蕭裕泉醫師眼科筆記

Using cataract surgery as a treatment for ocular hypertension -------------------------------------------------------------------------------- by Michelle Dalton EyeWorld Contributing Writer Cataract surgery can lower IOP in patients with ocular hypertension (OH), according to results from a large cohort study.1 Steven L. Mansberger, M.D., director, Glaucoma Services, Devers Eye Institute, Portland, Ore., and colleagues determined "someone who has early glaucoma or needs only 10-20% IOP lowering should be considered for cataract surgery," he said, but does stress the results are only applicable for those with OH, a point co-author James D. Brandt, M.D., professor of ophthalmology, and director, Glaucoma Service, University of California-Davis, reiterated. "We only evaluated OH. It is dangerous to extrapolate the findings of this study to those with glaucoma. It's a whole different population, especially those on one or more meds,"Dr. Brandt said.　　　　　　

[June 2011 EyeWorld] Cataract and glaucoma don't go together like a horse and carriage by Matt Young EyeWorld Contributing Editor There are problems treating both diseases in the same patient, but modern solutions exist      A new report refers to cataract as the "silent enemy" in relation to glaucoma and trabeculectomy surgery, and it's no wonder why. In a nutshell, cataract formation is likely after trabeculectomy surgery. Subsequent cataract surgery leads to frequent bleb failure. Cataract surgery in patients requiring filtration surgery remains an issue of contention, according to the report, published online in January in the British Journal of Ophthalmology. "Cataract should not remain the silent enemy of successful trabeculectomy surgery," lead author Rashmi G. Mathew, M.R.C.Ophth., Moorfields Eye Hospital, London, said in the report. "Reviewing the literature does provide clarity on some issues surrounding this topic."   It

Pseudophakic dysphotopsia  Managing multifocal IOL dysphotopsia by Ellen Stodola EyeWorld Staff Writer  Patients may complain of an arc image, usually in one quadrant, that bothers them. It is usually described after many of the square-edge optic lenses are placed in the bag. The image is depicted by the drawing of the light rays hitting the square edge of the optic. Source: Doug Katsev, MD Dysphotopsias can be a potential problem after surgery, especially with multifocal IOLs O ne issue for patients receiving multifocal IOL implants is the potential for dysphotopsias, which can be bothersome and sometimes affect vision. Richard Tipperman, MD, Wills Eye Hospital, Philadelphia; John Berdahl, MD, Vance Thompson Vision, Sioux Falls, S.D.; Audrey Talley Rostov, MD, cornea, cataract, and refractive surgeon and partner, Northwest Eye Surgeons, Seattle; and Douglas Katsev, MD, Sansum Clinic, Santa Barbara, Calif., commented on dysphotopsias and how to address them

Pseudophakic dysphotopsia  Treating, eliminating negative dysphotopsia by Vanessa Caceres EyeWorld Contributing Writer  Slit lamp image shows the nasal anterior capsule overlying the anterior surface of the IOL optic prior to Nd:YAG laser anterior capsulectomy. This shows the creation of an anterior capsule sector along the nasal aspect of the capsulorhexis following Nd:YAG laser anterior capsulectomy. Source (all): David Folden, MD; J Cataract Refract Surg. 2013;39:1110–1115 Treatments linked to suspected causes; prevention remains under investigation T he best way to treat negative dysphotopsia remains a hot topic among surgeons. Negative dysphotopsia that occurs right after cataract surgery is usually best left to resolve on its own. However, if the problem continues a few months after surgery, ophthalmologists must step in to provide a treatment. Their treatment approach usually depends on what they suspect is the cause. Looking at causes Negative dysphotops

Pseudophakic dysphotopsia  Understanding positive dysphotopsia by Michelle Dalton EyeWorld Contributing Writer  Piggybacking an IOL can help to stave off dysphotopsia. Source: Samuel Masket, MD  The visual disturbances exacerbated by ocular surgery can range from annoying to disabling P ositive dysphotopsia—the unwanted images including rings, arcs, and central flashes that become bothersome after IOL implantation—have been associated with everything from the patient's ability to recognize the edge of the implanted IOL to corneal disease to multifocal IOLs to an oversized peripheral iridotomy (PI) that allows too much light scatter in the back of the retina. Like most visual anomalies post-surgery, it's nearly impossible to determine who will be affected and who will not beyond a generalized "anyone who is at risk for glare or halo postop." Numbers may not bear it out, as positive dysphotopsia may not result in an IOL exchange but will result in

20140420第49次眼科地方醫學會 1.Ortho-K可以讓peripheral retina影像有點在前面，positive SA,可以抑制眼軸增長，瞳孔愈大，度數愈　　深、 抑制近視增長的效果愈好。 2.使用於對散瞳劑atropine無法忍受、近視持續進行、 可以使用。 3.配戴OK矯正度數愈多，產生愈多的spherical aberration 愈多 。 4.Aspherical SCL with positive SA的也可以抑制近視加深 。 5.OK直徑僅量接近角膜邊緣0.5mm。 6.自然的光線，也比較不會近視加深。 7.Scleral CL :像倒一碗水至眼睛上 。 8.Viscoat當成防火牆 。

Toric IOLs Off axis? Fixing a toric IOL that's malpositioned by Vanessa Caceres EyeWorld Contributing Writer Ophthalmic surgeons share pearls, perspectives T here's a starter question to ask if your patient has a toric IOL that is not at the right position postoperatively: Is the patient happy with his/her vision? "If their vision is 20/25 or perhaps even 20/40, I advise leaving it alone. There's no need to reposition their toric lens if they are happy," said Terry Kim, MD, professor of ophthalmology, Duke University Eye Center, Durham, N.C. "Many patients are happy with better, though not perfect, refractive outcomes," said Michael Y. Wong, MD, Princeton Eye Group, Princeton, N.J., and instructor, Rutgers Medical School, New Brunswick, N.J. However, if the patient is unhappy, there are a few choices to consider. First, consider the possible cause of his/her dissatisfaction. "If the patient is not happy, you have to go through a

Toric IOLs Measurement remains key to best toric IOL outcomes by Rich Daly EyeWorld Contributing Writer " D espite all this planning and preparation, one can still have uncontrollable intangibles and end up with residual, off-axis astigmatism. Just be prepared to handle these eventualities postoperatively …" – Sydney L. Tyson, MD Although many patients can benefit from toric lenses, surgeons have to take special care to ensure their fit and location A dhering to key measurement steps in toric lens implantation can keep both standard and challenging astigmatism patients on track. Although Sydney L. Tyson, MD, an attending surgeon at Wills Eye Hospital , Philadelphia , avoids implanting toric IOLs in eyes with highly irregular corneas for fear of inducing or worsening higher order aberrations, he does not limit toric lenses to patients with regular corneal astigmatism. "In general, I believe that maximizing the treatment

Impact of lens design and materials on cataract surgery by George H.H. Beiko, BM, BCh, FRCS(C) outcomes Analyzing the spectrum of light used for scotopic vision shows that blue light provides 35% of scotopic sensitivity. Source: George H.H. Beiko, BM, BCh, FRCS(C) Comparison of transmission of blue light in the natural crystalline lens and different current IOLs18 Source: George H.H. Beiko, BM, BCh, FRCS(C) S ynergy is the value and performance of any elements which, when combined, are greater than the sum of the separate individual parts. Achieving optical synergy in visual outcomes following cataract surgery is accomplished by selecting a high performance lens design produced with proven, high caliber materials. Proper lens selection has been shown to improve spherical aberration correction, chromatic aberration correction, light transmission, material clarity, as well as limit lens epitheli