蕭裕泉醫師眼科筆記

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...

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...

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 ...

The non-surgical option for vitreoretinal diseases -------------------------------------------------------------------------------- by Faith A. Hayden EyeWorld Staff Writer A graphic of the ocriplasmin molecule Source: ThromboGenics  A non-surgical treatment for symptomatic vitreomacular adhesion (VMA) including macular hole, vitreomacular traction syndrome (VMT), and epiretinal membrane (ERM) is now in the hands of the FDA. In April, ThromboGenics (Iselin, N.J.) submitted ocriplasmin for priority review by the agency, which could reach a decision on the drug by the end of the year. ThromboGenics is also pursuing European commercialization. Ocriplasmin could be available in Europe as early as October. "The product has been in development for eye diseases for about 5 years," said Ram Palanki, head of marketing, ThromboGenics. "We went through Phase I, II, and got our Phase III data in August of 2010. That's when we decided to go for the submis...

Perioperative pharmacology Groundswell for NSAIDs in CME battle -------------------------------------------------------------------------------- by Maxine Lipner Senior EyeWorld Contributing Editor The case pictured here required complete tarsorrhaphy and punctal plugs, and the patient ultimately healed with a residual scar and 20/40 vision Source: John R. Wittpenn, M.D. Why practitioners see NSAIDs as a pivotal component Nearly all cataract practitioners will tell you that NSAIDs are a vital part of practices' cystoid macular edema (CME) fighting regimen, despite the fact that this is an off-label use. "Some of the surveys suggest that in approximately 80% of cataract cases performed in the United States, patients are treated with topical NSAIDs at some point," said Michael B. Raizman, M.D., associate professor of ophthalmology, Tufts University School of Medicine, Boston. EyeWorld asked leading practitioners to share their thinking here. Clea...

糖尿病視網膜病變治療的新趨勢 署立基隆醫院 ＊台大醫院 眼科部 游建章 楊長豪＊ 前言         由於社會型態及生活習慣的改變與環境的變遷，糖尿病的盛行率逐年上升，糖尿病是開發中及已開發國家失明的主要原因之一。估計目前全世界有超過3億人口患有糖尿病，尤其在亞洲新興國家，其中有1/3在印度及中國。而根據世界衛生組織（WHO）統計糖尿病患比沒有糖尿病的人高出10-20倍的失明機會。在台灣糖尿病視網膜病變也是台灣中老年失明最重要的原因。而不論是第一型或第二型糖尿病的患者，都會受到糖尿病視網膜病變的影響。         在Wi s cons in糖尿病視網膜病變流行病學研究(wisconsin epidemiological study of diabetic retinopathy, WESDR)發現糖尿病視網膜病變的盛行率在第一型糖尿病病患確診三年、五年、十年、十五年後，分別為8%、25%、60%及80%，發病二十年後幾乎全部患者呈現不同程度的視網膜病變。 反觀第二型糖尿病患者於診斷成立之初，就有21%患者有視網膜病變，而且在發病二十年後則有60%患者發生視網膜病變。 糖尿病對眼睛的影響甚多，主要是視網膜病變，尤其以增殖性視網膜病變及黃斑水腫最會危及視力。糖尿病黃斑水腫造成視力損傷約有2.75％，對生活機能及品質的影響巨大。         糖尿病視網膜病目前一般接受的致病機轉如下：糖尿病病人在高血糖的狀況下，會經由polyol (聚醇)及hexosamine(己糖胺)途徑會合成diacylglycerol-prtein kinase C (DAG-PKC)、自由基、及 醣化產物 (advanced glycosylation endproducts, AGEs )。而這些正是糖尿病網膜病變的主要成因1,2。另外，有許多研究顯示，發炎反應在糖尿病網膜病變致病機轉上扮演重要的角色3。而這些途徑被活化後會導致視網膜神經層及視網膜微血管病變。這些影響包括增加細胞凋亡、神經膠細胞活化，及glutamate代...