3cataract surgery
白内障入院宣教流程及内容
白内障入院宣教流程及内容英文回答：Cataract is a common eye condition that affects the clarity of vision. When a patient is admitted to the hospital for cataract surgery, it is important to provide them with education and information to ensure they arewell-prepared for the procedure and recovery process. Here is a step-by-step guide on the cataract admission education process and the content that should be covered.1. Introduction and explanation of cataract: I would start by introducing myself as the healthcare provider and explaining what cataract is. I would use simple language and avoid medical jargon to ensure the patient understands. For example, I would say, "Hello, my name is [name]. I am here to help you understand cataract, which is a condition that causes clouding of the lens in your eye. This clouding can make your vision blurry or hazy."中文回答：白内障是一种常见的眼部疾病，会影响视力的清晰度。
眼科常用单词
眼科常用单词1. Eye: 眼睛2. Vision: 视力3. Optic nerve: 视神经4. Retina: 视网膜5. Cornea: 角膜6. Iris: 虹膜7. Lens: 晶状体8. Glaucoma: 青光眼9. Cataract: 白内障10. Macula: 黄斑11. Optometry: 验光12. Ophthalmology: 眼科学13. Eyeglasses: 眼镜14. Contact lenses: 隐形眼镜15. Prescription: 处方16. Eye drops: 眼药水17. Eye examination: 眼部检查18. Vision test: 视力测试19. Refraction: 屈光20. Astigmatism: 散光21. Myopia: 近视22. Hyperopia: 远视23. Presbyopia: 老花眼24. Eye surgery: 眼部手术25. Laser surgery: 激光手术26. Cataract surgery: 白内障手术27. Glaucoma surgery: 青光眼手术28. Corneal transplantation: 角膜移植29. Eye trauma: 眼外伤30. Eye infection: 眼部感染31. Conjunctivitis: 结膜炎32. Keratitis: 角膜炎33. Uveitis: 葡萄膜炎34. Optic neuritis: 视神经炎35. Macular degeneration: 黄斑变性36. Diabetic retinopathy: 糖尿病视网膜病变37. Strabismus: 斜视38. Amblyopia: 弱视39. Nystagmus: 眼球震颤40. Diplopia: 复视41. Blindness: 失明42. Eye pain: 眼部疼痛43. Eye fatigue: 眼疲劳44. Eyestrain: 眼疲劳45. Tearing: 流泪46. Red eye: 红眼47. Itchy eye: 眼睛痒48. Watery eye: 眼睛流泪49. Dry eye: 干眼症50. Eyelid twitching: 眼睑抽搐51. Eyelid edema: 眼睑水肿52. Eyelid drooping: 眼睑下垂53. Ptosis: 上睑下垂54. Entropion: 睑内翻55. Ectropion: 睑外翻56. Convergence insufficiency: 集合不足57. Exotropia: 外斜视58. Esotropia: 内斜视59. Lazy eye: 弱视眼60. Eyelashes: 睫毛61. Eyelid margin: 睑缘62. Eyelid lashes: 睑睫毛63. Eyelid reflex: 眼睑反射64. Eyelid cancer: 眼睑癌65. Eyelid hygiene: 眼睑卫生66. Eyelid surgery: 眼睑手术67. Eyelid spasms: 眼睑痉挛68. Eyelid massage: 眼睑按摩69. Eyelid wipes: 眼睑擦拭70. Eyelid stickers: 眼睑贴71. Eyelid bags: 眼睑袋72. Eyelid puffiness: 眼睑肿胀73. Eyelid twitching: 眼睑抽搐74. Eyelid eczema: 眼睑湿疹75. Eyelid fungus: 眼睑真菌感染76. Eyelid cyst: 眼睑囊肿77. Eyelid tumor: 眼睑肿瘤78. Eyelid laceration: 眼睑撕裂伤79. Eyelid trauma: 眼睑外伤80. Eyelid ulcer: 眼睑溃疡81. Eyelid abscess: 眼睑脓肿82. Eyelid edema: 眼睑水肿83. Eyelid infection: 眼睑感染84. Eyelid inflammation: 眼睑炎85. Eyelid allergy: 眼睑过敏86. Eyelid bump: 眼睑肿块87. Eyelid cancer: 眼睑癌88. Eyelid surgery: 眼睑手术89. Eyelid lift: 眼睑提升术90. Eyelid reconstruction: 眼睑重建术91. Eyelid plasty: 眼睑整形术92. Eyelid脂肪切除术: 眼睑脂肪切除手术93. Eyelid injection: 眼睑注射94. Eyelid filler: 眼睑填充物95. Eyelid tattoo: 眼睑纹身96. Eyelid makeup: 眼睑化妆97. Eyelid primer: 眼睑打底98. Eyelid liner: 眼睑眼线99. Eyelid shadow: 眼睑眼影100. Eyelid mascara: 眼睑睫毛膏。
白内障指南2021
白内障指南2021Introduction.Cataracts, the clouding of the lens of the eye, are the leading cause of blindness worldwide. Cataract surgery isthe most common surgical procedure performed globally, with over 20 million surgeries performed annually. The American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS) have recently updated their guidelines for cataract surgery. These guidelines provide evidence-based recommendations for the diagnosis, management, and treatment of cataracts.Diagnosis.Cataracts are diagnosed primarily through a comprehensive eye examination. This includes a visualacuity test, slit-lamp examination, and dilated fundus examination. The symptoms of cataracts can include blurred vision, glare, difficulty seeing at night, and faded colors.Management.The primary treatment for cataracts is surgery. However, there are certain cases where observation may be appropriate. For example, cataracts that are small and do not cause significant visual impairment may not require immediate surgery.Surgery.Cataract surgery involves removing the clouded lens of the eye and replacing it with an artificial lens implant. There are several different techniques for cataract surgery, including phacoemulsification, extracapsular cataract extraction, and laser cataract surgery. The choice of surgical technique depends on the individual patient'sneeds and preferences.Postoperative Care.After cataract surgery, patients will need to followspecific instructions for postoperative care. This may include using eye drops, wearing an eye patch, and avoiding strenuous activity. Most patients will experience a significant improvement in their vision within a few days after surgery.Conclusion.Cataract surgery is a safe and effective procedure that can significantly improve vision. The AAO and ASCRS guidelines provide evidence-based recommendations for the diagnosis, management, and treatment of cataracts.中文回答：2021年白内障指南。
介绍眼睛手术的英语作文
介绍眼睛手术的英语作文Eyes are the windows to the soul, but sometimes they need a little help to see clearly. Eye surgeries are medical procedures that can correct vision problems and improve the quality of life for many individuals.One common eye surgery is LASIK, which stands for Laser-Assisted in Situ Keratomileusis. This procedure reshapes the cornea using a laser to correct refractive errors like myopia, hyperopia, and astigmatism. LASIK is quick, with mostsurgeries taking only about 10 minutes per eye.Cataract surgery is another essential procedure, particularly for older adults. A cataract is a clouding ofthe eye's natural lens, which can cause vision to become blurry. During cataract surgery, the cloudy lens is removed and replaced with an artificial one, restoring clear vision.Glaucoma, a condition that can lead to vision loss, is treated with various surgical options. One such option is a trabeculectomy, which creates a new drainage pathway for the eye's fluid to lower pressure within the eye and preventfurther damage.Strabismus surgery corrects misaligned eyes, where the eyes do not look in the same direction simultaneously. This surgery adjusts the muscles that control eye movement,helping to improve both the appearance and function of theeyes.Retinal detachment surgery is a critical procedure for those experiencing a separation of the retina from the back of the eye. If left untreated, this condition can lead to permanent vision loss. The surgery involves reattaching the retina to prevent further complications.Post-operative care is vital after any eye surgery. Patients are usually advised to avoid rubbing their eyes, follow a prescribed medication regimen, and attend follow-up appointments to monitor healing and vision improvement.In conclusion, eye surgeries are an integral part of modern medicine, offering solutions to a variety of vision problems. With advancements in technology and techniques, these procedures continue to become safer and more effective, enhancing the lives of those who undergo them.。
眼的屈光和调节晶状体病
40-45million blindness，46% ?
55~60 3.9-10% 65~74 14.3 -23.5% >75 38.8-45.9%
The Beaver Dam Eye Study Baltimore Eye Study
白内障的定义
Definition of Cataract
Cataract is the turbid lens. That is, opacity of the lens of the eye, causing impairment of vision or blindness.
The light is strongly scattered by the opacity
视功能
Visual functional examination
Visual acuity
视力
Contrast sensitivity test
Macular function test
Visual electrophysiology test
对比敏感度 黄斑功能检查 视觉电生理检查
The lens is transparent and biconvex. The lens can be divided into three parts: nucleus, cortex, capsular bag. The normal lens is an avascular structure with no blood supply or lymphatic channels.
膨胀期白内障 Intumescent Stage
晶状体体积增大
瞳孔阻滞
前房变浅，房角关闭
眼科词汇中英文对照要点
v眼科词汇中英文对照A型超声图A-scan ultrasonographyB型超声图Maddox杆测验白内障Nd:Y AG激光囊切开术SRK公式，人工晶体状体度数测定二期人工晶状体植入术人工晶状体（IOL）上皮上皮水肿子午线晶状体干燥性角结膜炎无前房或浅前房无晶状体无晶状体眼镜无缝线白内障手术毛果芸香碱出血外伤性白内障外眼病外眼检查对比敏感度平坦部玻璃体切除术白内障手术白内障囊内摘除术（ICCE)白内障囊外摘除术（ECCE）皮质皮质性白内障皮质类固醇先天性白内障全身麻醉关节炎后房后房型人工晶状体后囊混浊地塞米松异物成熟期白内障红光反射老年性白内障冷冻器B—scan ultrasonographymaddox rod testingcataractNd：YAG laser capsulotomySRK formula, for IOL powersecondary intraocular lensintraocular lensesepitheliumepithelial edemameridianslenskeratoconjunctivitis siccaflat or shallow anterior chamberAphakiaAphakic spectaclesNo—stitch cataract surgerypilocarpinehemorrhagetraumatic cataractsexternal eye diseaseexternal eye examinationcontrast sensitivitypars plana lensectomycataract surgeryintracapsular cataract extraction （ICCE) extracapsular cataract extraction （ECCE) cortexcortical cataractscorticosteoridscongenital cataractsgeneral anesthesiaArthritisposterior chamberposterior chamber intraocular lenses posterior capsular opacification dexamethasoneforeign bodiesmature cataractsred reflexAge-related cataractsCryoprobe局部麻醉折叠式人工晶状体角巩膜切口角膜角膜水肿角膜曲率计角膜病变赤道周边部虹膜切除术屈光屈光不正表面麻醉视力视网膜色素变性视网膜脱离视轴青光眼青光眼斑点前房前房积血复视，单眼性玻璃体穿孔伤穿通伤结合膜瓣结膜切口脉络膜上腔出血脉络膜脱离虹膜虹膜切除术剥脱综合症（假性剥脱）恶性青光眼核核性白内障缺血性调节调节幅度透明质酸钠高度近视眼婴儿期白内障接触镜检眼镜检查球后麻醉球旁（周）麻醉local anesthesiafoldable intraocular lenses corneal-scleral incisioncornealcorneal edemakeratomtrykeratoplastyequatorperipheral iridectomyrefractionrefraction errortopical anesthesiavisual acuityretinitis pigmentosaretinal detachmentoptic axisglaucomaglaukomfleckenanterior chamberhyphemadiplopia，monocularvitreousperforating injurypenetrating injury, see also Trauma conjunctival flapconjunctical incisionsuprachoroidal hemorrhagechoroidal detachmentirisiridectomyexfoliation syndrome (pseudoedfoliation）malignant glaucomanucleusnuclear cataractischemiaaccommodationamplitude of accommodationsodium hyaluronatehigh myopiainfantile cataractscontact lensesophthalmoscopyretrobulbar anesthesiaperibulbar anesthesia眼内压升高眼内异物眼内炎眼压增高眼底粘弹剂维生素缺乏黄斑功能黄斑变性黄斑囊样水肿睑板腺炎睑缘炎裂隙灯检查超声晶状体乳化术睫状阻滞睫状麻痹剂解剖碱性烧伤缩瞳剂糖尿病阿托品，弱视治疗AC/A比率，比值，调节性复辏/调节比值弱视病因极性白内障手术杯/盘比眼外肌鼻泪道系统结膜炎新生儿眼炎眼眶早产儿视网膜病变视网膜母细胞瘤剥夺性弱视视神经萎缩角膜映光法垂直肌下斜上斜视力评估垂直性偏离下直肌不全麻痹elevated intraocular pressureintraocular foreign bodies endophthalmitis increased intraocular pressurefundusviscoelasticsvitamin deficienciesmacular functionmacular degenerationcystoid macular edemameibomianitisblepharitisslit-lamp examinationultrasound for phacoemulsificationciliary blockciliary-block glaucomaanatomyalkali injuriesmioticsdiabetes mellitusatropine in amblyopia treatmentAC/A ratio, See accommodative convergence/accommodation ratio amblyopiaetiologypolarcataract surgerycup/disc ratioextraocular musclesnasolacrimal systemconjunctivitisophthalmia neonatorumorbitalretinopathy of prematurityretinoblastomadeprivation amblyopiaoptic atrophycorneal light reflexvertical rectus muscleshypotropiahypertopiavisual assessmentvertical deviationsinferior rectus muscle上斜肌垂直性非共同性同视机单眼剥夺单眼抑制单眼运动麻痹不全麻痹调节性幅辏调节性内斜对侧的复视对抗肌E图表房角切开分离性垂直性偏离幅辏，集合分散下直肌异侧一致性，同侧复视检查巩膜巩膜扣带固视（视觉)光凝硅胶管植入过敏反应脉络膜葡萄膜虹膜炎虹膜睫状体炎后马托品后葡萄膜炎后退后粘连化脓性化学烧伤黄斑变性Hering运动一致法则Hess屏法Horner综合症眼压superior oblique vertical inconitancy amblyoscopemonocular deprivationmonocular suppressionmonocular eye movementspalsy, paralysisparesisaccommodative convergence accommodative esotropia contralateraldiplopiaagonist musclesIlliterate Egoniotomydissociated vertical deviation convergencedivergenceinferior rectus muscles heteronymoushomonymousdipiopiasclerascleral bucklingfixation （visual) photocoagulationsilicon intubationallergic reactionchoroidsuvealiritisiridocyclitishomatropineposterior uveitisrecessionposterior synechiaepyogenicchemical burnsmacular degengrationHering’s law of motor correspondence Hess screen testHorner’s syndromeintraocular pressureGraves(甲状腺）眼病激光治疗（激光手术）营养障碍假性外斜假性斜视间歇性睑外翻睑下垂交替抑制角膜角膜病变角膜曲率计角膜炎角膜移植术拮抗肌睫状肌麻痹性睫状体近点近点集合近点联合运动反射痉挛泪点泪囊泪囊鼻腔吻合术泪小管类风湿性关节炎棱镜眼球震颤棱镜检查立体感觉立体视觉立体视觉检查眼睑协同肌内毗赘皮内斜屈光性后天性共同性非调节性假性内斜内旋内隐斜皮质类固醇Graves （thyroid）eye disease laser therapy （laser surgery) dystrophy pseudoexotropia pseudostrabismus intermittentectropion blepharoptosis alternating suppression corneakeratopathy keratometrykeratitiskeratoplasty antagonist muscles cycloplegicciliary bodynear point ofnear point of convergence near synkinetic reflex spasm oflacrimal puncta lacrimal sac dacryocystorhinostomy canaliculirheumatoid arthritis prismsnystagmusprism test stereoscopic perception stereopsisstereo acuity testing eyelidssynergistsepicanthusesotropiarefractiveacquiredcomitant nonaccommodative pseudoesotropiaincycloesophoria corticosteroids偏中心固视交感性眼炎前房角镜强的松角膜混浊发生率青光眼植入阀青霉素眼部护理穹窿部切口球筋膜屈光不正屈光参差性热烧伤融合感觉性和运动性双眼视觉融合性集合融合性散开沙眼上睑下垂上直肌失明视交叉视力评估视盘视神经萎缩视神经炎视网膜遗传性全身病视网膜出血视网膜对应视网膜竞争视网膜色素变性同向运动瞳孔瞳孔光反射瞳孔散大瞳孔缩小托品卡胺外斜外侧直肌外伤eccentric fixation sympathetic ophthalmia gonioscopy prednisonecorneal opacityincidenceglaucoma implant procedures pencillinophthalmic carefornix incisionfascia bulbiisoametropic anisometropicthermal burnsfusionsensory and motor binocular visionfusional convergence fusional divergence trachomaptosissuperior rectusblindnessoptic chiasmvisual assessmentoptic discoptic atrophyoptic neuritisretinahereditarysystemic diseaseretinal hemorrhagesretinal correspondence retinal rivalrypigmentosaversionspupilspapillary light reflex mydriasismiosistropicamideexotropialateral rectus muscle trauma外旋外旋转外隐斜外展Worth四点检查法下斜肌下斜视下直肌霰粒肿新生儿淋球菌眼炎小梁切除术A型垂直肌无力调节缝线切口适应症新生儿眼炎眼镜调节性内斜结缔组织恶性色素上皮分离性眼位异常视网膜对应隐斜拥挤现象圆锥角膜YAG激光正位眼痣肿瘤眼球表面周边的轴长注视位置配偶肌板层角膜移植术表层角膜切除术带状疱疹单纯疱疹病毒干眼巩膜炎过敏性反应Excyclo-Extorsion （excycloduction）Exophoria AbductionWorth’s four-dot testInferior oblique muscleHypotropiaInferior rectuschalaziagonococcal ophthalmia neonatorum trabeculotomyA patternmyasthenia gravisadjustable suturesincisionindicationophthalmic neonatorumspectacleaccommodative esotropiaconnective tissuemalignantpignent epithelialdissociatedalignmentabnormal (anomalous) retinal correspondence phoria, heterophoriacrowding phenomenonkeratoconusYAG laserorthophorianevitumorsepibulbarperipheralaxial lengthgazeyoke musclelamellar keratoplastysuperficial keratectomyherpes zosterherpes simplex virusdry eyesscleritisallergic reaction虹膜切除术虹膜脱出红霉素化学烧伤环丙沙星间断缝合法碱性化学烧伤角膜磨削术角膜切开术角膜咬切器角膜移植术接触镜结膜瓣结膜结石金霉素,氯化四环素局部异体植片排斥片泪囊炎泪腺炎利福平睑板腺睑板腺炎氯霉素绿脓杆菌麦粒肿前房积血前房消失前房蓄脓强的松龙青霉菌属霰粒肿三叉神经散光色素沉着沙眼新生血管形成血管翳远视眼真菌翳状赘肉Goldmann眼底接触镜Goldmann压平眼压计Humphrey视野分析仪Maddox杆阿熙提iridectomyprolapse of iris erythromycin chemical burnsciprofloxacininterrupted suture closure technique alkaline burnkeratomileusiskeratotomycorneal puncheskeratoplastycontact lensconjunctival flapconjunctival concretions chlortetracyclineallograft rejection dacryocystitisdracyoadenitisrifampinmeibomian glandsmeibomitischloramphenicolpseudomonas aeruginosa hordeolumhyphemaflat anterior chamberhypopyonprednisolonepenicilliumchalaziontrigeminal nerveastigmatismpigmentationtrachomaneovasculariationpannushyperopiafungipterygiumGoldmann fundus contact lens Goldmann applanation tonometer Humphrey vision analyzer Maddox rodapostib等效镜度低视力助视器地形图第一焦点调节调节不足调节的近点调节反应调节范围调节范围（域）调节幅度调节痉挛调节麻痹对比敏感度干涉滤片光轴几何光学假性老视检眼镜检影镜检影镜法交叉柱镜法焦点焦度计角膜曲率计角膜移植术内皮细胞睫状肌麻痹验光界面近视近视力助视器老花棱镜棱镜度内皮细胞镜检查内皮显微镜逆动逆规散光前房角镜屈光参差屈光度屈光度人工晶体（IOL）人工晶体计算equivalent power low-vision aids topography primary focal point accommodation insufficiencynear point of accommodation responserangerange of accommodation amplitude of accommodation spasmparalysiscontrast sensitivity interferenceoptical axisgeometrical optics pseudopresbyopia ophthalmoscopy shiascopyretinoscopycross cylinderfocal pointsfocimeterkeratometerkeratoplastyendothelialcycloplegic refraction interfacesmyopianear—vision aids presbyopiaprismsprism diopterspecular microscopy specular microscopy against motionagainst-the-rule astigmatism gonioscopy 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妥布霉素地塞米松滴眼液对白内障术后干眼症患者眼部症状改善情况和泪膜稳定性的影响
DOI：10.19368/ki.2096-1782.2024.05.053妥布霉素地塞米松滴眼液对白内障术后干眼症患者眼部症状改善情况和泪膜稳定性的影响蒋宁南京市六合区中医院眼科，江苏南京211500[摘要]目的探究妥布霉素地塞米松滴眼液对白内障术后干眼症患者眼部症状改善情况和泪膜稳定性的影响。
方法选取2022年7月—2023年6月南京市六合区中医院收治的98例白内障手术后发生干眼症的患者为研究对象，经电脑随机分为两组，对照组（49例）行重组牛碱性成纤维细胞生长因子眼用凝胶治疗，观察组（49例）配合运用妥布霉素地塞米松滴眼液治疗。
经过30 d的持续治疗，对比两组眼部症状、泪膜稳定性、不良反应发生情况。
结果观察组眼表疾病指数量表（Ocular Surface Disease Index, OSFI）评分和角膜荧光染色（Corneal Fiuoresence Staining Score, CFS）评分低于对照组，差异有统计学意义（P均<0.05）；治疗后，观察组泪膜破裂时间、泪液分泌试验、泪膜厚度指标均优于对照组，差异有统计学意义（P均<0.05）；观察组不良反应发生率为8.16%，低于对照组的12.24%，差异无统计学意义（χ2=0.446，P=0.505）。
结论妥布霉素地塞米松滴眼液能够良好治疗白内障术后干眼症患者，改善眼部症状，保持泪膜稳定。
[关键词]妥布霉素地塞米松滴眼液；白内障手术；干眼症；眼部症状；泪膜稳定性[中图分类号]R77 [文献标识码]A [文章编号]2096-1782（2024）03(a)-0053-04Effects of Tobramycin Dexamethasone Eye Drops on the Improvement of Ocular Symptoms and Tear Film Stability in Patients with Dry Eye after Cataract SurgeryJIANG NingDepartment of Ophthalmology, Nanjing Liuhe District Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province, 211500 China[Abstract] Objective To investigate the effects of tobramycin dexamethasone eye drops on the improvement of ocular symptoms and tear film stability in patients with dry eye after cataract surgery. Methods A total of 98 patients with dry eye after cataract surgery treated in Nanjing Lihe District Hospital of Traditional Chinese Medicine from July 2022 to June 2023 were selected as the study subjects. They were randomly divided into two groups by computer. The con⁃trol group (49 cases) received recombinant bovine basic fibroblast growth factor eye gel treatment, and the observation group (49 cases) received tobramycin and dexamethasone eye drops treatment. After 30 days of continuous treatment, the ocular symptoms, tear film stability and adverse reactions occurence of the two groups were compared. Results The ocular surface disease index (OSFI) scores and corneal fiuoresence staining (CFS) scores in the observation group were lower than those in the control group, and the differences were statistically significant (both P<0.05). After treat⁃ment, the indexes of tear film breakup time, Schirmer Ⅱtext and tear film thickness in observation group were better than those in control group, and the differences were statistically significant (all P<0.05). The incidence of adverse re⁃actions in the observation group was 8.16%, lower than 12.24% in the control group, and the difference was not statis⁃tically significant (χ2=0.446, P=0.505). Conclusion Tobramycin dexamethasone eye drops can be a good treatment for patients with dry eye after cataract surgery, promoting benign improvement of ocular symptoms and maintaining tear [作者简介] 蒋宁（1966-），男，本科，副主任医师，研究方向为白内障。
前房巨眼白内障手术及特殊考虑说明书
Cataract surgery and anterior megalophthalmos:Custom intraocular lens and special considerationsFabio Marques Vaz,MD,Robert H.Osher,MDWe report a patient who presented with anterior megalophthalmos:corneal diameter of nearly17.0mm,anterior chamber depth of7.0mm,mild lens subluxation,and nuclear sclerotic cataract.Surgical management consisted of a scleral tunnel incision,capsule staining,a predeterminedcapsulorhexis size,microcoaxial phacoemulsification with torsional ultrasound,and implantationof a custom IOL to ensure endocapsular fixation.Special consideration must be given to thepatient with a very large anterior segment.J Cataract Refract Surg2007;33:2147–2150Q2007ASCRS and ESCRSAnterior megalophthalmos is a rare hereditary condi-tion with a constellation of findings that includes a hor-izontal corneal diameter greater than13.0mm (macrocornea),ciliary ring enlargement,anterior em-bryotoxon,mosaic corneal dystrophy,Krukenberg’s spindle,hyper-deep anterior chamber,iris hypoplasia, large capsular bag,and lens subluxation.1,2Cataract surgery in a megalophthalmic eye is challenging be-cause of the compromised view,cavernous chamber, unusually large dimensions that alter the surgeon’s prospective,thin peripheral cornea,and loose zonules. If each hurdle of the procedure is overcome,the surgeon must still confront a large lens that may lead to decentration of a standard intraocular lens(IOL) implanted in the capsular bag.We report a surgical approach using a scleral tunnel incision,estimation of the capsulorhexis size,capsule staining,slow-motion microcoaxial phacoemulsification with torsional ultrasound,and a custom IOL designed for this very large eye.CASE REPORTA43-year-old physician was referred with bilateral gradual loss of vision.On examination,the best corrected visual acu-ity(BCVA)was20/160in the right eye and20/40in the left eye;the refractive error wasÀ4.75C2.50Â104andÀ3.25 C3.50Â75,respectively.The corneal diameter was16.25mm in the right eye and16.50mm in the left eye(Figure1). Mosaic corneal dystrophy and posterior crocodile shagreen with dense Krukenberg’s pigmentary spindles were present (Figure2).The anterior chambers were cavernous(Figure3), and each pupil measured7.0mm in ambient light.The pu-pils were slightly eccentric,with atrophy of the iris stroma and multiple transillumination defects.Each lens showed moderate nuclear sclerosis;the left lens was mildly sublux-ated(Figure4).Gonioscopy revealed dense pigmentation on the trabecular meshwork.The ocular motility,visual fields,intraocular pressures,and fundi were unremarkable. Pachymetry was421m m in the right eye and424m m in the left eye.Keratometry measurements were41.00/43.27@112 and40.81/43.49@82,respectively.With the IOLMaster (Carl Zeiss Meditec),the anterior chamber depth was 6.9mm in the right eye and6.7mm in the left eye;the axial length was28.09mm and27.69mm,respectively.Ultra-sound biomicroscopy was unavailable.Because of the very large anterior segment dimensions, IOL companies were canvassed for assistance in designing a custom IOL for this patient.With assistance from Nick Ma-malis,MD,an IOL with a7.0mm optic and an overall length of16.0mm was designed.Bausch&Lomb volunteered to manufacture the IOL in a3-piece design with a silicone optic and a power of C11.00diopters.The first eye was scheduled for surgery to be followed by the second eye several months later.Using a retrobulbar block in the first eye and topical anes-thesia in the second eye,a4.0mm3-plane scleral tunnel in-cision was constructed.The anterior chamber was enteredAccepted for publication July26,2007.From the Hospital do Olho de Rio Preto and the Hospital de Olhos Jose Eutropio(Marques Vaz),Salvador,Brazil;and the University of Cincinnati(Osher),College of Medicine,and the Cincinnati Eye In-stitute,Cincinnati,Ohio,USA.Robert H.Osher,MD,is a paid consultant to Alcon,AMO,and Bausch&Lomb.Dr.Vaz has no financial or proprietary interest in any material or method mentioned.Corresponding author:Robert H.Osher,MD,Cincinnati Eye Insti-tute,1945CEI Drive,Cincinnati,Ohio45242,USA.E-mail: *************************.with a 2.2mm diamond keratome;a vial of an ophthalmic viscosurgical device (OVD)(sodium hyaluronate 2.3%[Hea-lon5])was necessary to partially fill the chamber.The ante-rior capsule was stained with trypan blue (Vision Blue),and a caliper was used to mark a 7.0mm zone on the ing the corneal marks as a guide,the capsulorhexis was completed with a bent 22-gauge needle,followed by gentle hydrodissection.Slow-motion microcoaxial phacoemulsifi-cation with torsional ultrasound was performed (Figure 5);the cortex was removed with a silicone irrigation/aspiration tip.The posterior capsule was vacuumed,and the capsular bag was expanded with another vial of the OVD.The inci-sion was enlarged to 4.0mm,and the custom IOL was folded and inserted without difficulty (Figure 6).The OVD was removed,the pupil was constricted with acetylcholine chlo-ride (Miochol),and a 10.0horizontal suture was passed to ensure a water-tight closure.The eye was dressed with pro-phylactic pilocarpine 2%,brimonidine (Alphagan),lantano-prost (Xalatan),timolol (Timoptic 0.5%),and moxifloxacin (Vigamox).A periocular triamcinolone (Kenalog)injection (1.0cc)was given through the lower lid.Postoperatively,the BCVA improved to 20/25in the right eye and 20/25in the left eye,with a refractive error of À0.25C 2.00Â112and C 0.25C 3.00Â78,respectively.The IOLs remained well centered without pseudophacodonesis.Thepatient,who was a surgeon,was very pleased with the visual result and was able to perform endoscopies within several days of surgery.DISCUSSIONThere are several challenges in performing cataract sur-gery in patients with megalophthalmos.The incision has to be carefully constructed because the cornea in these eyes is often quite thin.Barrett reported severe leakage of a clear corneal incision despite a small phaco and stab incision (presented as a video in the Interna-tional Video Symposium of Challenging Cases and Complication Management,ASCRS Symposium on Cataract,IOL and Refractive Surgery,San Diego,California,USA,May 2004).Therefore,in our patient,we made a scleral tunnel incision and sutured it.It is noteworthy that the stab incision leaked enough to require stromal hydration in each eye.Because the corneal dystrophy and extreme anterior chamber depth may compromise visualization,we chose to stain the capsule with Vision Blue,similartoFigure 2.Mosaic corneal dystrophy inmegalophthalmos.Figure 1.Slitlamp appearance ofmacrocornea.Figure 3.Cavernous 7.0mm anteriorchamber.Figure 4.Moderate nuclear sclerosis with mild lens subluxation.2148CASE REPORT:ANTERIOR MEGALOPHTHALMOSthe case of Lee et al.,3using a 3-step technique.4How-ever,establishing the proper capsulorhexis size can be difficult when all the landmarks and dimensions are abnormal.Therefore,we used an unpublished tech-nique to determine the capsulorhexis size (Frederico Marques,MD,and Robert Osher,MD,2003):In 10pa-tients with white cataract,the anterior capsule was stained with trypan blue.Following the capsulorhexis,the excised anterior capsule was placed on the corneal surface and the ratio of the diameter of the stained ex-cised capsule to the diameter of the underlying stained intracameral capsulorhexis edge was determined.The white background of the cortex made the contrast easy to photograph,and the mean magnification was ap-proximately 20%.Therefore,a caliper was set at 7.0mm,placing 2marks on the cornea to facilitate about a 5.5mm capsulorhexis in this patient.The phacoemulsification was uneventful,although the cortical behavior was stubborn,perhaps because of the mild zonular compromise.Although capsulartension rings were available,it was not necessary to implant one in either eye,as previously reported.5The big challenge was selection of the IOL.Cases of IOL malposition with endocapsular fixation have been reported.5–8Surgeons have tried to prevent this com-plication by implanting an iris-supported Binkhorst IOL,9suturing an anterior chamber IOL,7suturing the optic or haptic to the anterior capsule and iris,10and placing an iris-clip IOL in the posterior chamber.3Kwitko et al.6experienced dislocation of a standard size posterior chamber IOL.As a result,a special Sin-skey posterior chamber IOL with an optic of 7.0mm and an overall length of 18mm was implanted in the second eye.The authors recommended using a larger IOL diameter in patients with megalocornea.We considered using an anterior or posterior optic capture technique to achieve stable centration of the IOL.11We were fortunate that Bausch &Lomb was willing to manufacture a custom IOL for this patient.Unfortunately,the process took almost 1year and the patient was unwilling to wait the same period of time for the second eye when we realized that a stron-ger power would likely achieve a residual refractive error closer to emmetropia.Nevertheless,he was pleased with the visual outcome and the IOLs have remained perfectly centered (Figure 7).In summary,special considerations must be given to the patient with megalophthalmos who requires cata-ract surgery.While a candid discussion of the increased risk is necessary,it is likely that a well-planned approach will be successful.REFERENCES1.Duke-Elder S.Anomalies of the size of the cornea:anterior meg-alophthalmos.In:Duke-Elder S,ed,System of Ophthalmology.St.Louis,MO,CV Mosby,1964;vol.3,pt 2:Normal and Abnor-mal Development;Congenital Deformities;498–505Figure 6.Insertion of custom IOL into the capsularbag.Figure 5.Slow-motion microcoaxial phacoemulsification with tor-sionalultrasound.Figure 7.Appearance of megalophthalmic eye 2months postoperatively.2149CASE REPORT:ANTERIOR MEGALOPHTHALMOS2.Skuta GL,Sugar J,Ericson ES.Corneal endothelial cell mea-surements in megalocornea.Arch Ophthalmol1983;101:51–53 3.Lee GA,Hann JV,Braga-Mele R.Phacoemulsification in ante-rior megalophthalmos.J Cataract Refract Surg2006;32:1081–10844.Marques DMV,Marques FF,Osher RH.Three-step techniquefor staining the anterior lens capsule with indocyanine green or trypan blue.J Cataract Refract Surg2004;30:13–165.De Sanctis U,Grignolo FM.Cataract extraction in X-linked meg-alocornea;a case report.Cornea2004;23:533–5356.Kwitko S,Belfort R Jr,Omi CA.Intraocular lens implantation in an-terior megalophthalmus;case report.Cornea1991;10:539–541 7.Sharan S,Billson FA.Anterior megalophthalmos in a family with3female siblings.J Cataract Refract Surg2005;31:1433–1436 8.Javadi MA,Jafarinasab MR,Mirdehghan SA.Cataract surgeryand intraocular lens implantation in anterior megalophthalmos.J Cataract Refract Surg2000;26:1687–16909.Neumann AC.Anterior megalophthalmos and intraocularlens implantation.Am Intra-Ocular Implant Soc J1984;10: 220–22210.Dua HS,Azuara-Blanco A,Pillai CT.Cataract extraction andintraocular lens implantation in anterior megalophthalmos.J Cataract Refract Surg1999;25:716–71911.Gimbel HV,DeBroff BM.Intraocular lens optic capture.J Cata-ract Refract Surg2004;30:200–206First author:Fabio Marques Vaz,MDHospital do Olho de Rio Preto and Hospitalde Olhos Jose Eutropio,Salvador,Brazil2150CASE REPORT:ANTERIOR MEGALOPHTHALMOS。
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Optical Coherence tomography
several ultrasonic emulsifying machines • 蠕动泵 文丘里泵
16
IOL Monofocal Technology Advances
1949 PMMA 1983 SILICONE 1994 HYDROPHOBIC ACRYLIC Single-Piece Design 2005 + Aspheric Optic UV only UV and Blue Light Filtering
cataract abaissement Acupuncture of traditional chinese medicine
Phacoemulsification
(A) Povidone-iodine 5% is instilled;
(B) disinfect the skin around eye;
Corneal endothelium count
Eyes with decreased endothelial cell counts have increased vulnerability to postoperative decompensation secondary to operative trauma.
History of Cataract Surgery
This is the couching of Cataract in Europe between 2000BC to 1000 AD.
History of Cataract Surgery
• Jacques Daviel’s first scientific description of cataract extraction in 1752. • No anesthesia • No sutures • Sand bags to prevent movement of the head.
Topical anesthesia - 1993
• Dr. Freeman popularized the use of topical anesthesia in 1993. • Surgery can be performed without injection.
A story
1974, Chairmen Mao was diagnosed with a cataract , almost got blind for 1 year. 1975, Chairmen Mao took a cataract surgery.
The IOL is inserted into a cartridge for injection which is loaded into an injector handset
33
Sutureless Cataract Surgery 1991
• Dr. McFarland discovered that if he were to construct the incision as a valve, the incision would be self sealing. • Thus he started the “no stitch” cataract surgery.
Original Ridley Implant
Foldable implant - 1991
• In 1991, FDA approved the use of Silicone foldable implant. • With foldable implant inserted a 6 mm implant through a 3.2 mm incision opening. • One stitch surgery.
5
Preparation for operation
A detailed eye examination to predict postoperative vision - visual function -Introcular pressure, mydriasis, etc -A/B ultrasonic exam -IOL master -Corneal curvature -Corneal endothelium count
3
Examination method of cataract
• slit lamp
4
Preparation for operation
• elective surgery
• Systemic diseases control well, which is stable and the patients can tolerate operation , no active inflammation in the eye
(C) drapes isolate the eyelids from the operating field with insertion of a speculum.
• (A) Cortical lens matter is pulled centrally and aspirated: (B)
surgery of cataract
田甜
Treatment of cataract
• There isn’t any effective drug to the senile cataract. • It is major to operation.
2
Operative time
• At the immature or mature stage • The lens is extracted when the vision is affected or the complications occurred.
Numerous formulae have been developed which utilize keratometry and axial length to calculate the IOL power.
IOL master
• the IOL power • Depth of the anterior chamber Diameter of the cornea
Surgical management of unusual cataract
二、Case 1 --Cataract with obsolete uveitis
Female，67-year-old，Cataract，Obsolete Uveitis PE：VA 0.1(Left), Less circular pupil, Most posterior synechia, Brown lens opacity, Corneal endothelia cells 1036/mm2. Management：Phaco + IOL implantation + Pupil angioplasty, Postoperative VA 0.5, IOP 8mmHg
• Too hard lens nucleus may not adopt this method
44
Small incision manual cataract surgery
• (A)
Anterior chamber is entered; (B) capsulorhexis; (C) prolapse of nucleus into anterior chamber; (D) expression of nucleus; (E) cortical cleanup; (F) IOL in place
History of cataract surgery
• During World War II, Harold Ridley observed that aviators could tolerate shards of PMMA(polymethyl methacrylate)plastic from the aircraft canopies in their eyes. • He used this knowledge to create and to implant the first intraocular lens between 1949 and 1950.
– strongpoint:
• Self-healing wound • The corneal astigmatism after operation is fine • Visual restoration is soon
– Shortcoming:
• The apparatus s expensive
Preoperative
2 days postoperative
Case 2 --Complicated cataract after glaucoma surgery
History of cataract surgery.
• 1867 Henry Williams of England first described the use of sutures in cataract surgery.
History of cataract surgery
• In 1914, Van Lint of Brussels, described the use of anesthesia. • We are still using his technique – the Van Lint technique, to numb the eye.
Viscoelastic is injected into the anterior chamber
A-scan ultrasonography