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EyeWorld Chinese March 2022 Issue

复杂病例治疗策略 The Asia-Pacific Association of Cataract and Refractive Surgeons 中文版 eyeworldap.apacrs.org 第十八卷 第1期 2022 年 3 月 亚太白内障及屈光手术医师学会杂志 Licensed Publication

EWAP 2022年3月 3 Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific • China • Korea • India 编者信 EyeWorld • 亚太中文版 • 2022年 3月 • 第十八卷 第1期 本期杂志对术中屈 光导航系统及其 临床应用进行 了有趣的讨论。与其他地区相 比，亚太地区的白内障手术实 践模式通常很相似；然而，偶 尔也会有差异，比如亚太地区 与其他地区相比，散光人工晶 体的使用有所增加。 与美国相比，术中像差测 量是我们临床中很少使用的另 一项技术。发表的比较术中像 差测量在预测屈光结果方面的 疗效的结果是不一致的，最近的文章表明，准确的术前测量联合 使用现代化公式，球镜结果即使不优于也等于术中进行像差测量 的结果。 散光人工晶状体预测的准确性并不更具优势，使用术中像差 仪来确定轴位的频率相对较低,尽管一些美国手术医生对此很感 兴趣。这种差异部分可以由低度数散光人工晶体的相对使用频率 来解释。T2等低度数散光IOL 在美国尚不可用，但在新加坡和澳 大利亚等国家更为常见。在这种情况下，眼表和开睑器对手术的 干扰可能会影响术中像差测量轴位的可靠性。在高散光度数的散 光晶状体占主导地位的情况下，术中验光可能更可靠。 有过屈光手术史的患者的预后预测可能具有挑战性，建议进 行眼内像差测量。同样，没有迹象表明它比仔细的生物测量联合 现代化屈光术后公式更准确。报销的差异和收取额外费用的机会 也可能影响术中像差测量的普及。 然而，图像引导对齐在亚太地区非常流行。可使用不同的系 统，包括Calisto 和Verion，这些都是确定散光IOL 正确轴位的 有效方法。意外的识别问题相对较少，但手术医生应谨慎避免因 错误的图像采集而导致轴位错误。在我看来，使用toricCAM 等 应用程序精确确定参考轴的简单方法更可靠。我的临床中是使用 这两种方法来避免图像引导系统的技术问题和手术医生设置轴位 时的错误。使用这两种技术可以更可靠地确保散光晶状体轴位放 置的准确性，确保散光人工晶状体植入术后意外残余散光不成为 主要问题。 本期亚太版EyeWorld 正逢新冠病毒大流行2 年。我们对抗 Omicron 变异株时，倍感疲劳，幸运的是，它似乎没有以前的 变异株那么严重。在这场大流行期间，我们的新闻杂志一直保持 初衷，我们举办了虚拟会议，让我们可以随时获取信息并保持联 系。期待6 月份在韩国举行的下一次会议，届时我们可以面对面 会见旧识重续友情。 亲爱的读者朋友们， 爆竹声中一岁除，春 风送暖入屠苏”又 是新的一年，亚太 版Eyeworld 愿大家平安，健 康，彻底摆脱新冠的阴影，恢 复正常的交流和沟通。 本期杂志白内障专题的主题 是复杂病例的处理，内容涉及 负性眩光的处理策略；如何为 那些既往被认为不适合植入高 端晶状体的眼选择高端IOL；如 何满足角膜嵌体术后患者的屈 光需求；以及如何通过术前筛 查可能的影响视功能的因素， 提高手术技巧减少术中并发 症，利用术中导航系统等手段 提高白内障手术的预后。白内 障领域的专家对这些内容进行 了详细的分析和讨论，具有很 强的临床指导价值。 屈光专题重点介绍了LASIK 术后患者不满意的因素和处理原 则以及屈光性晶状体置换的策略。本期杂志特别介绍了近视防控 的最新进展。近视，尤其是高度近视是严重威胁视功能的疾病， 东亚学龄儿童的近视患病率高度73%，如何预防近视的发生发展 是眼科领域的重要任务。本期杂志的《阻止近视进展》一文详细 讨论了现有的近视防控措施以及效应，并介绍了最新的近视研究 结果。 角膜专题，除了讨论了DSAEK 及DMEK 移植片脱离处理策略 及单纯后弹力层剥离术的新进展以外，还特别讨论了“眼疼”。 “眼疼”是常见的眼科症状，也经常会有症状和体征分离的现 象。仔细分析病因，寻找适当的治疗手段非常重要。感兴趣的朋 友可以阅读本期杂志的“如何处理‘没有染色的疼痛’”。 青光眼是一种进行性疾病，许多病例不能通过药物和激光控 制疾病进展，而最终需要手术治疗。MIGS 手术是近年来青光眼 领域的热门话题，但是从控制眼压的疗效角度看，传统滤过手术 包括引流管手术仍然是手术金标准。因此滤过泡的处理，引流管 暴露是青光眼永远的话题。本期杂志对这些内容进行了讨论，希 望所有眼科医生能够牢记这些风险，在青光眼患者的随访中保持 警惕。 希望我们的杂志能给大家的临床工作带来一定的帮助！ 姚克 教授、主任医师 亚太白内障及屈光手术学会 候任主席 中华医学会眼科学分会 主任委员 EyeWorld中文版 执行主编 浙江大学眼科研究所 所长 浙江大学眼科医院 院长 浙江大学医学院附属第二院 眼科中心主任

4 EWAP 2022年3月 CONTENTS 专题 复杂病例治疗策略 07 负性眩光: 如何解释以及处理策略 by Ellen Stodola 16 非完美眼的高端IOL by Liz Hillman 19 既往角膜嵌体术后患者的RLE by Ellen Stodola 21 发现EBMD: 寻找视物模糊和其它表现 by Ellen Stodola 复杂病例治疗策略 白内障 24 预防和处理虹膜脱垂 by Liz Hillman 30 术中屈光导航系统 by Liz Hillman 03 编者信 新闻和观点 62 ‘残留散光对于人工晶状体患者 裸眼视力和患者满意度影响’回 顾 by Thomas Meirick, MD, and Parisa Taravati, MD 64 ‘不同设计的人工晶状体迟发囊 袋内IOL 脱位的复位手术’回顾 by Andres Parra, MD 39 DSAEK和DMEK的移植片脱离 by Ellen Stodola 46 白内障手术之前发现角膜疾病 by Ellen Stodola 50 如何处理‘没有染色的疼痛’’ by Liz Hillman 52 单纯后弹力层剥离（DSO） 新进展 by Liz Hillman 33 不满意的LASIK 患者 by Liz Hillman 36 阻止近视进展 by Liz Hillman 屈光 60 高危眼预防恶性青光眼 by Liz Hillman 青光眼 54 引流管侵蚀/暴露 by Ellen Stodola 58 处理滤过泡 by Ellen Stodola 角膜

www.apacrs2022.org 会议亮点 跆拳道大师 顶尖白内障手术窍门 合作单位 2022年 6月 11-12日 第34 届 亚太白内障及激光手术医师 学会年会, 首尔 大师讲堂和指导课程 由世界顶尖手术医生主持，内容涵 盖最相关的主题。 期待当今眼科手术领域最热门的话 题，如掌握散光人工晶状体、掌握 人工晶状体固定、掌握生物测量、 掌握屈光手术并发症、掌握角膜内 皮移植，以及前节手术医生掌握玻 璃体切除术。 KSCRS还将开设一门关于白内障基 本技术的指导课程。 APACRS LIM 讲座 APACRS LIM讲座是APACRS的最高 奖项。自1991年以来，为白内障和 屈光手术的发展做出杰出贡献的杰 出眼科医生被邀请在APACRS年会 上发表演讲。 姚克教授将在第34届APACRS年会 开幕式上做2022 APACRS LIM讲 座，题目是《中国的白内障：我的 白内障手术之旅——从晶状体娩出 到FLACS》。 APACRS 电影节 APACRS电影节兼具娱乐性和教育 性，创造性地展示了眼科手术的新 创新和突破。不容错过！ 白内障和屈光手术联合大会 (CSCRS) APACRS, ASCRS及 ESCRS联合大会 ZEN –质量和景深的平衡 在目前的人工晶体领域，图像质量 问题少于多焦点晶状体的非单纯单 焦点人工晶体正在取得进展。包括 EDOF、单焦点plus和其他设计，如 针孔人工晶体。敬请加入我们，看 看这一新系列的人工晶体能否有效 地弥补单焦点和多焦点人工晶体之 间的间隙。 研讨会 激动人心的研讨会，内容涵盖前沿 IOL创新，最新的手术技术，以及 具有挑战性的白内障病例 和并发症。 跆拳道大师 –顶尖白内障手术窍门 一些最著名的白内障手术医生介绍 实用的白内障手术技巧，手术医生 可以马上在手术室使用。 请登陆网站 www.apacrs2022.org 获取更多信息。

EYEWORLD ASIA-PACIFIC APACRS Publisher: EyeWorld Asia-Pacific Edition (ISSN 1793-1835) is published quarterly by the Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS), c/o Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, telephone (65) 6322-7469, fax (65) 6327-8630, email ewap@apacrs.org. Printed in Singapore. Editorial Offices: EyeWorldAsia-Pacific Edition: Asia-Pacific Association of Cataract &Refractive Surgeons (APACRS), c/o Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, telephone (65) 6322-7469, fax (65) 6327-8630, email ewap@apacrs.org. AdvertisingOffice: EyeWorldAsia-PacificEdition:Asia-PacificAssociationofCataract&RefractiveSurgeons (APACRS), c/o Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, telephone (1-703) 975-7766, email don@apacrs.org. Copyright 2021, Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS), c/o Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, telephone (65) 6322-7469, fax (65) 6327-8630, email ewap@apacrs.org. Licensed through the American Society of Cataract & Refractive Surgery (ASCRS), 4000 Legato Road, Suite 700, Fairfax, VA 22033-4003, USA. All rights reserved. No part of this publication may be reproduced without written permission from the publisher. Letters to the editor and other unsolicited material are assumed intended for publication and are subject to editorial review and acceptance. The ideas and opinions expressed in EyeWorld Asia-Pacific do not necessarily reflect those of the editors, publishers or its advertisers. Subscriptions: Requests should be addressed to the APACRS publisher, c/o Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, telephone (65) 6322-7469, fax (65) 6327-8630, email ewap@apacrs.org. Back copies: Subject to availability. Contact the APACRS publisher, c/o Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, telephone (65) 6322-7469, fax (65) 6327-8630, email ewap@apacrs.org. Requests to reprint, use or republish: Requests to reprint or use material published herein should be made in writing only to the APACRS publisher, c/o Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, telephone (65) 6322-7469, fax (65) 6327-8630, email ewap@ apacrs.org. Change of address: Notice should be sent to the APACRS publisher, c/o Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, six weeks in advance of effective date. Include old and new addresses and label from a recent issue. The APACRS publisher cannot accept responsibility for undelivered copies. KDN number: PPS1766/07/2013(022955) MCI (P) 039/02/2022 CHINESE EDITION Regional Managing Editor Yao Ke, MD Deputy Regional Editor He Shouzhi, MD Zhao Jialiang, MD Assistant Editors Zhouqi, MD Shentu Xingchao, MD INDIA EDITION Regional Managing Editor S. Natarajan, MD Deputy Regional Editor Abhay Vasavada, MD KOREAN EDITION Regional Managing Editor Hungwon Tchah, MD Deputy Regional Editor Chul Young Choi, MD EDITORIAL BOARD Chief Medical Editor Graham Barrett, MD Chief Publisher Ronald Yeoh, MD Executive Director Kathy Chen Kathy.chen@apacrs.org Publishing Consultant Donald R Long don@apacrs.org PUBLISHING TEAM Senior Staff Writer Chiles Aedam R. Samaniego chiles.samaniego@apacrs.org Production Team Javian Teh Huang Weitian Sunshine Ng Gretel Tan Christine Shimmon Aileen Bian ewap@apacrs.org Chan Wing Kwong, MD, Singapore Ronald Yeoh, MD, Singapore John Chang, MD, Hong Kong SAR Pannet Pangputhipong, MD, Thailand YC Lee, MD, Malaysia Hiroko Bissen-Miyajima, MD, Japan Kimiya Shimizu, MD, Japan Sri Ganesh, MD, India Chee Soon Phaik, MD, Singapore Johan Hutauruk, MD, Indonesia EDITORIAL MEMBERS 内⹼ 幵勈 恈ℶ╫╞⸩ Ji Won KWON South Korea 恈ℶ㧽和庁⯊ Kyung Sun NA South Korea Ⓤ⚦ Hyun Soo LEE South Korea CCC Sang Beom HAN South Korea 㻷Ⓣ䱾 Ronald YEOH Singapore 㫻Ⓣ岦 Ⓣ勏㽾ℎ Jin Seok CHOI South Korea 㫻Ⓣ岦 恈ℶ ╋㫻 Eun Chul KIM South Korea I & A Yang Kyung CHO South Korea ,2/㯐␨ Jong Joo LEE South Korea ࡧᙓᖐԍⓙ೹术 ൃ导Ἵᜅ 2022ㄷ6㧋12֑㣢㧢␰ • 08:00 – 09:30hrs 㖨有ㇽ大的基䬃恈⮳技术㫼基是噺 得恈ℶ技能的关柱。这门基于岉歔的课程为 ⓠ学的手术医生介绍了 恈⮳ℶ◙手术中的冒浏和教幰。 ⃾ヰ: Joon Young HYON, 6RXWK .RUHD • Hyung Keun LEE, 6RXWK .RUHD 2022年6月11-12日 第34 届 亚太白内障及激光手术医师 学会年会, 首尔 合作单位

̀䷅ EWAP 2022Ꭱ3ᰵ 7 by Ellen Stodola Editorial Co-Director 负性眩光是白内障 手术后患者可能 会面临的问题。 㚜然通常可以㽴行⪒解，但⭎位 医生表㖸，与患者讨论并解释发 生了㖬么情况，很重要。 -acN +olladay, MD 强♛了 患者更可能会ⓞ现负性眩光的危 险因素，尽管他㙭，ㅩ㣐法确㎐ 预测㙥会发生这种并发症。有一 些因素可能增加发生这种并发症 的风险，但很ㅗ预测㖬么时⨌会 发生以及㙥会发生这种情况。 Dr +olladay 在一㊬文章中 提ⓞ了主要的危险因素，1包括 明视下㟟⶧较㨏ᮢ较大的正 NaSSa 角ᮢ人工晶状体的㨼 状ᮢ人工晶状体Ⳳ离虹膜的轴㦢 Ⳳ离ᮢ⌳␊前囊膜⡐⡥在人工晶 状体前⌳␊ᮢ较高的屈光度（等 㟭⫊平㟭），以及人工晶状体 的光学部 労⻸Ⱗ部不是位于㙦 平。次要危险因素包括人工晶状 体的⍋㴛设计（方⍋⫊㴘⍋）ᮢ 人工晶状体的⏮⼛和负非球面。 Dr +olladay 㙭，㟟⶧较㨏 （㴢1 2 ⧛ゟ）的患者在强光 下ⓞ现负性眩光的风险较高。 Dr +olladay 㙭，他㗎图㦢 医生强♛这些因素在帮助术前识 别高危患者方面的重要性。 负性眩光是由╏过晶状体和 错过晶状体的光㦏之间的间㥦 引㋲的。Dr +olladay 㙭，在 术前，㽴㔩晶状体，是没有这 ⢔间㥦的。Dr +olladay 解释 㙭ᱶ“没有进入眼内的光㦏可以 进入☡晶状体和虹膜之间。”这 ⢔间㥦看㋲来像一⢔≣的⊙月㨼 ⫊㴘㨼，这⢔区域的光㦏不能☡ ▕视㠬膜。 他㙭ᱶ“我们在文章中提 ☡，当ㅩ♛㸟晶状体，使这⢔间 㥦变大，⡢变眼Ⲹ⹽的多种结 ⤕，这⢔⊙㴘㨼ⳟ会㦢卒␊移 ⛑，ㅩⳟ可以通过♛㸟错过晶状 体和╏过晶状体的光㦏的间㥦大 㨏，使⨋度变ⶽ⫊变⌍。”1 1icole )ram, MD 指ⓞ，任 何⹮㨻的晶状体都可能发生这种 并发症。患者的白内障手术往往 都很完美，可以看☡20/20。然 而，他们可能会看☡靠卒␊有一 ⢔⧴影。 “ㅩ要㾖的☾一⮔㖼是让患 者放㨲，ㅩ㺌☤这是㖬么，”㚵 㙭，㈉除任何视㠬膜⫊㔭经病 变，如视㠬膜㙲⼝⫊脱离，也很 重要。 Dr )ram 㙭，RoEert OsKer，MD 报⢄的术后☾1 㝢 ⓞ现负性眩光的患者⊇分比㴢 为1 %。2⫑于光㦏㽗㽹的负性 联系方式 Fram: drfram@avceye.com Holladay: holladay@docholladay.com Olson: RandallJ.Olson@hsc.utah.edu ⼝㥦☪㷹片，㦄㖸✠期➔㦢光学部⏠获，光学部位于⌳␊囊膜和卒␊囊膜表面，労位于 囊袋内。 来㴚: 1icole )ram, MD 本文最初发表于2021 年12 月期 EyeWorld。 经ASCRS OSKtKalmic SerYices CorS 许 可，㔐经㩌⡢发表于此。 ῞௥ᗛ光 如何Ḱ≋ϗ ع 处理ធᓲ

̀䷅ 8 EWAP 2022Ꭱ3ᰵ 眩光的原理是，一些光㦏被晶状 体㠘㎺，而一些光㦏没有被㠘 ㎺，3在⌳␊视㠬膜㔋㨼成一⢔ 㷹明间㥦，引㋲卒␊⧴影。 在手术前与患者交㜮时， Dr )ram 㙭，㚵会提☡，可 能会发生这种情况，尤其是需 要高度数人工晶状体⫊具有较 大NaSSa 角的患者。然而，㚵 不会提“眩光”这⢔╰。㚵会解 释㙭，使用的人工晶状体有可能 引㋲眩光⫊阴影，如果ⓞ现这⢔ 问题，㚵可以解ⴈ。 Dr )ram 㙭，要问患者， 这种情况是一直▌在还是偶尔 ⓞ现，这很重要。㚵㙭ᱶ“如 果它并不㽼是▌在，⫊者㺝是 在特定的㷹明㝫⮔下ⓞ现，我 会很⹤⤷，患者会适应，不需 要干预。”Dr OsKer 的研究发 现， 7% 的病例在一年内能⪒ 解。2㚵㙭，这对患者来㙭是非 常⼺人⤠㣚的。 Randall Olson，MD 同 意，这种情况常常发生在术后的 㟫⭎㺾，尽管他也有很多患者因 为这⢔问题持续▌在而被㽊㸓。 对于大多数患者来㙭，这 不是一⢔大问题。然而，Dr Olson 强♛，重要的是，不要⢄ 㚗患者ㅩ不㺌☤这是㖬么，⫊ 者这是一种⧋见的并发症。他 㙭ᱶ“我会提前让他们㺌☤，这 些人工晶体比我们㽴⭐的晶状体 㨏，可以发生这种情况，但这些 都是正常的。” “我看☡的大多数患者，当 他们来找我时，都被⢄㺌他们应 ⡡对㽴⭐的视力感☡满意，这 是一种⧋见的并发症，”他 㙭。“最➿ㇱ的是那些被认为 是⟈了的人。”Dr Olson 㙭， 他⢄㚗患者，这种情况会㽴行 㦫㖡。 Dr )ram 㙭，负性眩光的ㅗ 点在于㦢患者解释，不㺌☤是⟑ 对␊眼也会发生这种情况。“有 些患者㾖另一㺝眼Ⲹ之前会很 㨏㨲，这ⳟ是ㅩ㦍入⸵ⳅ的原 因，”㚵㙭。“如果两㺝眼差异 很大⫊有屈光参差，ㅩ需要㾖对 ␊眼手术。” 有一些处理方法。医生可以 㙭，“我们不㺌☤㸊正的发病 率，但是对␊眼发生这种情况 的⭎率㴢为 0%，”Dr )ram 㙭。㦢患者保㺆，如果发生这 种情况，ㆀ可以帮助他们。ㅩ 可以等一⢔月，看看是⟑会⧝ 㽊，⫊者为另一㺝眼Ⲹ选择不 同的策略，ⳟ是⯿晶状体放在 不同的位置。包括㾖➔㦢光学 部⏠获（ROC），使光学部位 于囊袋㔋方，而⯿労垂直放在 囊袋内。㑻片式人工晶状体最 适合。Dr )ram 㙭ᱶ“我们更 㥢⪎L161AO SoI3ort IOL B 和 L >BaXscK LomE@, 因为⥄Ⰾ 的㷿㔠率比⍧㥙㚙低，而㎒对 ⰲ状沟更友⧝。”㚵㙭，一片 式⍧㥙㚙晶状体采用ROC 植入 可能导致囊袋阻㺯，不适合此 手术。SamXel MasNet, MD 等 人 对此进行了报☤，发现使用 此策略时，100% 的患者☾✠㺝 眼没有ⓞ现负性眩光。 Dr )ram 㙭，这适用于那些 确实㋊不及待，又对☾一㺝眼的 结果感☡⸵扰，但由于功能不 ⧝，需要㾖另一㺝眼手术的患 者。但对于许多患者来㙭，㚵可 以等待，看看这⢔问题是⟑会随 㽥时间的㟺移而解ⴈ。⢗⳯㚵的 经验，通常3 ⢔月后，患者的情 况会有所⧝㽊。 对于负性眩光持续6 ⢔月 ⫊更⒌时间的患者，Dr )ram 㙭，ㆀ可能需要选择其它方法。 治疗策略是≿光学部前移，从而 ⯿㷹明间㥦移☡⌳视㠬膜之外。 ⌳␊囊膜被认为是与负性眩光相 ⤴的多种因素之一，用光学部 ⡐⡥⌳␊囊膜可以⡢㔂症状。 持续负性眩光的治疗策略包括 ROCᮢⰲ状沟人工晶状体ᮢ⌟ 㠈式人工晶状体和⌳␊囊膜㎐除 术。㚵㙭，如果患者的晶状体囊 膜㎐开直Ⳉ ⧛ゟ，并㎒如 果他们植入的是AcrySoI 人工晶 状体（Alcon），労垂直放置， ✠期ROC 效果最⧝ , 。㚵㙭， 其他平㜞的可预测性不高，因为 它们更加⭷㱚，可能会⪄回囊袋 ⹽。如果不能进行ROC，医生 可以㾖IOL 置换，植入㑻片式晶 状体，然后㾖ROC。 “如果前囊膜开ⶪ不㴰许这 么㾖，我们ⳟ≿晶状体放在ⰲ状 沟⹽，”Dr )ram 㙭。使用这 种方法，㚵会㎡㎡地⯿晶状体⤨ 定在虹膜㔋，这样它ⳟ不会随时 间而移⛑。在㚵与Dr MasNet 的研究中， ROC 的有效率为 6%，而ⰲ状沟放置IOL 为 6%。患者应了解，在ROC 手 术后，可能会发生㵍期囊膜㥻㢞 化，需要<AG 后囊㎐开术。 还可以使用⌟㠈式晶状体 植入，在晶状体⛇部㴿植入☾ ✠⢔人工晶状体，⡆助散㔠光

EWAP 2022Ꭱ3ᰵ 9 ̀䷅ 㦏，73% 的有效率。⢗⳯ Dr )ram 的经验，囊袋 对 囊 袋的置换作用并不⧝。 Dr )ram 还提☡)olden 6 和 CooNe 7 报⢄的使用⌳␊囊膜 ㎐除术的策略，㚵与Dr MasNet 的㵍期研究也表明⌳␊囊膜与负 性眩光的ⓞ现有⤴。然而，许多 策略，如ROC 和ⰲ状沟放置， 光学部前移，可能也⟛合光㦏 㽗㽹理论。⢗⳯Dr )ram 的经 验，⌳␊囊膜㎐除术减少了而不 是治㲢了负性眩光。对于不㦛置 换人工晶状体㎒㣐法㾖ROC 的 特定人工晶状体患者，这可能是 一⢔很⧝的策略。 Dr Olson 㙭，他⢄㚗患者 在进行任何手术之前，㺣少要等 待6 ⢔月，让大ㅚ有时间适应。 他㙭，㐣除⌳␊囊膜⫊⯿光 学部移☡囊袋⛇部都是有效的选 择。⌟㠈式植入也有效，但ㅩ⍄ 㩙确保有足够的ⶥ间，不会发生 色素⏏散。 Dr Olson 㙭，在这些情况 下，⤴⮒是不要认为负性眩光 是“异常的”。这是晶状体的部 分特性。 Dr Olson 最后强♛了⭎⢔ ⤴⮒原则。提前让患者㺌☤这是 常见和正常的。医生应⡡能够认 识☡这是㖬么，以⍏能够帮助患 者。Dr Olson 还⢄㚗患者，“ ㅩ㴣☇㨲它，大ㅚⳟ㴣ㅗ⨐视 它。”他㗎图让患者不要太☇㨲 它，因为它会㦫㟿，如果持续▌ 在，也可以解ⴈ。EWAP 参考文㦇 1. Holladay JT, Simpson MJ. Negative dysphotopsia: Causes and rationale for prevention and treatment. J Cataract Refract Surg. 2017;43:263–275. 2. Osher RH. Negative dysphotopsia: long-term study and possible explanation for transient symptoms. J Cataract Refract Surg. 2008;34:1699–1707. 3. Coroneo MT, et al. Off-axis edge glare in pseudophakic dysphotopsia. J Cataract Refract Surg. 2003;29:1969–1973. 4. Masket S, et al. Surgical management of negative dysphotopsia. J Cataract Refract Surg. 2018;44:6–16. 5. Masket S, Fram N. Pseudophakic negative dysphotopsia: Surgical management and new theory of etiology. J Cataract Refract Surg. 2011;37:1199–1207. 6. Folden DV. Neodymium:YAG laser anterior capsulectomy: surgical option in the management of negative dysphotopsia. J Cataract Refract Surg. 2013; 39:1110–1115. 7. Cooke DL, et al. Resolution of negative dysphotopsia after laser anterior capsulotomy. J Cataract Refract Surg. 2013;39:1107–1109. 编者≢ᱶDr )ram 在加利⡁ㅧ亚㺿，⿯㓸 侪，AdYanced Vision Care 工作，并声 明没有相⤴的经⭙利㯐。Dr +olladay 是 ☦⶛㑶㙱㺿，㩋㙱⛻，Baylor 医学㴠，眼 科系的临床教㗔，并声明没有相⤴的经⭙ 利㯐。Dr Olson 是㱴他㺿，㫺⨘⒯，㱴 他㺿大学，-oKn A Moran Eye Center, 眼科和视ⴇ科学系主任，并与3erIect Lens, 3erceiYe Bio, 以及TMClear 有利 㯐⤴系。 即使在最完美的白内障手术后，负性眩光也会随时⸵扰ㅩ。我阅读 了Dr +olladay, Dr Olson 和Dr )ram 的㋂论，我ⴇ☧这非常简 ⰴ详尽地解释了负性眩光的病因ᮢ风险因素和可能的治疗方法。 在我的临床中，我发现，随㽥人工晶状体设计ᮢ⏮⼛的⡢进，以及对 这⢔问题的更⧝理解，负性眩光的发生率有㦄㻚Ⰹ低。然而，还是有一些 患者ⓞ现了经♈的≣影。了解我们作为手术医生可以㾖些㖬么来避免⫊减 少这种主㚗是很重要的。正如我们所㺌，这种现象更可能发生在高度近视 植入⭁端度数IOL 的患者中。此外，前囊膜在⌳␊IOL 光学部有明㦄的重 ♢也被认为是㾏ⷍ⫎㗑。因此，尤其是近视眼，要㽂意前部㙲囊的大㨏。 在手术结㗲时，如果我发现有明㦄的前囊膜⡐⡥在光学部㔋时，我会⸷大 这一⊙的㙲囊。 经常会有患者在其他地方㾖了手术，但由于眩光而不满意来ⳟ㸓。在 这种情况下，最重要的是让患者放㨲，让他们㺌☤手术⫊人工晶状体都没 有问题。我发现，一☍患者㺌☤这是一种㮻㺌的现象，并㎒尽管手术和视 ⴇ效果最⧝，但仍可能发生，他们ⳟ会更容㯁Ⱗ㗖ㅩ给他们的建议。处理 的另一⢔⤴⮒问题是和患者的➔复㜮话。当这些患者来复㸓时，我会优㥸 考⿑他们，给他们Ⓦ足的时间，ㅓ㨲地㎣㝳他们的问题。一☍我们变☧带 有防㲡性，患者也会变☧更具⤁⫏性！因此，最⧝的办法是㝳取他们的意 见，㜯率地讨论可能的治疗方法，㗑㥸是等待和⤷␖。我通常会等待㺣少 3 ☡6 ⢔月，然后㴿计⪆任何手术干预。我的㗑选方法是尽可能通过前囊 ⶪ对IOL 进行➔㦢光学⏠获。如果不可行，我会用ⰲ状沟植入的人工晶状 体㾖IOL 置换。 当这样的患者来找ㅩ㾖☾✠眼手术时，要提前和患者讨论同一⢔问题 可能会发生在对␊眼，以及ㅩ能㾖些㖬么来防止这种情况发生。如果是 单Ⰽ点人工晶状体的话，我会选择一种适合➔㦢光学⏠获的人工晶状体设 计，⫊者在ⰲ状沟植入的㑻片式人工晶状体。 㽼而㬀之，从我处理负性眩光的经验来看，我发现Ⓑ实是最⧝的策 略。对这种⧋见的术后现象要直㬀不⪼，如果这⢔问题持续⸵扰他们的 话，在➔复㽩㫛后，㔱㺣可能㝳取别人的意见后要进行➔㦢光学⏠获⫊人 工晶体置换。 编者㽂ᱶDr SamaresK SriYastaYa 声明没有相⤴的经⭙利㯐。 Samaresh Srivastava, DNB Consultant Raghudeep Eye Hospital, Jaipur, India. samaresh@raghudeepeyeclinic.com ASIA-PACIFIC PERSPECTIVES

On 27 November 2021, Johnson & Johnson Surgical Vision convened the Expert Panel in Cataract Surgery (EPICS) TECNIS SynergyTM User Meeting with 12 ophthalmologists from across Asia Paci c, moderated by Dr Fam Han Bor. The experts shared best practices and experiences in patient selection, preoperative evaluation and counselling, as well as postoperative management to optimize patient outcomes with TECNIS SynergyTM. Asian patients’ unique near vision needs A de nition of patients’ vision needs after cataract surgery is important when implanting presbyopia-correcting intraocular lenses (PCIOLs),1 with distances of near vision varying according to the occupation and lifestyle of patients, and may include distances of 25, 30, 33, 35 or 40 cm.1-3 While there is often a need to hunt for the sweet spot with existing trifocal IOLs, near visual acuity (VA) is typically measured at 40 cm.4,5 However, visual performance at 33 cm is becoming increasingly important in meeting the near vision needs of Asian patients.1,6 Various studies have shown that Asians generally view reading materials such as their handheld smartphones and books at a closer distance due to their shorter stature – thus, proportionately shorter arm lengths – compared with Europeans and Africans.6,7 Furthermore, the more elaborate and intricate formation of Asian scripts, particularly Chinese scripts, require 1.5 times more VA than English characters.8 Studies have shown that the functional mobile usage distance is at 33 cm (Figure 1), and smartphones are generally held at an average viewing distance of 33.95 cm among Asians.1,6 “Asians need strong near and good intermediate vision due to challenges in reading Asian scripts such as Chinese, Hangul, Thai, Arabic and Japanese,” Dr Prin Rojanapongpun said. “Another consideration is the reading needs of patients, including tablet / book at distances of 30–35 cm and computer monitor at distances of 45–50 cm.” Speaking from experience in Taiwan, Dr Hsiao Yu-Chuan shared that such near vision needs are prominent among Taiwanese owing to the need for reading traditional Chinese script – which is more complex than simpli ed Chinese script. Clinical pearls on achieving high patient satisfactionwith TECNIS SynergyTM Continuous-Range-of-Vision IOL “For Asians, the functional mobile usage distance is at 33 cm, and smartphones are generally held at an average viewing distance of 33.95 cm.” FAM Han Bor Singapore CHUAH Kay Leong Malaysia HAN Sang-Youp South Korea HSIAO Yu-Chuan Taiwan KIM Myoung Joon South Korea Santaro NOGUCHI Japan Masayuki OUCHI Japan Robert PAUL Australia D RAMAMURTHY India Prin ROJANAPONGPUN Thailand Mahipal SACHDEV India Boonchai WANGSUPADILOK Thailand YAU Kin Hong Kong 33cm Mobile devices Print 40cm Figure 1. Optimal reading distances among Asians

Supported by TECNIS SynergyTM has been shown to offer a wider range of continuous vision with better near, maintaining 20/25 or better VA from -3.0 D to in- nity (Figure 2).10 Furthermore, TECNIS SynergyTM gained an additional line of VA at -3.0D and beyond and achieved higher VA at all distances compared with other trifocal lenses. Most experts agreed that TECNIS SynergyTM IOL is a hybrid PCIOL utilizing various technologies and falls under a new “continuous-range-of-vision” category. Dr Masayuki Ouchi noted that TECNIS SynergyTM is able to provide good vision across distance, intermediate and near to his patients. “TECNIS SynergyTM lls the gaps of troughs created by other trifocal IOLs on the TECNIS SynergyTM represents a new “continous-range-ofvision” category of PCIOL With the evolving needs of modern-day patients, visual tasks including reading, viewing mobile phones, working on computers, walking up the stairs and travelling are becoming increasingly important – and these encompass near, intermediate and distance vision. The ideal IOL should offer good distance through near vision with acceptable glares and halos. However, while most multifocal IOLs deliver good near and distance vision, there remains a gap in intermediate vision.9 Johnson & Johnson Vision has a long history of providing high-quality IOLs. In 2014, Johnson & Johnson Vision pioneered the extended depth of focus (EDOF) technology and introduced the rst EDOF lens, TECNIS SymfonyTM – providing patients with high-quality contrast vision from distance through to functional near vision. Subsequently, Johnson & Johnson Vision succeeded in combining the multifocal and EDOF technologies to deliver continuous high-contrast vision of 0.1 logMAR or better, across distance to even up close at 33 cm.1,6 The TECNIS SynergyTM IOL is patient-centric, allowing patients to experience a range of uninterrupted vision. defocus curves and provides a continuous range of vision. There is no need to hunt for a reading spot,” said Dr Rojanapongpun. What users think of TECNIS SynergyTM Dr D Ramamurthy noted that with TECNIS SynergyTM, mix-and-match implantation of IOLs and micro-monovision are no longer necessary. “Tweaking of the power of the lenses is not required with the use of newer generation formulas for my patients with bilateral implantation of TECNIS SynergyTM, and they are able to function at all distances,” he added. Dr Santaro Noguchi performed a study comparing Alcon’s PanOptix® (n>300) and TECNIS SynergyTM (n=60). Patients receiving TECNIS SynergyTM achieved better distance VA outcomes both with and without correction compared with those receiving PanOptix®. Patients receiving TECNIS SynergyTM also reported higher spectacle independence across all distances compared with patients receiving PanOptix® (97.92% versus 93.43% for far vision; 98.96% versus 95.34% for intermediate vision; and 89.58% versus 75.99% for near vision). There was signi cantly greater visual comfort in viewing mobile phones, viewing under dim light conditions, and for near work in patients receiving TECNIS SynergyTM compared with those receiving PanOptix®. Glare and halos were comparable for TECNIS SynergyTM and PanOptix® when measured three-month postoperatively. Although present, glare and halos did not affect Copyright 2022 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. All other trademarks are the intellectual property of their respective owners. © Johnson & Johnson Surgical Vision, Inc. 2022. PP2022CT4024 Figure 2. Binocular distance-corrected defocus curves from head-to-head clinical study10* vs PanOptix® IOL based on 3-month, interim postoperative data.

patients’ daily activities, including driving at night. In a prospective case series study, all patients who underwent bilateral TECNIS SynergyTM implantation achieved complete spectacle freedom for distance vision, with only 3.7% requiring glasses for intermediate or near vision tasks.11 Although 52.4% of patients reported experiencing halos under low-light conditions, 19% of them only experienced halos occasionally whereas 77.3% of the patients had never or occasionally experienced glare.11 The ndings of the study also substantiated the outstanding continuous range of vision covering 33 cm and beyond. “Personally, I nd that other trifocals do not provide near vision enough. TECNIS SynergyTM, on the other hand, delivers very good near vision compared with most other trifocals,” said Dr Fam Han Bor. In his practice, patients are often more concerned about near vision than dysphotopsia. “While my patients who were implanted with TECNIS SynergyTM have had good near vision, they also experienced glare and halos. However, they often think that the ‘trade-off’ is worth it and are satis ed with the near vision outcomes as they can get use to glare and halos over time.” “The visual performance of TECNIS SynergyTM is similar to other trifocals that cover 40 cm and beyond, except that bilateral TECNIS SynergyTM implantation gives good near vision even at 30–35 cm, especially under dim lighting conditions. My patients are quite comfortable with the glare and halos, although I have had one patient with underlying posterior polar cataract who is unable to tolerate glare and halos,” Dr Ramamurthy recounted. He advised surgeons to approach or counsel patients tting TECNIS SynergyTM in a similar way as they would with other trifocals. The right patients for IOLs are often those who seek spectacle independence.3 “Our current cataract patients never wish to wear glasses, considering their capabilities to multitask and their modern lifestyle,” said Dr Rojanapongpun. Generation B and Generation X females who have strong desire for spectacle independence and near vision are Dr Rojanapongpun’s ideal patients for TECNIS SynergyTM. “Indeed, Asian patients need strong near vision as they tend to hold their reading materials at a closer distance due to proportionally shorter arms,” he added. The experts attributed their preference for TECNIS SynergyTM over other trifocals to its continuous range of vision and outstanding near vision. “I do like both PanOptix® and TECNIS SynergyTM, but the reading vision with TECNIS SynergyTM far exceeds that of PanOptix®. I nd that there is a gap between the vision for reading and viewing computer with PanOptix®. However, the continuous range of vision with TECNIS SynergyTM helps my patients cope better with close visual tasks,” said Dr Robert Paul. “Another issue that concerns me with PanOptix® is glistening – many of my patients undergo lensectomy and clear lens extractions for cosmetic reasons and I do not wish to implant a lens that will potentially give glistening. This will affect the quality of vision in 10–15 years and resulting in the need for lens removal. Having said that, TECNIS SynergyTM is my preferred IOL for the better quality of vision and its near vision performance,” Dr Paul continued. Sharing his personal experience in implanting TECNIS SynergyTM, Dr Paul also advised surgeons to address postoperative residual astigmatism to maximize patients’ distance vision as it is less forgiving compared with other trifocals. Some patients may experience reduced quality of distance vision during the early postoperative period, he noted, but they eventually gained 6/6 or 6/5 vision with little to no refractive error. Most experts agreed that TECNIS SynergyTM can offer the best near vision needs for Asian patients amongst other PCIOLs. Achieving spectacle independence outweighs the issues patients may face with glare and halos, given that glare and halos can be easily manage. All experts also agreed that TECNIS SynergyTM allows greater ability to read ne print and at closer reading distances compared with other trifocals. Most importantly, TECNIS SynergyTM can ful l the unique vision needs of Asian patients, whose reading distance is typically at 33 cm.1,6 “Achieving spectacle independence outweighs the issues patients may face with glare and halos, given that glare and halos can be easily managed.” Dr. Clinical pearls on achieving high patient satisfactionwith TECNIS SynergyTM Continuous-Range-of-Vision IOL

Clinical pearls for TECNIS SynergyTM: Patient selection and preoperative counselling The experts noted that most patients adapt well with mild and non-disruptive glare and halos following TECNIS SynergyTM implantation. However, surgeons may encounter a patient who reports less than perfect distance vision and experiences glare and halos. Therefore, Dr Fam believed that good preoperative informed consent and managing patient expectations are crucial. Dr Rojanapongpun advocated patient counselling on their visual goals i.e., perfect clarity versus spectacle independence and prioritization of visual tasks i.e., high contrast versus high comfort. “Patients should be allowed time to discuss with their family and make clear decisions based on their visual task priority,” said Dr Rojanapongpun. Surgeons should understand patients’ expectations and different visual requirements depending on their lifestyle and work.3 According to Dr Rojanapongpun, patient satisfaction equals outcome minus expectations. “To achieve high patient satisfaction and ensure positive postoperative outcomes, assessment of ocular pathology of the cornea, macula and optic nerve head is important,” added Dr Rojanapongpun. He explained that an evaluation of whether the surgery can offer valuable changes to the patient is the key – “if the cataract is too mild, I would recommend my patient to defer the surgery.” A detailed preoperative ocular evaluation can help patients achieve positive outcomes as successful presbyopia-corrections are often based on eye health.3 To achieve best refractive outcomes, surgeons should minimize postoperative residual astigmatic error to ≤0.75 D and consider posterior corneal astigmatism (PCA) as well as surgically induced astigmatism (SIA) in surgical planning.14 Ocular surface conditions such as dry eye disease should also be managed as part of the preoperative assessment. Surgeons should also ensure that patients are aware of the tradeoffs associated with various IOLs. It is important to educate patients on the “give and take” of IOL implantation and that there is always a compromise between multifocality and spectacle independence. Copyright 2022 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. All other trademarks are the intellectual property of their respective owners. © Johnson & Johnson Surgical Vision, Inc. 2022 PP2022CT4024 Figure 3. Stepwise approach of preoperative assessment Supported by Step 1 Examine the ocular surface Treat tear film or ocular surface disorders. Step 2 Consider residual refractive error Aim for minimal residual refractive error. Select the lens option closest to plano, and if the first plus and first minus lens are equidistant, then select the first plus lens option (i.e., slight hyperopia). Step 3 Assess capsule and retina Rule out tilted lens position, zonular loss, poor capsular clarity and retina pathology. Step 4 Manage patient expectations Counsel patients on postoperative expectations. Avoid aggressive recommendation of TECNIS SynergyTM to patients who are poor adaptors and those with type A personality.

Dr Mahipal Sachdev explained that he would follow a stepwise approach of preoperative assessment (Figure 2). “Preoperative exclusion criteria such as preoperative dry eye, corneal scarring, pupil size of <2.5 mm and monofocal implant in the rst eye are important in managing postoperative challenges,” he clari ed. Accurate and reliable ocular biometry is essential for IOL power calculation.3,12 Dr Sachdev advised surgeons to analyze the posterior cornea using IOLMaster® 700 (ZEISS) and consider matching the residual cylinder with total keratometry and corneal topography. “Residual cylinder is detrimental to the patient and compromises the outcome any IOL implantations,” added Dr Ramamurthy. “Make sure you have accurate biometry and exclude all contraindications to any multifocals,” advised Dr Paul. Dr Fam shared that the target refraction for TECNIS SynergyTM should be emmetropia- or hyperopia-targeted and not myopia-targeted since TECNIS SynergyTM delivers good near vision. “By targeting myopia, the dysphotopsia will worsen and make the patient more unhappy,” cautioned Dr Fam. Dr Kim Myoung Joon shared that he uses an easy to remember ABC stepwise approach of preoperative assessments for all his PCIOL cases - Astigmatism control, Biometry, and, Corneal status. Large angle kappa plays a role in the decentration of multifocal IOLs and may result in glare and halos, although angle alpha better predicts photic phenomena with multifocal IOLs.3 As such, extremely large angle kappa and angle alpha should be avoided. Patients’ postoperative expectations should be adequately managed and be informed of the need to wear glasses for some activities as well as the possibility of visual disturbances such as glare and halos, especially at night.12 Clear communication such as showing patients various photic phenomena images during preoperative counselling is helpful in managing patient expectations. However, with neuroadaptation, photic phenomena will be tolerated and will not be too bothersome for patients. Furthermore, while glares and halos are common across all trifocals, patients receiving TECNIS SynergyTM who have been counselled can generally accommodate and tolerate them well. Clinical pearls for TECNIS SynergyTM: Postoperative management and neuroadaptation Visual neuroadaptation plays an important role in determining the nal visual outcomes after IOL implantation.13 PCIOLs may require 4–8 weeks for visual adaptation to attain excellent outcomes.12 Early postoperative neuroadaptation has been observed in patients with multifocal IOL implantation. In patients receiving multifocal IOL implantation, adaptation suppression was observed in the early postoperative stage, resulting in visual disturbances. However, these visual disturbances greatly improved following visual neuroadaptation by 3 months postoperation.13 “Neuroadaptation is very important, can be multifactorial, and may be attributable to personality,” said Dr Fam. All other factors such as dry eye and refractive error should be addressed before neuroadaptation. It is also helpful to consider patients’ age and ocular history. “I believe younger patients neuroadapt quicker than older patients,” noted Dr Ramamurthy. To speed up neuroadaptation, Dr Boonchai Wangsupadilok would give his patients some visual tasks to perform at home postoperatively. “I would get my patients to watch television for an hour a day and have them explain how they feel during the rst week follow-up. Generally, my patients can adjust within 2–4 weeks,” said Dr Wangsupadilok. For Dr Rojanapongpun, he would consider intervening if neuroadaptation failed 3–6 months postoperatively in patients with dysphotopsia. “Personally, I have had no issues with lens exchange within 6–12 months, if the surgery was performed well,” he noted. Glare and halos are more common among patients with large pupils.3 Before going to neuroadaptation, Dr Noguchi pointed out that it is important to focus on factors such as patient’s age and pupil size or position. Posterior vitreous detachment (PVD) is common after cataract surgery with IOL implantation.14 Although it is considered a complication of low clinical relevance, its occurrence suggests the impact of cataract surgery on the architecture of the ocular globe. However, PVD does not directly threaten vision. Dr Robert Paul explained that when patients complain of blurring or waxy vision, surgeons should not attribute all complaints to the optics of the lenses, but to rule out other factors. Clinical pearls on achieving high patient satisfactionwith TECNIS SynergyTM Continuous-Range-of-Vision IOL “Neuroadaptation is very important, can be multifactorial, and may be attributable to personality.”

The importance of TECNIS SynergyTM Toric II for presbyopia correction Experts have expressed great interest for TECNIS SynergyTM Toric II and agreed that more patients will bene t from its availability. “TECNIS SynergyTM Toric II is highly necessary, as multifocal IOLs do not tolerate residual astigmatism well – any residual astigmatism of >0.75 D will impair both distance and near vision,” shared Dr Ramamurthy and Dr Chuah. The squared and frosted haptic design of TECNIS SynergyTM Toric II IOL provides resistance to rotation.15 Its engineered design features an outstanding mean rotational stability of 0.87°.15 “We have seen amazing results in our rst few patients with the recent launch of TECNIS SynergyTM Toric II in Hong Kong,” said Dr Yau Kin. “Patients with mild astigmatism have shown accurate and stable outcomes with TECNIS SynergyTM Toric II – with 20/20 distance vision and near vision of J1 post-operation.” While TECNIS SynergyTM Toric II was only available in selected markets – including Australia, Hong Kong, Japan, and South Korea – at the point of the EPICS TECNIS SynergyTM User Meeting, it would be launched in other Asia Pacific markets in the rst half of 2022. Conclusion TECNIS SynergyTM is the lens of choice for a continuous range of vision, especially in ful lling Asian patients’ unique vision needs, necessitated by their shorter stature and thus shorter arm length compared with non-Asian patients; challenges faced in reading complex Asian scripts; as well as near reading needs at a distance of 33 cm and under dim lighting conditions. All experts agreed that full access to TECNIS SynergyTM and TECNIS SynergyTM Toric II IOLs can provide a complete visual range for patients and ful l patients’ vision needs. Surgeons are strongly advised to counsel patients and manage their expectations to optimize patient outcomes. References 1. Soler F, et al. Curr Eye Res 2021;46(8):1240–6. 2. Caltrider D, et al. Evaluation of visual acuity. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing;2022. 3. Xu C. Successful premium multifocal IOL surgery: Key issues and pearls. In: Wang X, ed. Current Cataract Surgical Techniques. IntechOpen;2021. 4. Jonker SMR, et al. J Cataract Refract Surg 2015;41:1631–40. 5. Lapid-Gortzak, et al. J Cataract Refract Surg 2020;46:1534–42. 6. Lan M, Rosen eld M, Liu L. Optom Vis Perf 2018;6(5):204–6. 7. Medscape. How is proportionality determined in the evaluation of pediatric growth hormone de ciency (GHD)? Available at https://www.medscape. com/answers/923688-163415/ how-is-proportionality-determined-in-the-evaluation-of-pediatric-growth-hormone-de ciency-ghd. Accessed January 2022. 8. Zhang J, et al. Optom Vis Sci 2020;97(10):865–70. 9. Shen Z, et al. Sci Rep 2017;7:45337. 10. Data on File, Johnson & Johnson Surgical Vision, Inc. DOF2020CT4014 – Forte 1 Study: A comparative clinical evaluation of a new TECNIS® PCIOL against PanOptix® IOL. 11. Ribeiro FJ, et al. J Cataract Refract Surg 2021;47:1448–53. 12. Data on File, Johnson & Johnson Surgical Vision, Inc. PP2020CT5232. 13. Zhang L, et al. Front Neurosci 2021 Jun 14;15:648863. doi: 10.3389/fnins.2021.648863. eCollection 2021. 14. Mirshahi A, et al. J Cataract Refract Surg 2009;35(6):987–91. 15. Data on File, Johnson & Johnson Surgical Vision, Inc., 2019. DOF20190TH4015. Copyright 2022 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. All other trademarks are the intellectual property of their respective owners. © Johnson & Johnson Surgical Vision, Inc. 2022 PP2022CT4024 Supported by “TECNIS Synergy™ is the lens of choice for a continuous range of vision, especially in fulfilling Asian patients’ unique near vision needs.” Dr.

16 EWAP 2022Ꭱ3ᰵ ̀䷅ by Liz Hillman Editorial Co-Director ┬৅ᦚᗣᖓ⛇ᝣ,O/ 人们经常会讨论， 为了成功地使用 高端ᮢ㥸进技术 的人工晶状体，眼Ⲹ需要满足㖬 么㝫⮔，但是对于那些希望不▝ ▝眼镜但眼Ⲹ又不够完美的患 者，⡡如何ㅞᱻ Eric DonnenIeld, MDᮢSteSKen ScoSer, MD 和 BlaNe Williamson, MD 认为， 有些情况完㐩不适合选择任何⹝ 视Ⱇ正人工晶状体，但随㽥⹝视 Ⱇ正人工晶状体㗊场的选择的增 多，即使有些患者▌在一定的眼 部疾病，也适合选择。 Dr Williamson 㙭ᱶ“我ょ 㝢㺣少有一⢔患者，㦛要使用多 Ⰽ晶状体，但是▌在一些情况， 可能不太适合。”然而，他⏣Ⓦ 㙭，举例来㙭，㜽ㅸ病眼病⫊ 青光眼并不是完㐩不能讨论。 “这是一⢔严重程度的问题，” 他㙭。 在Dr Williamson 的临床 中，患有严重青光眼ᮢ⪞⊍㙦 㺹ᮢ㋑㝇膜㬃ᮢ新生㫖管ᮢ视㠬 膜脱离史ᮢ中度㺣重度㑳视⫊复 视的患者不适合选择⹝视Ⱇ正人 工晶状体。患有㎡度㺣中度青光 联系方式 Donnenfeld: ericdonnenfeld@gmail.com Scoper: sscoper@cvphealth.com Williamson: blakewilliamson@weceye.com 眼ᮢ㎡度ᮢ不明㦄的视㠬膜前 膜ᮢ㢺定的⪞⊍变性⫊㵞Ⱗ㗖 过屈光手术的患者，在过㐣不会 考⿑⹝视Ⱇ正人工晶状体。较新 的技术，如Ⳃ㔪⸷展（EDO)） 人工晶状体和AcrySoI I4 ViYity Alcon ，这是一种非㬈 㔠EDO) 人工晶状体，可以为⹝ 视Ⱇ正提⤅机会。“ “我㎣㦢于在这些眼Ⲹ中使 用ViYity 和SymIony >-oKnson -oKnson Vision@，因为我们 㺌☤这些是EDO) 技术，没有 多⢔Ⰽ点。对于不太完美的眼 Ⲹ，它们的容错性更高。EDO) ⹮IOL 对于这⹮临ⰻ状㜢的眼 要优于㙣Ⰽ点⫊㑻Ⰽ点，”Dr Williamson 㙭。“我所㾖的最 重要的㖼情是确保他们了解他们 患有的不同眼病，以及这些疾病 会进一⏧影响他们的视力。” Dr ScoSer 㙭，对于多Ⰽ晶 状体，如3anOSti[ Alcon ， 201 年成为美国☾一⢔㈾准的 㑻Ⰽ点晶状体，严重的眼部疾病 会影响晶状体性能。他㙭，他不 会为患有任何⪞⊍病变ᮢ中度视 㠬膜前膜⫊严重眼表疾病的患者 提⤅这种晶状体。如果干眼症是 ㎡㢔的，他愿意用人工⹯㮤ᮢ ⹯㨏点㙠ᮢ;iidra liÁteJrast, 1oYartis ⫊Restasis（⪏䪡 素，AllerJan）治疗患者。如 果治疗后眼表有所⡢㔂，他会⹤ 意为他们提⤅㑻Ⰽ点晶状体。 Dr ScoSer 㙭ᱶ“但我会提 㨿他们，干眼症可能是一种〇性 病，为了使这种㑻Ⰽ点晶状体能 终㔩发⪫最⭧效果，他们⯿不☧ 不㣐㦎期地治疗干眼症。” 如果患者有更严重的眼表 疾病，如㔋㊦⫑底膜㱒㬤不 ⼈，Dr ScoSer 㙭，他会㾖㍳ 层角膜㎐除术以使表面光⪄。如 果恢复后情况⼈⧝，他会提⤅多 Ⰽ点晶状体。 如果患者因眼部状况而不适 合使用“任何带⪏的晶状体”， Dr ScoSer 认为ViYity 是一种 可行的选择，可以在一定程度㔋 实现眼镜㽴由。 “ViYity 晶状体没有⪏，所 以不会分光。因为它不分光， 所以我们不⍄☇㨲眼部病变，” 他㙭，他⯿其グ㗰为一种适合需 要多Ⰽ点晶状体患者的ⴊ⭧晶 状体。他的临床中仍然认为严 重的眼部病变是植入ViYity 的ⱏ 本文最初发表于2021 年12 月期 EyeWorld。 经ASCRS OSKtKalmic SerYices CorS 许 可，㔐经㩌⡢发表于此。

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