ISSN:1040-8738    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;It has been 10 years since I implanted the first multifocal intraocular lens (IOL). Unfortunately, there has been a gradual lessening of commitment to this modality by the ophthalmic community. The most important single factor for this lack of interest despite the more than adequate available clinical data is the repeated moving of “goal posts” by the American FDA when a multifocal lens style nears premarket approval.The refractive multifocal lens styles of lolab (Claremont, CA), Stortz Ophthalmics (St. Louis, MO), Domilens (Lyon, France), and Amo with the diffractive multifocals of 3M (St. Louis, MO), and Pharmacia (Kalamazoo, MI) and their recent modifications are reviewed. Reports show that they generally give excellent visual results depending on whether a near or distance dominant lens is indicated. The foldable Amo Array SA40N provides a good distance dominant foldable lens for the surgeon performing small incisions and has a small but dedicated surgical following.Loss of contrast sensitivity at low‐light levels remains a source of concern in certain professions and with certain lifestyles, and a report suggesting that many monofocal and multifocal patients do not achieve the standards set for night driving by the German Ophthalmic Society warrants further consideration.Development of a new accommodative IOL for small incision surgery is the only really new concept, and it will be interesting to see the results of independent reports.Spectacle dependence is considerably reduced with all the current multifocals when compared to monofocals, and for patients there are ample multifocal lens styles from which to choose. It is the author's opinion that more than 60% of the cataract population is currently suitable for multifocals if small incision surgery is performed. More multifocals would be used if price disparity with monofocals was reduced.

ISSN:1040-8738    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Although cataract surgery for senile cataract is routine and easily performed, the decision to remove the cataract in a patient with a history of uveitis is considerably more complex and usually involves multiple considerations, related not only to the cause of the uveitis but also to the appropriate surgical procedures. The problems confronting the ophthalmologist caring for the patient with uveitis begin with the first visit. Establishing a diagnosis and controlling the inflammation are the critical elements in the treatment of the patient; these two factors will determine the incidence of cataract formation and other complications, the appropriate time for cataract removal, and the surgical strategy, as well as determine the visual outcome long before surgery occurs. Diagnosis, control of inflammation, preoperative management, particularities of the surgical techniques, and postoperative complications in patients with a history of uveitis have been reviewed previously in this section. Our aims in this article are to review the literature on this subject over the past year and to reemphasize the idea of a model of zero tolerance for inflammation to minimize the incidence of cataract and irreversible damage of ocular structures essential to good vision.

ISSN:1040-8738    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Retrobulbar blocks, although widely used, still have potentially serious complications. Topical anesthesia presents less risk of injury to the globe and less pain but requires careful usage and an experienced surgeon. New techniques, however, allow for an increase in the percentage of patients able to have topical anesthesia. Preoperatively, 2.5% phenylephrine is found to be just as effective as 10% phenylephrine, and, when compared with wound closure and surgeon's experience, the effect of prophylactic medications was found to be negated. Postoperatively, diclofenac is found to be as effective an anti‐inflammatory agent as prednisolone. Also, the addition of 10% phenylephrine to 4% pilocarpine drops enhances the effectiveness of pharmacologic treatment of postoperative iridocorneal adhesions. In addition, ophthalmologists should be aware of emerging antibiotic resistance.

ISSN:1040-8738    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Evolution in cataract surgery developed along two fronts: technique and timing. New cannulae with very wide aspiration ports permit nucleosuction; a manual small incision method that fractionates and aspirates the nucleus. Phacoemulsification is made easier and safer with phaco sweep. Posterior capsule polishing is gentle if the only vacuum is generated by the infusion passing through the system and the aspiration tubing is not used. Fibrin glue may make long corneal incisions as stable as short ones. Several studies challenge our conventional thoughts simultaneous bilateral cataract surgery and whether patients need to be examined on the first postoperative day.

ISSN:1040-8738    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Keratometry and videokeratography are the most important means of evaluating induced corneal changes after surgery and have comparable sensitivities in the paracentral region of the cornea. When cataract surgery is planned, corneal topography can be used preoperatively in the calculation of IOL power, particularly in difficult cases, such as in patients who have undergone corneal refractive surgery or penetrating keratoplasty. A study published in the past year suggests that the mean power in ring 3 of the Tomey TMS‐1 videokeratoscope (Cambridge, MA) appears to give the most accurate estimate of corneal power for the calculation of IOL power after radial keratotomy. In the case of PRK, traditional methods of determining the corneal power can lead to great amounts of anisometropia. Further research is needed to develop more accurate methods of calculating IOL power after PRK. Videokeratography can also be used before cataract surgery in planning the location and size of the incision. In general, smaller temporal incisions result in less astigmatism than do larger superior incisions. Postoperatively, videokeratography can be used to detect tight sutures, torsion of the wound, internal wound gape, and irregular astigmatism, as well as to guide suture removal or in cases where best‐corrected visual acuity is not adequate and there are no other obvious causes for poor vision to determine if corneal irregularities are present.

ISSN:1040-8738    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Ophthalmologists continue to choose topical antibiotics and corticosteroids more frequently than injectable agents for their current cataract surgical techniques. The preoperative use of povidone‐iodine 5% and the postoperative use of impregnated soft contact lenses have helped augment our therapeutic armamentarium. NSAIDs play an important role in decreasing postoperative convalescence with fewer side effects. The intracameral administration of heparin and antibiotic solutions is discussed.

ISSN:1040-8738    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Corneal complications following cataract surgery and intraocular lens implantation continue to be more unusual because of advances in our surgical techniques. Complications can still occur, however, and can include mechanical or toxic injury of the endothelium, stripped Descemet's membrane, epithelial toxicity and disruption, infectious keratitis, and epithelial ingrowth. Endothelial cell survival after cataract extraction and lens implantation are still major concerns. Healing of the cornea following clear corneal incisions has become more important as this technique is more frequently used, and several studies are looking at the results of clear corneal incisions performed for cataract surgery. Patients with ocular surface disease still require extra lubrication and management of blepharitis to prevent epithelial toxicity at the time of surgery as well as postoperatively. As incisions move back to the cornea from the distant limbus, careful observation for complications involving the cornea will be needed. Still, modern day cataract extraction and lens implantation are extremely gentle on the cornea.

ISSN:1040-8738    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Surgical management of coincident cataract and glaucoma has become very common for ophthalmic surgeons. As the medical options continue to improve, many patients with glaucoma do not require surgical intervention until the time of cataract extraction. Therefore, combined glaucoma procedures are becoming increasingly common. With the advent of small‐incision phacoemulsification and trabeculectomy with releasable sutures and antimetabolites, techniques have improved considerably in the recent decade. This article discusses many of the important topics as they relate to this subject. It is not a comprehensive review, but rather discusses the literature over the scanning period of this periodical.

ISSN:1040-8738    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;The multifactorial nature of cataractogenesis has been further exposed in recent epidemiologic studies, most efficiently by four case‐control studies. The factors found include various plasma constituents, steroids, alcohol, diabetes, hypertension, hyperlipidemia, and obesity. Further examination of dietary factors leaves confusion as to their role in the prevention of cataract.

ISSN:1040-8738    

出版商:OVID    

年代:1997

数据来源: OVID