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.　　　　　　...

Using cataract surgery as a treatment for ocular hypertension ________________________________________ by Michelle Dalton EyeWorld Contributing Writer James D. Brandt, M.D. Steven L. Mansberger, M.D.           C ataract 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, es...

30130324 眼科教授醫學會學會 ReSTOR Toric +2.5D Central zoom 0.938mm 較大 Cataract 先做 dominant eye, +2.5D in dominant eye Distant vision excellent Flap thickness 愈薄，愈不會 dry eye. Nerve supply 非只是 3 ， 9 點進入，是從 360 度進入， 所以 hinge 在那個位置，其實沒差！（新觀念） Flap diameter 愈大，愈乾。 逆性散光或斜性散光，要注意非角膜散光比率高，約 10%! 角膜塑型術及近視雷射手術，可減少旁中心離焦， 可以控制近視度數加深。戴眼鏡會有旁中心離焦，近視度數易會加深。 現在有一種鏡片，可以控制近視度數， 眼鏡也要戴好 戴眼鏡如果沒戴好或戴歪 , 戴眼鏡如天天地震 , 也容易加深 近視 300 度以內，除非內隱斜視太強，可以看近不戴眼鏡， 不然建議都戴著，近視比較不會加深。因為看近要調整力較好。 CCC coming full circle Touqui effect, 當角膜前表面後表面的軸度沒有很一致時， 有時會開到 45 度，不是想像中在合力的中間 , 變成怪怪的！ 術前提到 dry eye symptm  

 Anit-inflammation Perfecting cataract surgery EyeWorld Supplement to EyeWorld August 2012 Inflammation remains a significant challenge to modern cataract surgery. Left untreated, inflammation can ruin even the most consummately performed surgery utilizing the most advanced techniques and technology. Experts gathered to discuss “Ocular Anti-Inflammation: Prevention, Diagnosis, and Curative Treatment Options” at an EyeWorld Educational Symposium held at the 2012 ASCRS•ASOA Symposium & Congress. The event was supported by an educational grant from ISTA Pharmaceuticals (Irvine, Calif.). NSAID issues 2012 “Cataract surgery is evolving,” said Dr. Katsev. According to Dr. Katsev, patients’ standards have been increasing in the last decade in part thanks to the increasing role of premium IOLs in cataract surgery. In that time, the use of premium IOLs has increased dramatically, he said, but the promise of great vision these IOLs make does not necessa...

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...

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