EyeWorld Korea September 2013

12 EWAP FEATURE September 2013 Removal of dense cataract Source : Jeffrey Pettey, MD 이 내려앉지 않도록 낭 내에도 넣어줍니다” 라고 말했다. Dr. Kim은심지어수술이다끝날무렵 에도 viscoelastic사용을 계속하라고 강조 했다. 그때가바로실수를할수도있는순간 이기때문이다. “수정체낭이매우늘어져있 어 phaco tip에닿을수도있습니다”라고덧 붙였다. 남아 있는 작은 부분이라도 한번 더 잡아당겨 수정체낭을 채워주는 것은 이런 위험에서 피할 수 있도록 해준다고 그녀는 설명했다. 분산되는 성질이 강한 viscoelastic의 사용은 경성 백내장 환자에게 있어 각막 내피세포를 보호하는 역할을 한다고 Dr. Bordewick은 말했다. “저는 제거하려는 조각의아래위에이러한 viscoelastic을사용 하는 것에 조금도 주저함이 없습니다. 가끔 후방 판은 분리하기가 어렵지요. 카뉼라와 보호외피(protective sleeve)를 사용하여 제거한다면, 판아래쪽으로 visco를넣은후 후낭에서 앞쪽으로 움직입니다. 이렇게 하면 제거하기가 훨씬 쉬워집니다”라고 말했다. 또한 lens가제대로중앙에왔는지확인 하기 위해서는 필요하다면 CTR을 사용하는 것도 고려해야 한다고 Dr. Kim은 강조했다. Phaco에 의한 화상? 만나보았던 선생님들은 그렇게 자주 phaco에 의한 화상을 경험하지는 않지만, 그 위험은 언제나 있다고 Dr. Bordewick은 말했다.“만약당신이일반적으로높은setting의 phacoenergy를사용하고있다면,이는당연한 걱정입니다. 저는짧게파열하는데 phaco를 사용하고, 사용하는 열을 최소화하기 위해 잘게 자르는 과정을 더 합니다”라고 그녀는 설명했다. Dr. Pettey는 얼마 전 phaco로 인한 화상 환자를 refer받은 적이 있다. 그는 Majid Moshirfar, MD (professor of ophthalmology, University of Utah, Department of Ophthal- mology and Visual Science and in practice John A. Moran Eye Center, Salt Lake City)의 충고를 따랐다. “상처 가장자리가 어구형 (fish-mouthed)일때,상처끝이오그라들게 하는 공백을 채울 무엇인가가 필요합니다. 제 마지막 경우는 상처에 큰 함몰이 있는 환자였고, 타이트하게 봉합하기보다는, 상 처에 양막을 살짝 덮어 봉합시 나타나는 긴 장도를 줄여주고 filler처럼 작용하도록 했 습니다.”라고 Dr. Pettey는 말했다. 환자는 결과에 만족했고 좋아진 나안시력에 놀라 워했다. EWAP Editors’ note: The physicians have no fi- nancial interests related to this article. Contact information Bordewick: eyestuff3@new.rr.com , dbordewick@baycare.net Kim: 408-851-4012, evasterbunny@ gmail.com Pettey: 801-581-2352, jeff.pettey@hsc. utah.edu 경성 백내장에 - from page 11 TECNIS ® Monofocal Intraocular Lens (IOL) Warnings: Physicians considering lens implantation under any of the conditions described in the Directions for Use labeling should weigh the potential risk/benefit ratio prior to implanting a lens. Precautions : Do not resterilize or autoclave. Use only sterile irrigating solutions such as balanced salt solution or sterile normal saline. Do not store in direct sunlight or in temperatures over 45°C. Adverse Events: The most frequently reported adverse event that occurred during the clinical trial of the 1-Piece lens was macular edema, which occurred at a rate of 3.3%. Other reported reactions, occurring in less than 1% of patients, were secondary surgical intervention (pars plana vitrectomy with membrane peel) and lens exchange (due to torn lens haptic). TECNIS ® Multifocal 1-Piece Intraocular Lens (IOL) Warnings: Physicians considering lens implantation under any of the conditions described in the Directions for Use labeling should weigh the potential risk/benefit ratio prior to implanting a lens. Some visual effects associated with multifocal IOLs may be expected because of the superposition of focused and unfocused images. These may include a perception of halos/glare around lights under nighttime conditions. It is expected that, in a small percentage of patients, the observation of such phenomena will be annoying and may be perceived as a hindrance, particularly in low-illumination conditions. On rare occasions, these visual effects may be significant enough that the patient will request removal of the multifocal IOL. Under low-contrast conditions, contrast sensitivity is reduced with a multifocal lens compared with a monofocal lens. Therefore, patients with multifocal lenses should exercise caution when driving at night or in poor-visibility conditions. Patients with a predicted postoperative astigmatism >1.0 D may not be suitable candidates for multifocal IOL implantation since they may not fully benefit from a multifocal IOL in terms of potential spectacle independence. Care should be taken to achieve centration, as lens decentration may result in patients experiencing visual disturbances, particularly in patients with large pupils under mesopic conditions. Precautions: The central one millimeter area of the lens creates a far image focus; therefore, patients with abnormally small pupils (~1mm) should achieve, at a minimum, the prescribed distance vision under photopic conditions; however, because this multifocal design has not been tested in patients with abnormally small pupils, it is unclear whether such patients will derive any near-vision benefit. Autorefractors may not provide optimal postoperative refraction of multifocal patients; manual refraction is strongly recommended. In contact lens wearers, surgeons should establish corneal stability without contact lenses prior to determining IOL power. Care should be taken when performing wavefront measurements, as two different wavefronts are produced (one will be in focus [either far or near], and the other will be out of focus); therefore, incorrect interpretation of the wavefront measurements is possible. The long-term effects of IOL implantation have not been determined; therefore, implant patients should be monitored postoperatively on a regular basis. Secondary glaucoma has been reported occasionally in patients with controlled glaucoma who received lens implants. The intraocular pressure of implant patients with glaucoma should be carefully monitored postoperatively. Do not resterilize or autoclave. Use only sterile irrigating solutions such as balanced salt solution or sterile normal saline. Do not store in direct sunlight or in temperatures over 45°C. Emmetropia should be targeted, as this lens is designed for optimum visual performance when emmetropia is achieved. Adverse Events: The most frequently reported adverse event that occurred during the clinical trial of the TECNIS ® Multifocal IOL was surgical reintervention, which occurred at a rate of 3.7% (lens-related: 0.6%; non-lens- related: 3.2%). Surgical reintervention included lens exchange, retinal repair, iris prolapse/wound repair, trabeculectomy, lens repositioning and lens removal due to patient dissatisfaction. The second most frequent adverse event was macular edema, which occurred at a rate of 2.6%. Other reported reactions were hypopyon and endophthalmitis, each occurring at a rate of 0.3%. Caution: Federal law restricts these devices to sale by or on the order of a physician. Do not use the lens if the package has been damaged. The sterility of the lens may have been compromised. Attention: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions. Important Safety Information 2013.02.05-CT6339