蕭裕泉醫師眼科筆記

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  IOL Power Calculations After Keratorefractive Surgery How the Pentacam simplifies an increasingly important task. BY WARREN E. HILL, MD Performing IOL power calculations for eyes with prior RK and LASIK is becoming more and more of a problem for ophthalmologists; in fact, it is something of a tsunami that will wash over many practices. In the US alone, millions of patients have undergone RK and LASIK since these procedures were first introduced, and a significant portion of these individuals are nearing the age at which cataract surgery is becoming commonplace. More than ever, ophthalmologists now need a workable strategy for easily and successfully handling IOL power calculations following all forms of keratorefractive surgery.  A TWO-PART PROCESS  Calculating the IOL power for the postkeratorefractive surgery patient is a two-part process. First, we must estimate the central corneal power as best as we can. The problem with using standard equipment is that keratometer...

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.　　　　　　...

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 ...

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 dyspho...

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...