蕭裕泉醫師眼科筆記

Challenging cataract cases Managing the rock hard cataract by Faith A. Hayden EyeWorld Staff Writer -------------------------------------------------------------------------------- An example of a white cataract Source: Gary Miller, C.R.A., O.C.T.-C. Pearls of wisdom for a successful surgery Removing a hypermature cataract is not an everyday occurrence at ophthalmology practices in the United States. But these extreme cases do happen with some frequency stateside, particularly in rural areas. Without proper precautions the surgery can head south at an alarming rate, with a sudden jagged strip of white extending end-to-end across the blue-stained capsule. This complication, known as the Argentinian Flag Sign (AFS), is the most common complication for intumescent cataracts and one of the more dangerous. How do you manage a white cataract successfully? Can the Argentinian Flag Sign be avoided altogether? EyeWorld spoke with a number of cataract surgeons who answered th...

Foveal contrast sensitivity affected by glaucoma by Matt Young EyeWorld Contributing Editor Could contrast sensitivity testing help detect glaucoma earlier? A scene as it might be viewed by a person with glaucoma. A new study found that central vision is significantly decreased by the disease Source: National Eye Institute, In contrast to conventional wisdom, new research finds that sharp central vision is significantly decreased by glaucoma. The research, published in January in Archives of Ophthalmology, found significantly lower foveal contrast sensitivity in both photopic and mesopic conditions in eyes with glaucoma. “The maintenance of good visual acuity until late in the disease and the absence of characteristic central visual field defects lead to the belief that the fovea remains unaffected in the early stages of the disease,” reported co-lead study author Hani Levkovitch-Verbin, M.D., Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel. “Ho...

Phacoemulsification sleeve frequently overlooked prior to use by Matt Young EyeWorld Contributing Editor Last summer, Dr. Johansson's office noticed a problem with the phacoemulsification equipment when preparing for a coaxial micro-incision surgery. The operation staff observed that the protection chamber and one silicone sleeve were firmly attached to each other inside the package. The very thin silicone sleeve could have been easily damaged during handling and separation of the two items. In this case, the equipment was exchanged completely, and the observation was reported to the manufacturer. The surgery was uneventful Source: Bjorn Johansson, M.D. Although clinical staff must examine surgical instrumentation before use, a recent report recommends taking time to explore one element that tends to be overlooked: the phacoemulsification sleeve. “In addition to examining the irrigation and aspiration of the phacoemulsification probe, we recommend spa...

Blue light-filtering lens reduces accident risk in simulator by Maxine Lipner Senior EyeWorld Contributing Editor Testing in a driving simulator showed that patients with blue light-filtering lenses had an edge in glare conditions Source: Robert D. Gray, Ph.D. AcrySof Natural lens may help ameliorate glare problems while driving Patients who receive the AcrySof Natural SN60AT (Alcon, Fort Worth, Texas) blue light-filtering lens are not only less susceptible to glare, but also experience fewer collisions with oncoming cars than those with traditional lenses, according to Robert D. Gray, Ph.D., senior lecturer, School of Sport and Exercise Science, University of Birmingham, England. In the January issue of the Journal of Cataract and Refractive Surgery, investigators led by Dr. Gray compared the effects of glare on those who received the blue light-filtering lens to those with a comparable acrylic IOL with no blue light filter. This study was an outgrowth of an earlie...

Femtosecond phenomenon: Burgeoning alternative applications by Maxine Lipner Senior EyeWorld Contributing Editor Considering new possibilities for femtosecond technology from lenticule extraction to etching flaps with the femtosecond laser and more, this technology is making inroads in many areas of ophthalmology, according to Ginny L. Kullman, M.D., assistant professor, Ochsner Medical Center, New Orleans. In the September-November 2010 issue of Seminars in Ophthalmology, Dr. Kullman, together with Roberto Pineda, M.D., assistant professor of ophthalmology, Harvard Medical School, Boston, and director of refractive surgery, Massachusetts Eye and Ear Infirmary, Boston, reviewed the latest advances in this area. “I was doing my fellowship at Massachusetts Eye and Ear and we had a research core review project —the topic was technological advances in the field of ophthalmology,” Dr. Kullman said. “I wanted to target it more to cornea as I was doing a cornea fellowship.” Dr. Kul...

[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's...