said clinicians should continue to carefully examine those patients at risk for the posterior segment disease. "[Cataract surgeons] need to be very careful to risk-assess the patients," said Timothy W. Olsen, M.D., chairman, ophthalmology department, Emory University School of Medicine, Atlanta. "The phenotype of macular degeneration gives the examining physician many clues as to the level of risk for progression," Dr. Olsen continued. "Cataract surgeons' obligation is that if they don't feel comfortable risk-assessing the patient's macula, they need to send it to someone who can." This ...