...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Ophthalmology Management >When the surgeon must choose
【24h】

When the surgeon must choose

机译：什么时候外科医生必须选择

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

ROSA BRAGA-MELE, MDThe desired outcome and how to get itI had myopic LASIK refractive surgery about 15 years ago. I was originally a -7.0 D myope. But what has happened is I have a bit of mini monovision; one of my eyes is plano, and the other eye is about a -0.75 D. I still like being able to read without glasses even though I am an early presbyope. So, if I were to have cataract surgery I would likely want to do almost the same thing. I would want an aspheric IOL, because I’ve had myopic LASIK before and that would be best to optimize my vision. So either a Tecnis (Abbott Medical Optics) or AcrySof IQ (Alcon).If I had any corneal astigmatism, I would want a toric IOL, and I would want to have a monovision with about 1 to 1.5 diopters difference between the two eyes. My left eye is my distance dominant eye, and I would remain with that aiming for plano, and my right eye for some reading up close. That difference would be sufficient for reading on a computer or iPad. For smaller print, I would just throw on a pair of readers. I wouldn’t tolerate a larger difference between my eyes.The femto questionI don’t necessarily want femto. I would probably just go to a more seasoned, accomplished surgeon. But femto definitely has some advantages, so I wouldn’t rule it out at this point.I think femto really excels for dense cataracts, loose zonules and white cataracts — it really benefits those patients. Obviously if the patient has corneal astigmatism that needs to be treated and a toric IOL isn’t an option, then the AKs with the femto are just as good if not better than a manual LRI. But those are the cases where I would definitely want to use femto.As for dropsI believe in using a good drop regimen, such as a nonsteroidal anti-inflammatory with ?less corneal toxicity, better penetration and lower dosing, so something like Prolensa (bromfenac ophthalmic solution, Bausch + Lomb), which is once-a-day dosing, or Acuvail (ketorolac, Allergan), which is twice-a-day. I think a topical steroid is good to treat inflammation and decrease your?cystoid macular edema?risk; a topical antibiotic, for seven days, also helps.I am very reserved as to whether intracameral antibiotics are necessary. I do not think they are standard of care and although they do offer some benefits, ?toxic anterior segment syndrome still worries me, so the less that goes in my eye, I think the better.For presbyopia cataract patients?I talk to my patients to find out what their needs are. I give all my patients a choice for IOLs if they are appropriate for their lifestyle and their eyes (as long as there is no precluding ocular condition).However, if they have been monovision contact lens wearers, I really just discuss doing monovision with an intraocular lens, aiming for the same refractive difference that?they’re used to.If they were multifocal contact lens wearers, then, again, a multifocal IOL may be the best thing.Or, if they are a low myope, I ask them if they like to take their glasses off to read and explain that might be an option for them, to aim for them to be a low myope postop and wear glasses for distance.It depends on informing the patient properly; I don’t really have a go-to, it depends on the patient’s lifestyle and what he or she wants.Rosa Braga-Mele, MD, MEd, FRCSC, professor of ophthalmology, University of Toronto; director of Cataract Surgery,?Kensington Eye Institute, Toronto; director of Professionalism and Bio-Medical Ethics, dept. of Ophthalmology, U of TDr. Braga-Mele has financial interests with Alcon, Abbott Medical Optics and Allergan.
机译：期望的结局和获得方法大约15年前，我进行了近视LASIK屈光手术。我本来是-7.0 D型近视。但是发生的事情是我有一些小型的monovision。我的一只眼睛是平光的，另一只眼睛是-0.75 D的。即使我是老花眼，我仍然喜欢不戴眼镜就能阅读。因此，如果我要进行白内障手术，我可能会想做几乎相同的事情。我希望使用非球面IOL，因为我之前曾进行过近视LASIK手术，这将是优化视力的最佳选择。因此，无论是Tecnis（雅培医疗光学公司）还是AcrySof IQ（爱尔康公司）。如果我有任何角膜散光，我会想要一个复曲面IOL，并且我希望有一个单眼视力，两只眼睛之间的屈光度相差约1到1.5。我的左眼是我的远距离优势眼，而我的目标是平视，而我的右眼则可以近距离阅读。这种差异足以在计算机或iPad上阅读。对于较小的印刷品，我只会请一些读者来参加。我不会容忍我的双眼之间更大的差异。毫微微问题我不一定要毫微微。我可能只会去找一个经验更丰富，经验丰富的外科医生。但是，毫微微肯定有一些优势，因此在这一点上我不排除它的存在。我认为毫微微在密闭性白内障，松散的小带和白色性白内障方面确实很出色，它确实使这些患者受益。显然，如果患者需要治疗角膜散光，并且不能使用复曲面人工晶体，那么带有毫微微电镜的AK甚至比手动LRI更好。但是在那些情况下，我绝对想使用Femto。至于滴剂，我相信使用良好的滴剂方案，例如非甾体类抗炎药，角膜毒性小，渗透性更好，剂量更低，因此像Prolensa（bromfenac）眼药水，博士伦（Bausch + Lomb），每天一次，或Acuvail（酮咯酸，艾尔建（Allergan）），每天两次。我认为外用类固醇激素对治疗炎症和减少黄斑囊样水肿风险有好处。外用抗生素，持续7天也有帮助。我非常确定前房内抗生素是否必要。我不认为它们是标准的医疗服务，尽管它们确实可以提供某些好处，但是“中毒性眼前节综合征”仍然令我感到担忧，所以我认为越少越好。对于老花眼白内障患者？我与我的患者交谈找出他们的需求。我为所有患者提供了适合其生活方式和眼睛的IOL选择（只要不排除眼部疾病），但是如果他们曾是Monovision隐形眼镜配戴者，我真的只是在讨论与如果他们是多焦点隐形眼镜配戴者，那么再次使用多焦点人工晶状体可能是最好的选择;或者，如果他们是低度近视，我会问他们如果他们想摘下眼镜来阅读和解释，这可能是他们的一种选择，则希望他们成为近视度数低的人，并戴上一定距离的眼镜。我真的没有去做，这取决于患者的生活方式和他或她想要的东西。Rosa Braga-Mele，医学博士，医学博士，FRCSC，多伦多大学眼科教授;多伦多肯辛顿眼科研究所白内障手术主任;专业和生物医学伦理学部主任。博士，眼科学博士。 Braga-Mele与Alcon，Abbott Medical Optics和Allergan有财务利益。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号