PL5-1
Improving Surgical Efficiency with Advanced Technology
Dr. David Lubeck
Medical Director, Arleo Eye Institute
formerly Eye Physicians and Surgeons of Ithaca
The technologies available for phacemulsification today greatly contribute to more efficient, more reliable and safer surgery with better surgical outcomes.
The superior fluidic performance of our latest generation technology phacoemulsification system enables us to better utilize Vacuum and flow rates for lens removal. In some cases we achieve vacuums in excess of 600mmHg and use extremely fast rise times, yet we are able to minimize actual flow rate through the anterior chamber. When this technology is properly used it dramatically improves the efficiency of the lens emulsification and evacuation. In some case we can virtually eliminate our use of ultrasound power for lens removal.
Alternative energy removal modalities such as sonic oscillations (NeoSoniX) have proven to be a useful complement to ultrasound. The oscillations contribute to the overall reduction of ultrasound power by reorienting the lens material on the phaco tip. This is particularly effective for evacuating harder lens fragments during the Quadrant Removal or Chop phase of the procedure.
More recently we’re having great success using AquaLase technology for lens removal. I’ve successfully combined a Pre-Chop technique with the newly designed AquaLase Tip. This has provided a significant improvement in surgical efficiency. I’ve been very pleased with the safety profile and surgical results.
Advancements in Dual Bevel and High Performance Steel Blade Keratomes and Sideport Knives enable us to achieve much better wound construction. This helps minimize wound leakage as well as to reduce BSS volume and turbulence. All these factors contribute to a more predictable surgery and better outcomes.
The combined use of a Dispersive and Cohesive Viscoelastic enables us to provide optimal endothelial protection while achieving necessary space maintenance. Very shortly we’ll have one viscoelastic product that for the first time is going to effectively fulfill both roles.
Finally, one of the most exciting developments has been the 2.2mm Coaxial Incision Phaco system. This micro-coaxial approach provides us the ability to deliver a 6.0mm State of the Art Aspheric Single-Piece Natural Lens through a 2.2mm incision We are consistently getting superb results with the new Apodized lens technology and are anxiously awaiting the Natural Version.
Proper selection and use of improved surgical tools along with sound surgical technique enable us to perform surgeries with few to no complications. This means higher efficiency and effectiveness which translates to better immediate and long-term patient post-operative outcomes for our patients.
PL5-2
Beyond the ISCEV Standard: extended electrophysiological techniques in the diagnosis of retinal disease.
Graham E Holder, Moorfields Eye Hospital, London, UK
In 1989, the International Society for Clinical Electrophysiology of Vision (ISCEV) introduced a Standard for the performing of clinical electroretinography (ERG). This proposed a minimum data set that should be obtained from all patients, and included a rod specific ERG (dim flash, dark adapted eye); a Standard response (mixed rod-cone, bright flash, dark adapted eye); and two measures of cone function, the response to a 30Hz flicker stimulus and a single flash ERG, both obtained in fully photopic conditions using a rod-suppressing background.
The presentation will address the use of ERG in the diagnosis of retinal disease by using illustrative cases. The results of other investigations, such as fundus autofluorescence imaging, will be shown where appropriate. In addition, the limitations of the Standard will be discussed using clinical examples to show how additional recordings or techniques may be needed, and that ERG recording restricted to the basic Standard responses can even result in misdiagnosis. These additional techniques will include ON-/OFF- response recording, S-cone ERG recording, and the use of extended dark adaptation or altered inter-stimulus intervals.
PL5-7
Latest Advances in Lamellar Keratoplasty
Professor Donald Tan, FRCSE FRCSG FRCOphth FAMS
Deputy Director, Singapore National Eye Centre
Director, Singapore Eye Research Institute
Professor and Head, Dept of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore
Corneal transplantation is one of the most frequently performed, and successful forms of organ transplantation today, and several long-term corneal transplant registries, mainly in the West, are now in existence. The Singapore Corneal Transplant Study (SCTS) was initiated at the Singapore National Eye Centre in 1991, and SCTS now represents the only large, long-term Asian corneal transplant database in existence. SCTS consists of over 1700 corneal transplants spanning a period of 15 years (1991-2006), and detailed analysis to ascertain risk factors for graft success and failure are underway. The overall success rate of corneal transplants are equivalent to the best results in the West, with 1 year graft survival of 91%.
Recent advances in transplantation surgery are now enhancing success rates. A clear shift to lamellar keratoplasty (LKP) procedures has occurred over the last decade, and one in five transplants performed at our centre are now lamellar keratoplasty procedures. Modern indications include anterior stromal and posterior stromal/descemet’s replacement, the salvage of refractive surgery disasters, and tectonic and therapeutic indications, and analysis of our SCTS data confirms enhanced graft survival and success in LKP procedures as compared to penetrating keratoplasty (PKP). New surgical techniques of lamellar surgery include total anterior stromal replacement (Deep Lamellar Keratoplasty – DLKP), microkeratome-assisted anterior and posterior lamellar surgery, and the recent advent of new femtosecond lasers with enhanced surgical precision, leading to enhancement of refractive and visual results. New developments in lamellar keratoplasty are transforming the surgical field of corneal transplantation, and will lead to enhanced visual and long-term success in the alleviation of corneal blindness.
PL5-8
液相芯片技术在眼科临床及科研工作中的应用
胡诞宁
New York Eye and Ear Infirmary, New York Medical College, New York, USA
液相芯片指用荧光编码微球及悬浮芯片原理进行多种生物分子测定的一种新颖技术,具有高通量及自动化的特点,能在短时间内检测一个标本内多种分子,快速､灵敏､准确,尤其是所需标本量很少,非常适合眼科应用｡
本法原理是在荧光编码的高分子微球上交联各种探针,制成悬浮液,加入标本,待测的分子与微球上的探针结合,使之呈色｡应用流式细胞仪的双激光读出微球种类及其荧光强度,与标准分子的剂量-荧光强度曲线进行比较,即可自动算出标本内各种分子的含量｡目前应用较多是测量蛋白,也可用于测量mRNA｡
近年我们应用Luminex100仪,STarStation程序及Bioscience的多种细胞因子微球,一次可测定Il-1, IL-1Ra, IL-2, IL-2Ra, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-15, IL-17, TNFα , IFNα , IFNγ, GM-CSF, MIP-1α, MIP-1β, IP-10, MIG, Eotaxin, RANTES, MCP-1等25种细胞因子的含量,灵敏度达pg级｡已在临床上用于检测各种眼病时(尤其是葡萄膜炎)房水及玻璃体内细胞因子今量,只需50微升标本,在5小时内就可一次测出上述25种细胞因子的含量｡对于研究葡萄膜炎发病机制,作出临床诊断､分类､鉴别诊断､评估病情､预后及治疗效果都有重要意义｡
在科研工作中己用于研究各种细胞表达及分泌上述25种细胞因子的功能及其调控｡通过对人类视网膜色素上皮细胞的研究,发现该细胞能分泌22种细胞因子,其中6种是以前尚未报告的。对人类葡萄膜黑色素皮细胞的研究，首次发现该细胞能分泌多种细胞因子，指示该种细胞在眼部炎症及免疫反应中起到重要作用。
本法还可用于病原体及其抗体、生长因子、金属蛋白酶、雕亡基因等的检测，在眼科具有广阔的应用前景。
PL5-3
Treatments of macular hole retinal detachment due to high myopia-A comparison of various surgical techniques in the past decade
Jorn-Hon Liu
Cheng Hsin General Hospital, Taipe
PL5-4
PREVENTION OF RHEGMATOGENOUS RETINAL DETACHMENT
Norman e. Byer, m.d.
The era of successful treatment of retinal detachment began with the work of jules gonin of switzerland about 80 years ago. Because certain retinal lesions could be seen to be associated with retinal tears, the idea soon arose that perhaps if these lesions, seen in other eyes before retinal detachment, could be treated in some manner, it might be possible to prevent later detachment. Various methods were tried beginning in the 1930s with diathermy (electrocautery). This was later replaced with xenon photocoagulation, and still later by cryotherapy and laser photocoagulation. This became the worldwide standard of treatment for many years. This was especially true in the case of “fellow” eyes of patients who had already suffered retinal detachment in their primary eyes. The lesions that were considered particularly suspicious included all retinal breaks (of all types), lattice degeneration, cystic retinal tufts, and senile (acquired) retinoschisis.
This concept of treating these lesions in order to “prevent” retinal detachment rested on three assumptions, which unfortunately had not been well established by natural history studies. These assumptions were that: 1) the incidence of fellow eye detachments was from 20% to 50%; 2) these abnormal lesions were the sites at which new retinal breaks were going to occur; and 3) the treatment of these lesions would significantly reduce the incidence of fellow-eye detachments. Later long-term natural history studies revealed that these three earlier assumptions were greatly exaggerated, and were not accurate. The actual facts are that: 1) the incidence of fellow-eye detachments is no greater than 5%; 2) in as high as 80% of fellow eyes, the causative retinal breaks occur not at these visible lesions, but in areas of the retina which appear normal; and 3) the incidence of retinal detachments in fellow eyes is reduced only very slightly, if at all.
In conclusion it has now been well established that rhegmatogenous retinal detachment cannot be significantly prevented by so-called “prophylactic” treatment of visible pre-existing lesions of the retina. However many detachments can be prevented by a different approach altogether. This is achieved by the prompt diagnosis of acute posterior vitreous detachment in patients who notice new “floaters” or “light flashes” in their vision. Such patients should be carefully examined with indirect ophthalmoscopy and scleral indentation, to discover any new tractional retinal tears. Such tears should then be immediately treated with either laser photocoagulation or with cryotherapy. Among such patients this treatment can reduce the incidence of retinal detachment from about 35% to less than 5%. This is the only proven method of preventing retinal detachment, and should now be considered to be the accepted standard of treatment for the prevention of this blinding disease.
PL5-5
arget IOP and Glaucoma: Brief Remarks
Pei-fei Lee, MD
Albany, NY 8-8-06, USA
It has been stated that "the things you have learn after you think you know it all are the most important". It is true in life, medicine and teaching especially in the understanding and management of glaucoma. I would like to point out a couple of facts which I have learned after 50 years of glaucoma practice which also confirming the teaching of Dr. Paul A Chandler , a great teacher in the field of clinic glaucoma: 1. Sufficient pressure lowering can halt glaucoma damage and 2. the more the optic nerver damage the lower IOP is required.recent literature reported the elevated IOP and a wide range of IOP variation are the major risk factors for glaucoma progression. However, the standard clinic follow-up evaluations performed today are insufficient to identify these phenomena. Detailed total patient and ophthalmological evaluations, family history, social, and side-effects of medications are important criteria in order to establish a proper target IOP and to stablize glaucoma individually. A proper target IOP range considerations in identifying for stable glaucoma control are many: the patient’s general health, overall eye status , their normal level of IOP variations and status of the optic nerve and visual field. To identify and establishing the individual Target IOP is one of most important factor in glaucoma control.
PL5-6
Sweet Hyperopia: Refractive Changes in Acute Hyperglycemia
Ping-I Chou , MD1; Ming-Cheng Tai, MD1; Da-Wen Lu, MD,Ph.D1 Liang-yen Wen, MD
1Department of Ophthalmology, Tri-Service General Hospital,
National Defense Medical Center,Taipei, Taiwan
Department of Ophthalmology,Tri-Service General Hospital,325, Cheng-Kung Rd. Sec. 2,Taipei 114, Taiwan,Republic of China.
Purpose: A prospective study was performed to evaluate refractive and ocular biometric changes in acute hyperglycemic status in patients with diabetes mellitus.
Methods: From January to August 2002, 48 eyes of 24 patients with persistent diabetes and a plasma glucose level ≥17 mmol/l or HbA1c ≥10.0% on admission were enrolled in this prospective study. Upon admission to Tri-Service General Hospital in Taipei, Taiwan, these patients underwent intensive glycemic control. The basic ophthalmic examinations, including visual acuity, intraocular pressure measurement, slitlamp, and fundus examinations were conducted. The ocular parameters including refraction, anterior chamber depth, lens thickness, axial length, mean keratometry, and thinnest corneal thickness were evaluated by A-mode scan and Orbscan II. Each patient underwent clinical follow-up visits at 1, 2, and 4 weeks after the acute hyperglycemic episode.
Results: Of the 24 patients, 18 were male and 6 were female. The mean age of the patients was 55 years (range: 38-69). Comparing the refractive status on admission and at Week 4, we found 8 cases (16 eyes, 33%) showed hyperopia during hyperglycemia (+1.9±0.8 D), but in the other 16 cases (32 eyes, 67%), there were no significant changes. In addition, there were also no significant changes in anterior chamber depth, lens thickness, axial length, thinnest corneal thickness, or mean keratometry in the follow-up period.
Conclusions: Transitory hyperglycemia produces hyperopia. The alteration in refractive index in the lens may contribute to the hyperopic change, but no change of ocular biometrics in lens or cornea is observed.
PL5-7
Latest Advances in Lamellar Keratoplasty
Professor Donald Tan, FRCSE FRCSG FRCOphth FAMS
Deputy Director, Singapore National Eye Centre
Director, Singapore Eye Research Institute
Professor and Head, Dept of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore
Corneal transplantation is one of the most frequently performed, and successful forms of organ transplantation today, and several long-term corneal transplant registries, mainly in the West, are now in existence. The Singapore Corneal Transplant Study (SCTS) was initiated at the Singapore National Eye Centre in 1991, and SCTS now represents the only large, long-term Asian corneal transplant database in existence. SCTS consists of over 1700 corneal transplants spanning a period of 15 years (1991-2006), and detailed analysis to ascertain risk factors for graft success and failure are underway. The overall success rate of corneal transplants are equivalent to the best results in the West, with 1 year graft survival of 91%.
Recent advances in transplantation surgery are now enhancing success rates. A clear shift to lamellar keratoplasty (LKP) procedures has occurred over the last decade, and one in five transplants performed at our centre are now lamellar keratoplasty procedures. Modern indications include anterior stromal and posterior stromal/descemet’s replacement, the salvage of refractive surgery disasters, and tectonic and therapeutic indications, and analysis of our SCTS data confirms enhanced graft survival and success in LKP procedures as compared to penetrating keratoplasty (PKP). New surgical techniques of lamellar surgery include total anterior stromal replacement (Deep Lamellar Keratoplasty – DLKP), microkeratome-assisted anterior and posterior lamellar surgery, and the recent advent of new femtosecond lasers with enhanced surgical precision, leading to enhancement of refractive and visual results. New developments in lamellar keratoplasty are transforming the surgical field of corneal transplantation, and will lead to enhanced visual and long-term success in the alleviation of corneal blindness.
PL5-8
液相芯片技术在眼科临床及科研工作中的应用
胡诞宁
New York Eye and Ear Infirmary, New York Medical College, New York, USA
液相芯片指用荧光编码微球及悬浮芯片原理进行多种生物分子测定的一种新颖技术,具有高通量及自动化的特点,能在短时间内检测一个标本内多种分子,快速､灵敏､准确,尤其是所需标本量很少,非常适合眼科应用｡
本法原理是在荧光编码的高分子微球上交联各种探针,制成悬浮液,加入标本,待测的分子与微球上的探针结合,使之呈色｡应用流式细胞仪的双激光读出微球种类及其荧光强度,与标准分子的剂量-荧光强度曲线进行比较,即可自动算出标本内各种分子的含量｡目前应用较多是测量蛋白,也可用于测量mRNA｡
近年我们应用Luminex100仪,STarStation程序及Bioscience的多种细胞因子微球,一次可测定Il-1, IL-1Ra, IL-2, IL-2Ra, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-15, IL-17, TNFα , IFNα , IFNγ, GM-CSF, MIP-1α, MIP-1β, IP-10, MIG, Eotaxin, RANTES, MCP-1等25种细胞因子的含量,灵敏度达pg级｡已在临床上用于检测各种眼病时(尤其是葡萄膜炎)房水及玻璃体内细胞因子今量,只需50微升标本,在5小时内就可一次测出上述25种细胞因子的含量｡对于研究葡萄膜炎发病机制,作出临床诊断､分类､鉴别诊断､评估病情､预后及治疗效果都有重要意义｡
在科研工作中己用于研究各种细胞表达及分泌上述25种细胞因子的功能及其调控｡通过对人类视网膜色素上皮细胞的研究,发现该细胞能分泌22种细胞因子,其中6种是以前尚未报告的。对人类葡萄膜黑色素皮细胞的研究，首次发现该细胞能分泌多种细胞因子，指示该种细胞在眼部炎症及免疫反应中起到重要作用。
本法还可用于病原体及其抗体、生长因子、金属蛋白酶、雕亡基因等的检测，在眼科具有广阔的应用前景。
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