蕭裕泉醫師眼科筆記

 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...

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...

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...

Ocular allergies Combination drops are first-line therapy for allergies by Jena Passut EyeWorld Staff Writer Most practitioners agree that combination drops are the go-to therapy for SAC (pictured here) Source: Andrea Leonardi, M.D. Many ocular allergy suffers first try to quash symptoms by self-medicating with over-the-counter drops, but different classes of medications, especially combination antihistamine/mast cell stabilizers, are quite effective treating the irritating condition, according to several practitioners who spoke to EyeWorld. More than 90% of patients with ocular allergy symptoms are affected by either seasonal allergic conjunctivitis (SAC) or perennial allergic conjunctivitis (PAC), with swelling and itching being hallmark symptoms. Drop therapies available today attempt to stave off allergic conjunctivitis by focusing on the characteristic mast cell degranulation that is associated with the condition. Mast cell stabilizers help prevent the release of ...

Complicated cataract cases Cornea editor's corner of the world Pterygium surgery trends and pearls by Vanessa Caceres EyeWorld Contributing Editor Pterygium is a common problem that, if managed incorrectly, can lead to a more significant clinical condition post-op. A recurrent pterygium is a different disease than a primary pterygium. Recurrences are more inflamed, progress more rapidly, lead to more conjunctival scarring, are more difficult to surgically remove, and are more likely to lead to loss of vision. Therefore surgeons need to use an operative technique that first and foremost reduces the recurrence rate and leads to the best outcome. Clinical trials have definitively shown that the bare sclera technique has a very high recurrence rate (25-90%) and should never be used as the sole procedure. Excision with some adjunct therapy is the treatment of choice. Surgeons have many options available to them and have to make surgical decisions that they feel are the correc...

Deciphering dry eye therapies by Faith A. Hayden EyeWorld Staff Writer -------------------------------------------------------------------------------- Dry eye syndrome (DES) is one of the most common reasons a patient presents to an ophthalmologist's office. It affects 10-15% of U.S. adults, or about 80 million people. DES usually affects post-menopausal women, adults over the age of 65, and younger individuals who wear contacts for extended periods of time. Other diseases such as diabetes, rheumatoid arthritis, lupus, and Sjogren's syndrome can also bring on DES. There is no perfect or agreed-upon solution for the disease, and every doctor seems to have his or her own preferred management method. Treatment for this condition varies wildly, often depending on the cause of the disease, severity of the symptoms, and lifestyle of the patient. When deciding which therapy to prescribe to a patient suffering from the itchiness, redness, and pain associated with this cond...