高度近視引起的白內障手術治療
----丈夫回家的故事
影片中接受白內障手術的主角---廖先生，左眼30年前因工作受傷失明，只靠他唯一高度近視(約800多度)的右眼生活，但是因為年輕時個性豪邁重朋友，所以這20多年來幾乎沒有回家，都是太太一個人獨撐家庭跟經濟，直到最近這半年來右眼越來越模糊，生活上發生困難，不得已才連絡上他的太太，回到他離開許久的家。但是他的太太發現廖先生只待在家中也不太愛出門，跟以前非宅男個性的他不太一樣，而且在家裡都得摸索家具前進，吃飯時甚至夾不到飯桌上的飯菜，起初廖先生還不願意來就醫，反倒是她的太太苦口婆心堅持要帶他來給蕭醫師檢查，經過檢查後發現廖先生是高度近視所引起的核性白內障(nucleus sclerosis)，視力連0.01都不到，只能看見眼前30公分的手指頭幾隻，甚至連電腦驗光機都無法測得他的度數。.....手術影片(5:05)
核性白內障(nucleus sclerosis)，視力連0.01都不到，只能看見眼前30公分的手指頭幾隻，甚至連電腦驗光機都無法測得他的度數。
其實高於800度以上的高度近視患者，很容易引起早發性的核性白內障(nucleus sclerosis)，這些核性白內障有時會讓近視的度數飆更高。據報告統計，這些人比起沒有高度近視的人提早約10~15年發生白內障。
配合使用本院設備的光學同調電腦斷層儀(HD-OCT)，清晰可見高度近視的廖先生有鞏膜凸出(staphyloma)問題，而視覺中心視小凹(fovea)也在鞏膜凸出(staphyloma)的斜部(slope)。
光學同調電腦斷層(HD-OCT)圖---可見有鞏膜凸出(staphyloma)，視小凹(fovea)在鞏膜凸出(staphyloma)的斜部(slope)。
本院擁有可藉由高階雷射光學測量技術，提升手術前水晶體計算精準度的HaagStreit Lenstar LS900光學式人工水晶體測量儀。即便是遇近視度數過深的患者都可測得最適宜的測量公式及數據，降低高度近視白內障手術的誤差值。
蕭醫師預計在這一次手術中一起幫他矯正四樣問題～
矯正一：嚴重的白內障治療cataract
矯正二：矯正高度近視問題 high myopia
矯正三：矯正散光astigmatism
矯正四：非球面鏡片細膩矯正高階球面像差aspheric lens, correct positive spherical Aberration
使用設備：
◎最新愛爾康穩復明白內障晶體乳化儀(Alcon Centurion Vision System)
◎自動人工水晶體植入器(Autosert IOL Injector)
◎植入高階可舒智慧型非球面散光矯正軟式人工水晶體(Acrysof IQ TORIC IOL)妥瑞明
手術這天，蕭醫師幫廖先生施行右眼白內障手術，一併矯正他的高度近視及散光。手術兩週後，廖先生的右眼視力已經恢復到0.8以上，恢復視力的廖先生終於可以回到正常的日常生活，他很感謝蕭醫師幫他治療眼睛及手術，看他回診給蕭醫師看的時候，眼神及外觀好了許多，雖然我們看不出來他感謝他的太太的樣子，但他的太太倒是非常高興而且滿臉輕鬆的笑容，因為他的先生終於可以恢復行動自如的生活了。我們希望他能珍惜這失而復得的右眼視力，也能重新建立失而復得的家庭關係，別再動不動又想要離家出走啦~手術影片(5:05)
參考資料
High Myopia and Cataract Surgery
Original article contributed by:
All contributors:
Alpa S. Patel, M.D. and Amanda Tang, MD
Assigned editor:
IOL Calculations
One of the difficulties with preoperative calculations in highly myopic patients is the determination of axial length. As axial length increases, measurements may become less reliable. An estimated 70% of eyes with axial length greater than 33.5 mm are estimated to have posterior staphylomata, or localiazed ectasia of the sclera, choroid, and retinal pigment epithelium. However, almost all eyes with pathologic myopia are thought to have some degree of posterior staphylomata.
Not all experts agree on the best method to measure axial length. According to some sources, if a patient is able to fixate on a target, automated biometry such as the IOL Master (Carl Zeiss Meditec) may be able to estimate the patient's refractive axial length, from the corneal vertex to the fovea, with fairly high accuracy. In other studies, the IOL Master was found to underestimate the power of the IOL for eyes with axial length > 27.0 mm and eyes receiving a negative power IOL. In addition, A-scan contact and immersion biometry measures the anatomical axial length, from the corneal vertex to the posterior pole, and may overestimate axial length in the presence of staphyloma, leading to unexpected hyperopia.
There is also controversy over which formula is the best for calculating IOL power. Traditionally, the SRK/T, a third generation formula, is thought to be an accurate formula for patients with high axial length. In a 2012 study, however, the Haigis formula was found to be superior to the SRK/T, SRK II, and Holladay I. 81% of eyes had refractive error within 1.0 D of predicted, and 54% were within 0.5 D of predicted using the Haigis formula. In contrast, 59.5% of eyes were within 1.0 D of predicted, and 29.7% were within 0.5 D of predicted using the SRK/T formulaStill, the third generation (Holladay I, Hoffer Q, SRK/T) and fourth generation (Haigis, Holladay II) formulas may all tend to overminus IOLs in patients with high myopia.
高度近視引起的白內障手術治療
----丈夫回家的故事
影片中接受白內障手術的主角---廖先生，左眼30年前因工作受傷失明，只靠他唯一高度近視(約800多度)的右眼生活，但是因為年輕時個性豪邁重朋友，所以這20多年來幾乎沒有回家，都是太太一個人獨撐家庭跟經濟，直到最近這半年來右眼越來越模糊，生活上發生困難，不得已才連絡上他的太太，回到他離開許久的家。但是他的太太發現廖先生只待在家中也不太愛出門，跟以前非宅男個性的他不太一樣，而且在家裡都得摸索家具前進，吃飯時甚至夾不到飯桌上的飯菜，起初廖先生還不願意來就醫，反倒是她的太太苦口婆心堅持要帶他來給蕭醫師檢查，經過檢查後發現廖先生是高度近視所引起的核性白內障(nucleus sclerosis)，視力連0.01都不到，只能看見眼前30公分的手指頭幾隻，甚至連電腦驗光機都無法測得他的度數。.....手術影片(5:05)
核性白內障(nucleus sclerosis)，視力連0.01都不到，只能看見眼前30公分的手指頭幾隻，甚至連電腦驗光機都無法測得他的度數。
其實高於800度以上的高度近視患者，很容易引起早發性的核性白內障(nucleus sclerosis)，這些核性白內障有時會讓近視的度數飆更高。據報告統計，這些人比起沒有高度近視的人提早約10~15年發生白內障。
配合使用本院設備的光學同調電腦斷層儀(HD-OCT)，清晰可見高度近視的廖先生有鞏膜凸出(staphyloma)問題，而視覺中心視小凹(fovea)也在鞏膜凸出(staphyloma)的斜部(slope)。
光學同調電腦斷層(HD-OCT)圖---可見有鞏膜凸出(staphyloma)，視小凹(fovea)在鞏膜凸出(staphyloma)的斜部(slope)。
本院擁有可藉由高階雷射光學測量技術，提升手術前水晶體計算精準度的HaagStreit Lenstar LS900光學式人工水晶體測量儀。即便是遇近視度數過深的患者都可測得最適宜的測量公式及數據，降低高度近視白內障手術的誤差值。
蕭醫師預計在這一次手術中一起幫他矯正四樣問題～
矯正一：嚴重的白內障治療cataract
矯正二：矯正高度近視問題 high myopia
矯正三：矯正散光astigmatism
矯正四：非球面鏡片細膩矯正高階球面像差aspheric lens, correct positive spherical Aberration
使用設備：
◎最新愛爾康穩復明白內障晶體乳化儀(Alcon Centurion Vision System)
◎自動人工水晶體植入器(Autosert IOL Injector)
◎植入高階可舒智慧型非球面散光矯正軟式人工水晶體(Acrysof IQ TORIC IOL)妥瑞明
手術這天，蕭醫師幫廖先生施行右眼白內障手術，一併矯正他的高度近視及散光。手術兩週後，廖先生的右眼視力已經恢復到0.8以上，恢復視力的廖先生終於可以回到正常的日常生活，他很感謝蕭醫師幫他治療眼睛及手術，看他回診給蕭醫師看的時候，眼神及外觀好了許多，雖然我們看不出來他感謝他的太太的樣子，但他的太太倒是非常高興而且滿臉輕鬆的笑容，因為他的先生終於可以恢復行動自如的生活了。我們希望他能珍惜這失而復得的右眼視力，也能重新建立失而復得的家庭關係，別再動不動又想要離家出走啦~手術影片(5:05)
參考資料
High Myopia and Cataract Surgery
Original article contributed by:
All contributors:
Alpa S. Patel, M.D. and Amanda Tang, MD
Assigned editor:
IOL Calculations
One of the difficulties with preoperative calculations in highly myopic patients is the determination of axial length. As axial length increases, measurements may become less reliable. An estimated 70% of eyes with axial length greater than 33.5 mm are estimated to have posterior staphylomata, or localiazed ectasia of the sclera, choroid, and retinal pigment epithelium. However, almost all eyes with pathologic myopia are thought to have some degree of posterior staphylomata.
Not all experts agree on the best method to measure axial length. According to some sources, if a patient is able to fixate on a target, automated biometry such as the IOL Master (Carl Zeiss Meditec) may be able to estimate the patient's refractive axial length, from the corneal vertex to the fovea, with fairly high accuracy. In other studies, the IOL Master was found to underestimate the power of the IOL for eyes with axial length > 27.0 mm and eyes receiving a negative power IOL. In addition, A-scan contact and immersion biometry measures the anatomical axial length, from the corneal vertex to the posterior pole, and may overestimate axial length in the presence of staphyloma, leading to unexpected hyperopia.
There is also controversy over which formula is the best for calculating IOL power. Traditionally, the SRK/T, a third generation formula, is thought to be an accurate formula for patients with high axial length. In a 2012 study, however, the Haigis formula was found to be superior to the SRK/T, SRK II, and Holladay I. 81% of eyes had refractive error within 1.0 D of predicted, and 54% were within 0.5 D of predicted using the Haigis formula. In contrast, 59.5% of eyes were within 1.0 D of predicted, and 29.7% were within 0.5 D of predicted using the SRK/T formulaStill, the third generation (Holladay I, Hoffer Q, SRK/T) and fourth generation (Haigis, Holladay II) formulas may all tend to overminus IOLs in patients with high myopia.
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