Optometry clinics : the official publication of the Prentice Society最新文献

The development of posterior capsule opacification secondary to extracapsular cataract extraction is a common occurrence. The patient complains of decreased visual acuity, glare, and sensitivity to light. The YAG laser posterior capsulotomy has become standard treatment for this anomaly: an opening is created in the opacified posterior capsule, which immediately improves visual acuity. This review describes the indications, preparation, procedure, follow-up, and complications associated with using a yttrium-aluminum-garnet (YAG) laser to perform capsulotomy.

Management of open-angle glaucoma is complex and consists of medications, laser therapy, and conventional surgery. Laser therapy is a vital component of management, with the most common procedure being a trabeculoplasty, which reduces intraocular pressure by increasing aqueous outflow. This review discusses the indications, contraindications, and specific techniques for laser trabeculoplasty. The use of holmium sclerostomy is also discussed. With recent advances in laser and fiberoptic technology, sclerostomy is proving to be a simpler procedure than conventional filtering surgery, while providing comparable effectiveness.

Ophthalmic laser procedures are not a significant cause of liability claims. When claims are brought, they usually allege negligence, breach of the doctrine of informed consent, or both. The most likely cause of a liability claim is laser photocoagulation for diabetic retinopathy. Among anterior segment procedures, treatment for glaucoma is most likely to produce a claim.

Keratoconus is characterized by the presence of corneal distortion (secondary to thinning of the apex) and either Fleischer's ring (found in 57% of patients) or Vogt's striae (found in 44% of patients). Often the only presenting symptom is decreased visual acuity. Steep keratometric readings are not usually diagnostic; 18% of patients with keratoconus have readings flatter than 45.00 D. Treatment requires correction of acuity with spectacles or contact lenses. More advanced cases are generally managed with rigid gas-permeable contact lenses. Corneal scarring occurs in approximately 43% of cases; 10% to 20% of patients require penetrating keratoplasty to restore acuity.

Inflammation is a fundamental defense mechanism that is of great significance for the practitioner attempting to diagnose and treat corneal disease. This discussion summarizes the cause, effects, and management of ocular inflammation, with emphasis on the ramifications for the cornea.

Five recent professional liability claims involving the cornea are reviewed, arising from five unusual conditions: fungal infection following corneal abrasion with a tree branch; herpes simplex-induced neurotrophic keratitis resulting from contact lens wear; corneal necrotization caused by lime particulate matter splashed into the eye; siderosis-related retinal detachment secondary to a penetrating iron foreign body; and fluctuating acuity, halos, and flare resulting from radial keratotomy. Emphasis is on how these claims might have been avoided.

The majority of complications associated with laser procedures can be minimized or avoided through proper technique. The astute clinician is aware of all potential complications and is prepared to manage any undesired effects promptly and correctly. This review discusses how to minimize the risk of significant complications and describes the appropriate treatment protocols for complications associated with specific anterior segment laser procedures.