蕭裕泉醫師眼科筆記

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...

2012.11.10( 六 ) 台灣醫學週               近視手術後的注意事項 1.     年紀 40 歲以上       Regression 在度數愈多愈會，每年 0.06D? 10 年 100 度    40 歲以上要留一眼一點度數，或手術後會引起一些 high order aberration, 看      近會較好，遠不行， 尤其是 spherical ab >0.4uRMS    Constrast 下降 2. 高度近視手術前、手術後要追蹤 3.   PreLASIK, 有 small break,lattice 要先預防性雷射治療。 4. 近視雷射手術後 13mmHg 就有點高標 , 或 &>10 mmHg 就要注意 5.   Suction ring 60-70mmHg 及 LASIK 対視神經不會有傷害。 不管是對 青光眼 或非青光眼的病人 , Suction ring 60-70mmHg 較怕是會發生 CRAO 、 CRVO 6. 利用 OCT 可以做青光眼較好的評估 7.   Arcuate scotoma    Double Arcuate scotoma 8. RNFL loss 在 color 相片會暗暗的 9. Aspheric IOL 負 球面像差會較適合手術後的病人 , 因為術後會有正           球面像差 10. RK 病人、尤其高度近視近視雷射手術後會較算不準 IOL 11. 年紀大，瞳孔小，做 RK 矯正軽度近視 12. 高度近視放 Toric 眼壓低些較不転 13. YAG laser0.5mj, 長差不多好再打，復發性角膜糜爛。 打在 ant.   ...

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 ...

Ocular allergies Calming allergic conjunctivitis by Faith A. Hayden EyeWorld Staff Writer     A patient with SAC Source: Ira J. Udell, M.D. April showers bring May flowers and endless misery to those suffering from seasonal and perennial conjunctivitis caused by pollen, mold, and grasses. 'Tis the season for red, itchy eyes, so EyeWorld spoke with two experts about diagnosing and treating patients with these ocular issues. Seasonal or perennial? The differences between seasonal and perennial allergies are limited, said Leonard Bielory, M.D., Springfield, N.J. Other than their frequency, primary differences are severity of symptoms and root cause. Seasonal allergies occur during the spring and fall months and are typically caused by pollen, grass, and ragweed. The intensity of seasonal allergic conjunctivitis (SAC) can be explosive for a number of weeks, depending on the level of exposure to the specific allergen circulating. "Tree pollen counts can go u...

Corneal diagnoses and systemic disease Ophthalmologists can diagnose deadly disease at slit lamp by Jena Passut EyeWorld Staff Writer A patient with Fabry's disease and a characteristic cornea verticillata Amiodarone deposition in the cornea Source (all): W. Barry Lee, M.D. Fabry's disease presents with corneal verticillata Imagine looking into the slit lamp and seeing something that, without a doubt, tells you the patient sitting there is suffering from a debilitating disease that will kill him. Now, imagine he has no idea. The patient has several seemingly unrelated symptoms, including a strange skin rash, nausea, unexplained pain, and hypertension. When an ophthalmologist spots a characteristic cornea verticillata, the patient most likely is suffering from Fabry's disease, also known as Anderson-Fabry disease, angiokeratoma corporis diffusum, and alpha-galactosidase A deficiency. Fabry's disease patients lack an enzyme called alpha galac...