Developments in ophthalmology最新文献_第2页

Enhanced Trabeculectomy: The Moorfields Safer Surgery System. 强化小梁切除术:Moorfields更安全的手术系统。

Developments in ophthalmology Pub Date : 2017-01-01 Epub Date: 2017-04-25 DOI: 10.1159/000458483

Peng Tee Khaw, Mark Chiang, Peter Shah, Freda Sii, Alastair Lockwood, Ashkan Khalili

{"title":"Enhanced Trabeculectomy: The Moorfields Safer Surgery System.","authors":"Peng Tee Khaw, Mark Chiang, Peter Shah, Freda Sii, Alastair Lockwood, Ashkan Khalili","doi":"10.1159/000458483","DOIUrl":"https://doi.org/10.1159/000458483","url":null,"abstract":"Trabeculectomy with antifibrotic treatment is still the most popular incisional procedure for glaucoma filtration surgery (GFS) worldwide. The advent of antifibrotic agents reduced failure due to scarring but resulted in increased complications. Advances in trabeculectomy surgery have been driven by the need to minimise the risk of: (1) complications and (2) surgical failure. This chapter covers preoperative, intraoperative, and postoperative strategies, which improve the outcome of GFS. Strategies to reduce the risk of complications centre on the prevention of postoperative hypotony by minimising the risk of overdrainage, postoperative wound leaks, and poor bleb morphology. Surgical techniques to reduce the risk of postoperative fibrosis by the use of antifibrotic agents (including mitomycin C) are discussed in detail. These techniques are based on a combination of considerable clinical experience, observation, and laboratory research. The need to address pre-, intra-, and postoperative issues in each individual patient is emphasised. These changes are embodied in the system we call the \"Moorfields Safer Surgery System.\" The use of these strategies has considerably reduced the incidence of major complications, including hypotony, cystic blebs, and endophthalmitis in practices around the world. Most of these techniques are simple, require minimal equipment, and can be easily mastered. They are associated with an improvement in overall outcome and it is hoped that this chapter will help the reader benefit from these advances.","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"15-35"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34941168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 43

Laser-Assisted Techniques for Penetrating and Nonpenetrating Glaucoma Surgery. 激光辅助技术用于穿透性和非穿透性青光眼手术。

Developments in ophthalmology Pub Date : 2017-01-01 Epub Date: 2017-04-25 DOI: 10.1159/000458490

Noa Geffen, Ehud I Assia, Shlomo Melamed

{"title":"Laser-Assisted Techniques for Penetrating and Nonpenetrating Glaucoma Surgery.","authors":"Noa Geffen, Ehud I Assia, Shlomo Melamed","doi":"10.1159/000458490","DOIUrl":"https://doi.org/10.1159/000458490","url":null,"abstract":"The use of lasers is slowly pervading all subspecialties of ophthalmology, especially glaucoma, and lasers are slowly replacing many glaucoma surgeries. Conventional trabeculectomy has so far remained the gold standard for glaucoma surgery and efforts are being made to develop a new surgical approach to overcome the limited success rate and safety issues of this traditional procedure. There is a great interest in using lasers for ab interno and ab externo penetrating and nonpenetrating filtering surgery. Theoretically, laser-assisted surgery offers the potential advantage of improved accuracy, repeatability, and safety, although the main drawback of using lasers for this purpose is the potential collateral damage induced by the scattered energy. Collateral thermal damage adjacent to the sclerostomy site is believed to be detrimental to the long-term success of the filtering procedure. Employing a laser with high water absorbance and low light scattering reduces the extent of collateral thermal damage and improves the long-term surgical success. An increasing number of different radiation sources have been examined for penetrating and nonpenetrating glaucoma surgery with various success rates.","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"100-112"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34942204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Retinal Vein Occlusions. 视网膜静脉阻塞。

Developments in ophthalmology Pub Date : 2017-01-01 Epub Date: 2017-03-28 DOI: 10.1159/000455278

Jost B Jonas, Jordi Monés, Agnès Glacet-Bernard, Gabriel Coscas

{"title":"Retinal Vein Occlusions.","authors":"Jost B Jonas, Jordi Monés, Agnès Glacet-Bernard, Gabriel Coscas","doi":"10.1159/000455278","DOIUrl":"https://doi.org/10.1159/000455278","url":null,"abstract":"Retinal vein occlusions (RVOs) have been defined as retinal vascular disorders characterized by dilatation of retinal veins with retinal and subretinal hemorrhages, macular edema, and a varying degree of retinal ischemia. Retinal angiography, either as fluorescein and indocyanine green (ICG) angiography or in the form of optical coherence tomography (OCT)-based angiography, is essential for the diagnosis and assessment of the prognosis of RVOs. It allows the differentiation of diverse types of RVOs, such as perfused or nonperfused, as well as the detection of different modalities in the natural history of RVOs. OCT angiographic imaging in combination with dye angiography (fluorescein or ICG) is the most effective method to assess the amount and location of cystoid macular edema and the persistence, regression, and degree of ischemia. OCT can additionally display the presence and integrity of the outer limiting membrane and of the inner and outer segments of the photoreceptors as useful biomarkers for the prognosis and as a guide for the treatment of RVO. Due to the relatively often benign and self-limiting course of nonischemic RVOs, therapy may initially be delayed. If macular edema extends into the foveolar region and persists, intravitreal medical therapy including steroids (triamcinolone; fluocinolone or dexamethasone in slow-release devices) and/or anti-VEGF (vascular endothelial growth factor) drugs (bevacizumab, ranibizumab, aflibercept) may be intravitreally administered, avoiding the irreversibly destructive effect of laser coagulation, which previously was applied in a 'grid' pattern over the extrafoveolar leaking area. The side effects of intraocularly applied steroids in relatively young patients including cataract formation and ocular hypertension have to be considered.","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"58 ","pages":"139-167"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000455278","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34862635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Surgical Management of Pediatric Glaucoma. 小儿青光眼的外科治疗。

Developments in ophthalmology Pub Date : 2017-01-01 Epub Date: 2017-04-25 DOI: 10.1159/000458495

Ingrid Chang, Joseph Caprioli, Yvonne Ou

引用次数: 43

Macular Edema of Choroidal Origin. 黄斑脉络膜源性水肿。

Developments in ophthalmology Pub Date : 2017-01-01 Epub Date: 2017-03-28 DOI: 10.1159/000455282

Gisèle Soubrane

{"title":"Macular Edema of Choroidal Origin.","authors":"Gisèle Soubrane","doi":"10.1159/000455282","DOIUrl":"https://doi.org/10.1159/000455282","url":null,"abstract":"Macular edema is most often clinically defined as an accumulation of serous fluid within the neurosensory retina with increased thickness of the central retina. In exudative age-related macular degeneration the leakage of fluid from the choroidal new vessels may be the origin of macular edema. Their abnormal permeability and the inflammatory reaction are mechanisms involved in this accumulation of fluid, which occurs in all layers. Cystoid macular edema is more often associated with subepithelial occult choroidal neovascularization (CNV) than it is with pre-epithelial classic CNV. The simultaneous presence of choroidal new vessels and ME implies a number of cellular dysfunctions especially of Müller cells and subsequently metabolic alterations. The leakage from the choroidal new vessels, predominantly vascular endothelial growth factor (VEGF)-induced, may produce a large accumulation of fluid under the neurosensory retina. It is also likely that the key signaling steps occur prior to the upregulation of VEGF either initiated by, or facilitated by, cytokines, which act under normal basic conditions to counterbalance the integral VEGF effects and, in pathologic circumstances, may either counteract or serve to amplify the process.","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"58 ","pages":"202-219"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000455282","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34862029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Miscellaneous. 杂项。

Developments in ophthalmology Pub Date : 2017-01-01 Epub Date: 2017-03-28 DOI: 10.1159/000455283

Catherine Creuzot-Garcher

引用次数: 0

Central Serous Chorioretinopathy. 中枢性浆液性脉络膜视网膜病。

Developments in ophthalmology Pub Date : 2017-01-01 Epub Date: 2017-03-28 DOI: 10.1159/000455267

Alejandra Daruich, Alexandre Matet, Francine Behar-Cohen

引用次数: 18

Viscocanalostomy and Canaloplasty: ab Externo Schlemm's Canal Surgery. 粘管吻合术和管道成形术:外部施勒姆管手术。

Developments in ophthalmology Pub Date : 2017-01-01 Epub Date: 2017-04-25 DOI: 10.1159/000458491

Matthias C Grieshaber

{"title":"Viscocanalostomy and Canaloplasty: ab Externo Schlemm's Canal Surgery.","authors":"Matthias C Grieshaber","doi":"10.1159/000458491","DOIUrl":"https://doi.org/10.1159/000458491","url":null,"abstract":"Ab externo Schlemm's canal (SC) surgery (e.g., viscocanalostomy and canaloplasty) is a valuable alternative to glaucoma filtration surgery. It targets the abnormally high resistance to outflow in the trabecular meshwork (TM) and reestablishes the physiologic outflow system. In viscocanalostomy, viscoelastic substance is injected to dilate SC, which in turn leads to microdisruptions of the inner wall. In canaloplasty, the additional intracanalicular stent (suture or Stegmann Canal Expander®) keeps the canal patent and enhances the circumferential flow. A prerequisite for these procedures to work is the integrity of the distal outflow system, which can be evaluated by 2 clinical tests before surgery: provocative gonioscopy with blood reflux, and fluorescein channelography. Ab externo SC surgery is suitable for open-angle glaucoma, but also for angle closure glaucoma in combination with cataract extraction. Intraocular pressure reduction to the mid-teens for viscocanalostomy and to the lower-teens for canaloplasty can be expected. The majority of complications seen in filtering surgery are largely eliminated by the nonpenetrating and bleb-independent approach. Postoperative care is minimal as no bleb management such as needling is required, and hypotony-related complications are largely avoided by the intrinsic resistance of the physiologic outflow system. With its efficacy and high safety profile, ab externo SC surgery will continue to play an increasing role and will change the current concept of glaucoma surgery towards earlier intervention. Surgeons will be well advised to implement these antimetabolite-free procedures into their armamentarium to meet the expectations of the demanding glaucoma patient.","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"113-126"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34942205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 17

Surgical Treatment of Angle-Closure Glaucoma. 闭角型青光眼的手术治疗。

Developments in ophthalmology Pub Date : 2017-01-01 Epub Date: 2017-04-25 DOI: 10.1159/000458493

Dawn Lim, Maria Cecilia Aquino, Paul Chew

引用次数: 0

Surgical Management and Techniques. 手术管理和技术。

Developments in ophthalmology Pub Date : 2017-01-01 Epub Date: 2017-04-20 DOI: 10.1159/000459702

Marco Codenotti, Lorenzo Iuliano, Gisella Maestranzi

引用次数: 3