ISSN:1040-8738    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

There have been major changes over the past 5 to 10 years in our understanding of both the chemical basis for and the surgical treatment of cataract in infants and children. Important questions that remain to be answered include the appropriate power and design selection criteria for intraocular lens implantation, as well as management of the posterior capsule and long-term refractive sequelae.In the past 10 years, there have been radical changes in the management of visually significant cataract in the infant and child. Whereas lens removal, subtotal posterior capsulectomy, vitrectomy, and aphakia were once the standard of care, many physicians now feel that small incisions, phacoemulsification technology, and intraocular lenses (IOLs) are best for these patients. Work is continuing to accumulate a significant body of evidence to evaluate results of these changes in technique and to develop optimal IOL designs and selection criteria for these specialized cataract patients.

ISSN:1040-8738    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Today, cataract surgeons can control postoperative refraction after cataract removal with improved intraocular-lens calculation formulas and minimal invasive surgery. However, a physiologically healthy status of the human lens (transparency, accommodation) cannot yet be regained completely postoperatively. Refractional outcome should be planned by the surgeon according to the patient's requirements. The preoperative planning also should include consideration of the intraocular-lens material needed.

ISSN:1040-8738    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Although no major breakthroughs have emerged in the area of lens insertion techniques and technology, small incremental advancements continue to take place for the placement of foldable intraocular lenses through small incisions. Folders have become more innovative in their ability to fold lenses effectively, and inserters have been downsized and enhanced to allow insertion through smaller incisions with more effective purchase of the lens. New cartridge injectors are increasing in popularity because of their ease of use and ability to pass through smaller incisions, especially with modifications. In addition, knowledge regarding techniques and complications of noncapsular supported intraocular lenses continues to increase, adding to our ability to choose the proper technique for secondary lens insertion in these selected patients.

ISSN:1040-8738    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In the past year, harmony has developed among diverse areas of research in cataractogenesis. A number of epidemiologic studies have identified new, or strengthened the role of previous, risk factors in the development of cataract. Age, tobacco smoking, alcohol consumption, and inhaled corticosteroids have been implicated. Clinical observation of cataract in diseases such as cystic fibrosis, atopic dermatitis, Alzheimer's disease, and mitochondrial cytopathy have led to hypotheses of formation. The basic science research has, in some cases, given support to the clinical hypotheses, especially with respect to the role of estrogens and protein condensation in cataract as well as other systemic diseases. Although oxidative stress continues to be the leading proposed mechanism of cataractogenesis, genetic mechanisms are gaining increasing popularity. Finally, the results of previously contraindicated surgical management of cataract in the setting of advanced diabetic ocular disease and age-related macular disease are highlighted.

ISSN:1040-8738    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The current state of cataract surgery for the millennium may be stated as "minimally invasive techniques." This review presents recent articles on the perioperative use of antibiotics (primarily fluoroquinolones), nonsteroidal antiinflammatory drugs (Voltaren and ketorolac), and new corticosteroids (rimexolone and loteprednol etabonate). Preoperative topical application of ofloxacin or ciprofloxacin results in a satisfactory minimal inhibitory concentration for most pathogens. However, one cannot determine the actual effect of intraoperative antibiotics on acute postoperative endophthalmitis, because of its low overall incidence. Nonsteroidal antiinflammatory drugs, especially Voltaren, may offer equivalent antiinflammatory efficacy (for both postoperative inflammation and cystoid macular edema) without the typically corticosteroid-associated adverse events. Rimexolone and loteprednol etabonate, two new corticosteroids, may offer good antiinflammatory efficacy with greatly reduced risk for elevation of intraocular pressure.

ISSN:1040-8738    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Developments of anesthesia for cataract surgery emerging from literature published during the scanning period include new drugs for sedation before general anesthesia and some discussion about monitoring. A few articles report on both improvements in and complications of peribulbar and retrobulbar injections. There are studies confirming the efficacy of sub-Tenon and topical anesthesia, sometimes associated with facial block. A tendency toward topical anesthesia emerged. Intraocular drug delivery was studied for toxicity both for cornea and for retina, in experimental and clinical settings.

ISSN:1040-8738    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Snellen chart visual acuity has been the gold standard to measure the preoperative indication of cataract surgery as well as the postoperative outcome. To a patient with cataracts, the disability goes beyond their loss of visual acuity. Glare disability has often been studied independently. Newer studies, however, show that there is more integration with clinical and non-clinical vision. For example, studies are looking at integrating unilateral versus bilateral procedures, type of cataract, type of procedure, the patient's daily needs, and the patient's state of mental and physical health. Questionnaires are being developed to bring into focus nonclinical issues of visual function and quality of life. Understanding the full spectrum of disability associated with visual impairment from cataracts can help clinicians improve their approach to treatment and rehabilitation of these patients.

ISSN:1040-8738    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This article reviews some of the advances that have taken place in the surgical techniques for difficult cataracts such as rock-hard, white, and posterior polar cataracts. Fashioning a central space, modified chopping maneuvers, and creation of multiple small fragments have enabled the surgeon to consistently achieve a successful outcome. A judicious combination of chop and separation movement in a step-by-step manner reduce the stress of the procedure and make it safer. Raised intracapsular pressure and poor visibility are dealt with through various innovative techniques. Use of high-viscosity sodium hyaluronate and double capsulorhexis allow the surgeon to achieve capsulorhexis with a high success rate. A controlled and gentle approach to phacoemulsification has proven to be the key factor for success in posterior polar cataracts.

ISSN:1040-8738    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Lasers have been investigated for cataract removal for nearly two decades. The technology has now reached a stage at which cataract can indeed be removed entirely with laser alone. Neodymium:yttrium-aluminum-garnet and erbium:yttrium-aluminum-garnet are the laser sources being utilized at the present time by manufacturers of laser cataract surgery systems. Initial clinical experience reported in the literature has served to highlight both the laser's capabilities and areas that need further refinement. Despite the thrill associated with the availability of this alluring new technology for cataract removal, laser systems with higher efficiency and innovative surgical techniques to optimally utilize their capabilities are necessary if laser cataract surgery is to be an improvement over current techniques.

ISSN:1040-8738    

出版商:OVID    

年代:1999

数据来源: OVID