低濃度0.01%阿托品(Atropine)治療近視，防止加深效果好，幾乎沒有副作用~

低濃度0.01%阿托品(Atropine)治療近視，防止加深效果好，幾乎沒有副作用~

      每學期家裡有小學生的家長，一半以上都有收到學校視力不良檢查通知單的經驗。注意喔!這並不是請家長隨便在街頭巷尾的眼鏡行給孩子們配付眼鏡的聖旨。這時候應該找一家診所或醫院，做完整的驗光檢查並與診療的醫師用心溝通，需有完整治療近視計劃，軟硬體皆備(檢查設備、最新眼藥水配方…)。如果是第一次發現近視問題，通常先以散瞳劑每晚睡前使用，追蹤用藥後視力狀況，評估是否需更換藥水濃度或改以角膜塑形鏡片來控制近視度數加深的問題，才是學童視力檢查的目的喔!

 

 2017年6月 國際醫學新聞：

https://kknews.cc/zh-tw/health/y6ex8kg.html

新加坡國家眼科中心進行大型的研究計畫，以0.01%阿托品(Atropine)，為該國5~9歲的孩子防治近視加深的問題。這些研究證實，使用0.01％濃度的阿托品眼藥水，能在幾乎無副作用的情況下，有效減緩六歲和以上孩童近視加深的速度達五、六成。

近年美國眼科醫學會已多次刊登新加坡眼科醫學中心的研究成果（ATOM2相關研究），2016年美國眼科醫學雜誌還特別著文指出：「低濃度0.01%阿托品(Atropine)的使用是人類對抗近視的一大進展！」；低濃度0.01%阿托品用於治療兒童近視的安全性以及效果，近年已經過許多國際重量級研究證實，而成為當今全球眼科界大力推動的熱門進步的治療方向！

本診所於2017年11月開始，引進0.01%阿托品(Atropine)，目前使用不含防腐劑單支包裝，健保沒有給付，如果有想以低濃度0.01%阿托品(Atropine)來治療自己小孩子近視的家長們，歡迎帶您們的小朋友來我們診所治療。

 新眼光眼科診所   官網

新眼光眼科診所   粉絲團

70歲的病人還可以讓媽媽陪看病～驚嚇但又也溫暖 - 視網膜裂孔(Retinal break)

70歲的病人還可以讓媽媽陪看病～驚嚇但又也溫暖 - 視網膜裂孔(Retinal break)

開業多年的蕭醫師被這『講究的一家人』嚇到了..........

(此為示意圖，非患者本人)

尹奶奶今年70歲，平常人不舒服一定要去台大醫院找教授醫師看診，對醫療要求一絲不苟，不是醫學中心等級的不可能去看診。

前些日子早上起床時，尹奶奶覺得飛蚊症突然出現很多，而且模糊黑影數量多得讓她眼花，因為實在太不舒服了，一時又約不到台大教授的門診，只好先到離家2分鐘路程的『新眼光眼科診所』掛號看診。經過問診，蕭醫師幫奶奶做了散瞳檢查，確定為視網膜裂孔合併視網膜出血，必需做網膜雷射固定及止血。看診經驗豐富的蕭醫師聽完奶奶的就醫習慣，也主動問尹奶奶要不要幫她開轉診單，到她熟悉的台大醫院做視網膜雷射治療，尹奶奶想了想說：『我每次經過你的診所，都看患者滿滿的，櫃檯前還排隊排到騎樓去，你應該也沒太差勁，既然這裡有視網膜雷射設備，那就在這裡治療好了。』

雷射治療後一週回診的這一天，尹奶奶檢查後恢復良好，但她對著蕭醫師說：『我媽媽很擔心我到小診所看醫生，她很不放心，想進診間問蕭醫師幾個問題。』接著我們就看到一位九十幾歲的奶奶撐著拐杖由老兒子攙扶緩慢步入診間…蕭醫師忍不住起立迎接，只差沒親自過去攙扶步態不穩的『病人家屬們』；對尹奶奶的媽媽解釋完病情後，蕭醫師羨慕地說：『好好喔！70幾歲來看醫生，媽媽還可以陪你來、好關心你耶……』同行的老兒子說：『我們兄弟姊妹看醫生，媽媽常常都要陪著來…』

開業多年的蕭醫師被這『超級講究的一家人』嚇到了，其實住家附近如果有可靠的診所，還是鼓勵大家配合醫療分級，讓醫療資源能有效使用在每個需要的民眾身上，況且大部分診所的醫師也都是資深主治醫師，都是有豐富的醫療經驗。但是，無論如何~能讓90多歲的媽媽帶著來看病…絕對是無比珍貴的幸福。

 

各式各樣的視網網膜裂孔，如箭頭所示~

視網膜裂孔在剛形成的時候，有時沒有特別的眼睛症狀，但是有時會有飛蚊症突然變多、視力模糊、或有合併黑影及閃電的感覺。如果及早發現並適時雷射固定處理，將可以避免視網膜剝離造成視力永久受損的情形。

 視網膜裂孔有時會撕裂到血管，造成眼球內出血也就是玻璃體出血，此時會造成視力嚴重下降，通常需等到血塊吸收一些，再找出視網膜裂孔的位置，再做視網膜雷射手術。

  新眼光眼科診所   官網

新眼光眼科診所   粉絲團

白內障追蹤定位手術--- 精準植入光動科技進階多焦點人工水晶體

白內障追蹤定位手術---

精準植入光動科技進階多焦點人工水晶體

Customized Phacoemulsification with VERION^™ Image Guided System --- Alcon PanOptix IOL for Micro-incision Cataract surgery

                                                       Sep. 25. 2017

雷女士是一位年約65歲的神職人員，這半年來視力覺得越來越模糊，甚至連講道時，戴著原本的老花眼鏡看講稿都相當吃力，於是來到我們眼科求診。

蕭醫師詳細檢查後診斷有雙眼白內障、老花眼、高度近視問題，因此藉著這次白內障手術中，為雷女士植入最新『光動科技』設計的可舒諦視進階多焦點人工水晶體(Alcon PanOptix IOL, ENLIGHTEN)，可一併解決高度近視、老花眼的困擾。

雷女士在術後第1週回診，經檢查結果雙眼視力看遠可達1.0 (20/20)及看近可達J1(1.0視力)，雷女士相當驚訝視力看遠、看中、看近都變好了，加上此種人工水晶體運用『光動科技』，提升光能利用率，減低光干擾設計；因此瞳孔依賴度低，即使光線昏暗下也絲毫不影響看近閱讀、看手機的清晰度！！

新聞(蕭裕泉醫師專訪)

點選看影片(內含真實手術畫面4:15)

 

手術影片(4:15)

參考資料：

 

 

 

 

 

 新眼光眼科診所   官網

新眼光眼科診所   粉絲團

客製化微創小切口白內障追蹤定位手術-色散消除，色彩更飽和!!

客製化微創小切口白內障追蹤定位手術---

 精準植入添視明新視延全焦段散光人工水晶體

(影片4:53 影片含手術過程)

Customized Phacoemulsification with VERION^™ Image Guided System ---TECNIS Symfony Toric IOL for Micro-incision Cataract surgery

July. 31. 2017

色散消除，色彩更飽和，提高對比敏感度，影像清晰不失真!!

 

(影片4:53 影片含手術過程)

 

 

65歲的簡先生，原本是高度近視，只有夜間開車時覺得吃力，現在連白天都覺得視力模糊而不敢開車出門。蕭醫師詳細檢查後發現簡先生有雙眼白內障及左眼黃斑部分離病變，加上老花眼、高度近視及散光，都是讓他視物不清的原因。

為了在手術中精準植入高階全焦段散光人工水晶體(TECNIS Symfony Toric IOL)，必須藉由威力揚定位系統(VERION Image Guided System)來達到最精準的手術矯正治療。術後簡先生覺得視力看遠看近都變好，也覺得更有自信，視力甚至比年輕時看得更加清楚，不論白天或夜間開車都清晰銳利。

 

大幅降低各種光線波長不同而造成的色差現象，影像色彩更飽和，接近自然眼的視力品質!

 

植入此類型高階多焦點人工水晶體，手術後享受遠、中、近視力清晰不失真!

 

白內障手術並植入『高階全焦段人工水晶體』，讓屈光聚焦形成一段延續而清楚的屈光焦段、而非焦點!能同時獲得遠、中、近距離的連續優質視力，讓整段景深都清晰明亮無色散!

~合適使用此種『高階全焦段散光人工水晶體』的病人~

1.長時間看遠中距離的工作者

  如：電腦使用上班族、職業駕駛、軍警人員....等。

2.眼睛曾接受近視散光雷射的病人

3.有輕度視網膜、黃斑部病變的病人

  如：高度近視視網膜退化、黃斑部增生薄膜、糖尿病視網膜出血水腫....等。

4.青光眼、視神經輕微病變者

5.白內障手術後不想再戴近視、遠視、散光、老花眼鏡者

6.其它，醫師評估適合使用者

 

(影片4:53 影片含手術過程)

參考資料:

https://www.vision.abbott/us/iols/toric/tecnis-symfony-toric.html

 

Liam Jordan, Associate Editor

PUBLISHED 3 MARCH 2017

New Torics: What You Need to Know

An in-depth look at the Symfony, ReSTOR and enVista toric lenses.

For years, surgeons outside of the United States have had access to more varieties of toric intraocular lenses than their U.S. counterparts. However, thanks to the recent approval of Alcon’s ReSTOR +3 D multifocal toric and Abbott’s Symfony, as well as a new lens in the pipeline, U.S. surgeons’ options are multiplying. More options, however, means more information to sift through as you put these new lenses into practice. In this article, experienced surgeons offer their insights into the new lenses, both approved and on the horizon, focusing on the AMO Symfony, the ReSTOR +3 D multifocal toric and Bausch + Lomb’s enVista toric, which is currently in trials. 

AMO’s Symfony Toric

The recently approved Symfony toric sets itself apart from similar lenses by being the only extended depth of focus lens approved in the United States. This hydrophobic, acrylic EDOF lens is able to achieve this extended-depth-of-focus through some unique design elements. The Symfony has a defractive grating on its face, similar to multifocal lenses, but has some significant differences. The ring structures have z-shaped echelette formations that elongate the focus area, rather than splitting and dispersing the light. 

Jim Loden, MD, an ophthalmologist based in Nashville, provides some

 

The Symfony has four toric models to correct up to approximately 3 D of stigmatism at the corneal plane.

insight into the Symfony’s design: “We’re able to achieve an extended depth of focus through the manipulation of chromatic aberration,” he says. The spherical shape of the lens and the hydrophobic acrylic material elongate the depth of field. By addressing the chromatic aberration, you maintain a higher modulation transfer function and decrease the loss of contrast sensitivity you usually find with traditional multifocal lenses.” The design manipulates the chromatic aberration so that instead of dispersing the light, it helps collapse it into a tight region of focus, which improves contrast sensitivity. 

The Symfony has four toric models to correct up to approximately 3 D of astigmatism at the corneal plane. Models ZXT150, ZXT225, ZXT300 and ZXT375 correct 1.03 D, 1.54 D, 2.06 D and 2.57 D of astigmatism at the corneal plane, respectively. “For treating more than that, we have the option of doing bioptics,” says Dr. Loden. “I leave the patient with compound myopic astigmatism; I intentionally leave him with nearsightedness in the IOL calculation. Then I can just do LASIK surgery to correct the rest of the astigmatism. Say someone has six diopters of astigmatism preop. You’re going to get three diopters of it with the Symfony toric and correct 2.75 to three through the refractive surgery, depending on the calculation.”

In terms of postop rotation, Dr. Loden claims that it’s minimal. Because the Symfony lens is similar to the TECNIS Toric IOL, the FDA drew from the TECNIS Toric approval data, which reported that of the first eyes done with the toric lens, 97 percent had <10 degrees of rotation from baseline to six months. “I have presented that data, and I’m basically seeing zero rotation,” he says. “I have not come back and repositioned a Symfony toric yet. For those saying the lens is more prone to rotate, I’m not seeing that at all.” The same study reported more than 90 percent of eyes having ≤5 degrees of axis change between consecutive visits three months apart. 

Sioux City, Iowa, surgeon Jason Jones, MD, offers these tips for reducing the risk of rotational issues. “The first is to have a very clean surgical experience without any zonular compromise and have the capsulorhexis overlap the optic for 360 degrees,” he says. “Then, ensure you have complete viscoelastic removal from the posterior surface of the IOL. In my experience, I find that if I evacuate the viscoelastic from beneath the optic, it will disappear [from my view]. However, if I then rotate the lens 180 degrees and go behind the optic again, I’ll sometimes find a very small amount of viscoelastic remaining.

“In addition, though you of course leave the eye nicely closed and secure in terms of the wound, you might want the IOP to be a little lower than with a non-toric lens,” Dr. Jones adds. “This is so you don’t hyperinflate the capsular bag and the anterior segment, and instead have it ‘collapse’ around the haptic peripherally, if you will. 

“If you want to avoid a rotational issue, I’d look into a capsular tension ring,” he continues. “The first option along these lines would be a regular CTR that most surgeons are familiar with. This will help ensure the capsular bag is symmetrically expanded and that there’s no ovalization of the peripheral capsule. Ovalization can permit the lens to rotate, and this helps prevent that. The other strategy, though I don’t use it routinely, is to use a Henderson CTR. This device has undulations in the ring structure and it, theoretically, provides an interface for the haptics to interact with, peripherally, thus preventing a rotational problem. The last strategy—which most surgeons probably won’t want to employ—is to do some form of optic capture,” he continues. “In some circumstances you can consider a reverse optic capture in which the haptics are in the bag and the optic is prolapsed through the anterior capsulorhexis. I tend to avoid this in the Tecnis single-piece family because the optic has fairly thick peripheral structure and has a squared-off anterior and posterior edge, and I want to avoid any potential iris chafe. Other single-piece acrylic lenses from other manufacturers might be more agreeable to this strategy, however. For the Tecnis monofocal toric lenses, I’ve also employed optic capture through a posterior capsulorhexis, both secondarily in patients who experience rotation and in primary cases in which I want to avoid rotation. Though this ensures no postop rotation, it’s not for the faint of heart, since you must be willing and able to perform a posterior capsulorhexis.”

To aid in the implantation of the new toric Symfony, Abbott offers an online calculator. Visit it at https://www.amoeasy.com. 

新眼光眼科診所   官網

新眼光眼科診所   粉絲團

 

微創白內障手術~精準同步治療近視、遠視、散光、老花

(手術影片5:15)

(手術影片5:15)

植入高階多焦點散光人工水晶體(PhysIOL FineVision Trifocal Toric IOL)，藉由威力揚定位系統(VERION Image Guided System)在手術中可精準植入高階多焦點散光人工水晶體，期待能達到最正確的手術矯正治療。植入高階多焦點散光的人工水晶體，如果沒有對準到視軸中心(Visual axis)，或是散光軸度(Astigmatism axis)沒有對準，將會使多焦點散光人工水晶體的效果大打折扣，相當可惜。

 

(手術影片5:15)

 

(手術影片5:15)

 

新眼光眼科診所   官網

新眼光眼科診所   粉絲團

 

 

 

嬰幼兒童視力篩檢新時代來臨了-光導波折射驗光儀(ADAPTICA 2 WIN)

     

嬰幼兒童視力篩檢新時代來臨了-光導波折射驗光儀(ADAPTICA 2 WIN) 

本診所於2017年6月購進專門檢查嬰幼兒童視力屈光度數的儀器-『光導波折射驗光儀』(ADAPTICA 2 WIN)，能檢測出3個月大至3歲的嬰幼兒視力狀況，提早發現弱視及斜視(Ambyopia/Strabismus)的可能，可以量出近視(myopia)、遠視(hyperopia)、散光(astigmatism)、瞳孔距離(pupil distance)、眼位注視…等數據。

  

檢查過程為全自動拍攝，由醫師親自操作，有音樂可以吸引小兒注意，成功率及準確度近98%。此檢查屬預防保健項目，因此健保並無給付，自費檢查費用約NT 1000元，檢查結束後會列印報告，供家長參考及保存。 

 

新眼光眼科診所   官網

新眼光眼科診所   粉絲團

參考資料

The 2WIN main applications:

• Binocular refraction measurement in natural vision conditions.
• Refractive errors – Myopia, hyperopia, astigmatism and other amblyogenic factors. Un-aided binocular refraction of all other patients.
• Refraction of infants and children from 2 months of age, seniors, impaired and non-cooperative patients.
• Early detection and documentation of multiple amblyogenic factors. Un-aided binocular refraction of all other patients.
• Sight anomalies that may be related to anisometropia, anisocoria, strabismus, phoria.
• Pupil parameters – pupil size, pupil distance and head tilt.
• Automatic measurement of dynamic pupils response to programmable light stimulations.
• Over-refraction with glasses or contact lenses.
• Lens centering on spectacle frames.

Extended Range Refraction and Zoom [EZ-App]

The 2WIN measures spherical power in the range of -15D to +15D, being the only mobile, hand-held instrument to provide such extended measurement range.

The 2WIN measurement principle is eccentric photo-retinoscopy. InfraRed (IR) light is projected through the patient pupils and onto the retina. Depending upon the refractive error, the reflected light forms a specific crescent-shaped brightness pattern within the pupil. The 2WIN measures spherical power, cylinder power and axis by interpreting the reflected light crescent pattern and position.

Zoom of InfraRed Retinoscopy Images

Automatic zoom of InfraRed retinoscopy enables detection of artifacts due to other abnormalities (opacities such as cataracts, foreign bodies, etc.).

Corneal Reflexes Application [CR-App]

Thanks to the “Analysis of Corneal Reflexes”, the 2WIN can help your daily work by automating the analysis of refraction with a documented information of phorias and tropias (horizontal and vertical). This application provides complete information regarding the position of corneal reflexes.

Dynamic Pupillometry [DP-App]

Automatic measurement of dynamic pupil response to programmable light stimulations enables the detection of subtle pupillary changes, removing subjectivity from the pupillary evaluation.

Intermediate Distance Application [66cm-App]

Thanks to the 2WIN application “Intermediate Distance”, it is possible to identify the difficulties in focusing at VDUs Distance and to estimate the power of the additional lens needed on top of the prescription.

The 2WIN measures the patient’s refraction while reading from VDUs, at a distance of 66 cm (2’). In all those cases when reading at such distance proves difficult, the 2WIN calculates the necessary additional power (ADD) to restore the best vision. The application requires the use of an additional lens that is inserted in the central aperture of the 2WIN; the additional add-on lens together with a 66 cm reading chart compose the kit.

Lens Centering on Frames [LC-App]

This feature allows to accurately center spectacle lenses with reference to the actual visual axis of the eye (cornel reflex) for better vision comfort.

http://www.adaptica.com/products/2win/

     

美食街之白內障手術大成功~

美食街之白內障手術大成功~

白內障手術植入多焦點人工水晶體也可以順帶一起矯正老花眼

(影片4:28)(影片含手術過程)

 ----客製化微創小切口白內障追蹤定位手術，精準 計算及植入矯正老花的人工水晶體---Customized Phacoemulsification with VERION^™ Image Guided System and AutoSert IOL Injector---Micro-incision Cataract surgery   

張女士平時在百貨公司美食街擔任清潔人員，這半年來，因為常常看不清楚，工作起來很吃力，甚至收碗盤時及清潔桌椅時都看不清楚，常覺得桌子怎麼老是擦不乾淨，工作起來大不如以前的俐落。於是到我們眼科求診，被診斷是白內障問題，病人也想藉著這次白內障手術植入高階人工水晶體，一併解決遠視、老花眼的問題，對術後的效果心中充滿期待。

  

(影片4:28)(影片含手術過程)

藉由威力揚定位系統(VERION Image Guided System)在手術中可精準植入高階多焦點人工水晶體，期待能達到最正確的手術矯正治療。植入高階多焦點的人工水晶體，如果沒有對準到視軸中心(Visual axis)，將會使多焦點人工水晶體的效果大打折扣，相當可惜。

張女士在術後第1週回診，經檢查結果左眼視力看遠、看近皆可達1.0 (20/20)，張女士覺得視力看遠看近都變好，現在工作上更得心應手，也更有自信，既使已經62歲，現在的視力甚至比一些年輕的同事看得更清楚，她非常滿意這次的老花眼、白內障手術效果，很感謝新眼光醫療團隊的細心照顧與治療。

 (影片4:28)(影片含手術過程)

(白內障手術前,水晶體呈琥珀白色混濁)

 

(白內障手術後,清晰可見高階人工水晶體的多焦點繞射環)

參考資料：

Horizontal phaco chop makes cataract surgery more efficient with less ultrasonic energy

Learning phaco chop is a straightforward transition for experienced surgeons who use the divide-and-conquer technique.
Uday Devgan, MD

More than 20 years ago, Dr. Kunihiro Nagahara described the technique of phaco chop, which transformed cataract surgery by making it more efficient. His idea was simple: Use mechanical energy to break the cataract nucleus into smaller pieces instead of using the standard divide-and-conquer technique. Phaco chop requires less ultrasonic energy to disassemble the nucleus, and that means less damage to the delicate corneal endothelial cells, which makes for less inflammation and a faster postoperative recovery.

About phaco chop

Although the technique seems difficult, it is actually surprisingly simple to learn. Despite this reasonable learning curve, many cataract surgeons have not adopted this technique. During the course of the past 15 years, I have taught phaco chop to resident surgeons as part of their surgical training. Surgeons who currently use the divide-and-conquer technique are already adept at having a second instrument in the eye for the cracking portion of the nucleofractis technique. Learning phaco chop is a straightforward transition for these experienced surgeons.

The classic Nagahara technique is a horizontal chop, which means that the principal plane of movement is horizontal, parallel to the iris and lens surface. This is different from a vertical chop technique, whereby the goal is to propagate a crack vertically, toward the posterior capsule. For this article we will focus on the horizontal chop, which is suited to a wide range of nuclear densities and works well with most chopping instruments.

The only additional instrument that is needed is the chopper. This instrument has a tip that is just a few millimeters long in order to avoid touching the posterior lens capsule when the chopper is placed at the nucleus equator. The phaco platform settings must be adjusted so that the phaco probe is able to securely hold the cataract nucleus as the chopper divides it. This means that the vacuum level should be increased to 300 mm Hg to 500 mm Hg, depending on the size of the phaco tip, with a larger tip requiring less vacuum pressure than a smaller one. The flow rate and the bottle height/infusion pressure should be balanced and at a moderate range in order to facilitate nuclear fragment removal. Ultrasonic phaco power depends on the density of the nucleus, with a denser nucleus requiring more power.

The technique

Once the capsulorrhexis is created and hydrodissection is performed to mobilize the nucleus, the first move, which is also the most critical, is the proper placement of the chopper. This instrument needs to be placed around the lens equator, under the capsulorrhexis edge, and this view may be obscured by the iris if it is not maximally dilated. For beginners, I suggest sliding the chopper along the anterior surface of the lens and then pushing the capsulorrhexis edge until the chopper tip reaches the lens equator. At this point, the chopper will slightly drop as it reaches the lens equator and the capsulorrhexis will snap back into position. This is the correct placement of the chopping instrument, and it can be placed before impaling the nucleus with the phaco probe.

More experienced surgeons will simply tilt the chopper tip on its side and then pass it toward the lens equator, and once there, they will straighten the chopper so that it is in position. In order to chop the nucleus, we must fixate and stabilize it. This is done by burying the phaco tip into the nucleus and using the high vacuum level to hold it still. Now the chopping maneuver takes place by bringing the chopper toward the phaco probe to start a fracture in the lens nucleus. Then, the force vector shifts by about 90°, and the chopper is used to pull the two nuclear pieces apart. The fracture propagates through the entire nucleus, and two clean halves are created. At this point, the nucleus halves can be further chopper into quadrants or sextants.

As surgeons become more adept at this maneuver, a few subtle improvements can be incorporated. These include placing the chopper at the same time as the phaco probe impales the nucleus; chopping during the initial application of power as the phaco tip is being buried in the nucleus; using the phaco probe to push one nuclear half away from the other to facilitate the propagation of the nuclear split; and angling the phaco probe during sub-chops so that nucleus rotation can be minimized.

While we now have femtosecond lasers that can also divide the cataract nucleus into fractions, the horizontal phaco chop technique can achieve the same results more efficiently with less time and with a small degree of mechanical energy. This is a technique that has stood the test of time and has made cataract surgery more efficient and more enjoyable for the surgeon as well as the patient who gets the benefit of a minimally invasive technique and excellent visual results.

 

_{http://www.healio.com/ophthalmology/cataract-surgery/news/print/ocular-surgery-news/%7Bbea745da-ed27-45c8-93dd-bfbad8660ee1%7D/horizontal-phaco-chop-makes-cataract-surgery-more-efficient-with-less-ultrasonic-energy}

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白內障手術後,輕鬆看清遠、中、近 ---精準植入法西歐帕德多焦點人工水晶體

白內障手術後，輕鬆看清遠、中、近 

 ---精準植入法西歐帕德多焦點人工水晶體

  手術影片3:59

 手術影片3:59

客製化微創小切口白內障追蹤定位手術---

    精準植入法西歐帕德多焦點人工水晶體

Customized Phacoemulsification with VERION^™ Image Guided System and AutoSert IOL Injector---

PhysIOL FineVision Trifocal IOL for Micro-incision Cataract surgery

March. 27. 2017

60歲的朱女士，因為一直以來的800度高度近視，常常覺得看遠不夠清楚，看近又因為老花眼越來越加重，上班時看電腦、文件更覺得吃力，面對做了30幾年的熟悉工作，還是因為眼睛狀況不好，感到越來越吃不消，只好無奈提早申請退休！

因為這樣的困擾來到我們診所求診，幸運的是沒有其他視網膜疾病的影響，所以植入高階特殊功能多焦點人工水晶體(FineVision Trifocal IOL)可預期會有很好的效果，更藉由威力揚定位系統(VERION Image Guided System)，在手術中使多焦點人工水晶體精準定位置中，期待能達到最精準的手術矯正治療。植入多焦點的人工水晶體，如果沒有正確中心置位，也就是沒有置放在視軸中心(visual axis)，這將會使多焦點人工水晶體的效果大打折扣，相當可惜！

朱女士在術後第1週回診，經檢查結果雙眼視力看遠、看中、看近皆可達1.0 (20/20)，手術後視力變得非常清晰，日常生活也方便許多，她非常滿意這次的老花眼、白內障手術效果，直說自己實在太早退休了，覺得手術完的眼睛比十年前看得還清楚，原來現在最新的白內障手術是這麼精準又快速呀！

手術影片3:59

 

手術影片3:59

參考資料：

 Justification of the trifocality

Bifocal diffractive IOLs allow operated patients to some spectacle independence for distant (more than 2 meters) and near (between 35 and 40 cm) vision. These lenses have however not been shown to provide satisfactory intermediate vision.

Intermediate vision relates to activities such as computer work, car driving (instrument panel), music playing (musical chart), etc. In these activities for which good uncorrected vision is required for distances comprised between 60 and 80 cm) glasses may be required despite satisfactory near and distance uncorrected vision. Interestingly, the commercial release of the FineVision IOL was concomittent to the introduction of the iPad in the USA (march 10). Tablets are way heavier than books, and readers usually hold them on their laps, which increases the reading distance to the intermediate vision range (60 – 70 cm).

 

https://www.gatinel.com/recherche-formation/trifocal-implant-cataract-iol/

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白內障要等到『熟』才能開？？？

白內障要等到『熟』才能開？(手術影片9:04)

我們醫學上講熟的白內障(mature or hypermature cataract)是指放到幾乎完全失明嚴重型白內障，以現代小切口微創白內障超音波手術來說，只是增加手術醫師的困難度及手術風險，而且當白內障嚴重到一定程度，並不是拖延可以改善的，終需要面對它。

古時候的人說白內障要等到『熟』才能開！是果子『熟』了才能摘嗎？—其實只是增加手術的困難度及風險，而且忍著看不清楚的日子，撐到有一天還是要處理它的。  

過熟型白內障的定位微創手術 20161221 (手術影片9:04)

驚恐!!無比強大的台灣健保

  驚恐!!無比強大的台灣健保  

 

今天我們醫師發現這瓶德國(Germany)的進口藥---『Allergopos』：不含類固醇、用來治療過敏結膜炎的藥水，竟然健保署只給付52元給醫療院所！看它精緻的藥水瓶材質及外觀，我們每個使用的患者都對藥水的效果及舒適度好評不斷，我們醫師還以為這一瓶眼藥水藥價要200元以上呢！！

   

想想德國藥廠團隊研發、製造、量產、包裝、運抵台灣..…這一瓶品管優異的進口眼藥水，竟讓英勇無敵的健保將給付的金額壓制剩52元，臺灣健保真是太強大！

在逐年砍價之下，這些優良外商，最後可能都會選擇不進入台灣醫療市場，⋯

精準矯正散光的度數---可以使白內障老花眼手術更加完美

精準矯正散光的度數

       ---可以使白內障老花眼手術更加完美 

 手術影片(5:55)

曾女士是一位70歲的虔誠基督徒，每週都會到教會做禮拜，這半年來，因為在教會聽牧師講道時看不清楚牧師的臉，唱聖詩的時候即使戴上老花眼鏡也看不清楚歌譜，看遠看近都不清楚實在讓她非常苦惱，因此到我們眼科求診，當下被診斷有白內障，加上病人本身就有老花眼、遠視、及散光，所以想藉著這次白內障手術植入高階五合一人工水晶體，一併解決遠視、散光、老花眼的問題。

經過蕭醫師詳細眼科檢查，包括：裂隙燈檢查Slit Lamp、視野檢查Visual Field、視神經視網膜斷層掃描Optical Coherence Tomography；OCT、眼前房斷層掃描Pentacam、光學生物測量儀Lenstar LS900、眼球結構超音波A-Scan Sonography、眼底散瞳檢查……等等，認為她是單純白內障問題，因此建議可植入五合一多焦點人工水晶體(ReSTOR TORIC IOL)，藉由 貝爾特(Barrett Toric Algorithm)散光計算公式及威力揚定位系統(VERION Image Guided System)在手術中可微調出精細的散光度數及軸度，期待能達到最精準的手術矯正治療。植入多焦點的人工水晶體，如果沒有調整到正確的散光軸度及度數，將會使多焦點水晶體的效果大打折扣，相當可惜。

曾女士在術後第1週回診，經檢查結果右眼視力看遠、看近皆可達1.0 (20/20)，曾女士覺得視力看遠看近都變好，散光精準矯正後視力變得非常清晰，現在在教會做禮拜時，連聖經裡小小的字都可以看得很清楚，聖詩的歌譜當然更沒問題，日常生活也方便許多，她非常滿意這次的老花眼、散光、白內障手術效果，很感謝新眼光醫療團隊的細心照顧與治療。

   

參考資料

Dr. Barrett said that it is unique because it takes into account the posterior cornea and considers lens position for each individual patient versus using what is known about the average eye. My formula uses the Universal II, which is a method of predicting IOL power to work out where the lens is and uses that to calculate what is the effect of the cylinder power at the cornea.

The toric calculator by Barrett is based on his well proven Universal II formula.

a. Dynamic calculation of the lens position for cylinder power transformation to the corneal plane as well as consideration of the anterior and the posterior corneal curvature for cylinder power and axis calculation.

b. Considering the thickness and shape of the lens as well, which provides a more sophisticated way of predicting and translating the cylinder power, he said.

c. The formula is able to predict posterior corneal curvature without actually measuring it.

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