Ophthalmology clinics of North America最新文献

This article will help clinicians to be aware of their choices of local anesthetic solutions before they make their ocular anesthetic plan based on the specific requirements of the patient, the surgical procedure, and the properties of the local anesthetic. Choices of local anesthetic solutions and additives for both topical anesthesia and conduction blockade are discussed.

Economic evaluation is an increasingly important component of health and medical care policy making although it continues to be met with some resistance. Many fields of medical care services and public health have extensive economic evaluation literatures. In ophthalmology, the literature is less well developed and there is an ongoing discussion of the most appropriate methods. This article outlines different types of economic evaluations providing examples on their potential use in ophthalmic care decision making, reviews three articles in the brief recent literature on the cost-effectiveness of ophthalmic anesthesia and cataract surgery in the United States with a focus on explaining methods that were used, and discusses ways in which research in this area might be moved forward.

This article discusses the two types of anesthesia used during ocular surgery and their associated complications.

Local anesthesia is a common technique used to provide anesthesia for ocular surgical procedures. Despite improvements in operative conditions, there is still the potential for complications, both local and systemic, during routine procedures. This article discusses the physiology of neuronal function, the chemistry of various local anesthetic agents, and the pathogenesis of toxicity. It is vital for the practitioner to have thorough knowledge of these subjects in order to reduce risks when performing ophthalmic procedures.

Skillful anesthetic management is integral to optimal outcomes after ophthalmic surgery. Although the majority of ophthalmic operations in the United States are performed with local anesthetic techniques, nonetheless general anesthesia may be either necessary or advisable in several challenging circumstances. Ophthalmic patients are often at the extremes of age, and not uncommonly have extensive associated systemic or metabolic diseases. Because the complications of ophthalmic anesthesia can be vision threatening or life threatening, it is imperative that the ophthalmologist and the anesthesiologist understand the complex and dynamic interaction among patient diseases, anesthetic agents, ophthalmic drugs, and surgical manipulation. Effective communication and planning among all involved are essential to safe and efficient perioperative care.

Ophthalmic pathology in infants and children undergoing eye surgery ranges from the rare and atypical to the commonplace. These pathologies include nasolacrimal duct obstruction, strabismus, congenital or traumatically induced cataracts, penetrating eye injuries, glaucoma, retinopathy of prematurity, intraorbital tumors, and more. Nasolacrimal duct stenosis, cataracts, and traumatic eye injuries often occur in otherwise healthy pediatric patients; however, many ophthalmopathies can be associated with other congenital disorders that may have important anesthesia implications. In this article, we will review pertinent anesthesia issues within the context of various ophthalmic diseases.

This article reviews clinical and optical data for three unique lens designs: the ReSTOR diffractive intraocular lens (IOL), the Vision Membrane, and the ReZOOM refractive multifocal IOL.

The light adjustable lens (LAL) is an innovative intraocular lens optic composed of partially polymerized macromers with an appropriately bonded photosensitizer. The injectable technology and multifocality associated with the LAL can produce precise refractive correction and, it is hoped, the type of accommodative range that is taken for granted during youth. Combining these technologies with a lens material that behaves like the crystalline lens of 25-year-old could precisely return near and distance vision to older adults.

Although presbyopia is ostensibly an age-related disease of the lens, ciliary body, and zonular apparatus, surgeons have nonetheless persevered in their attempts to create a solution to the problem of diminished near vision by performing keratorefractive procedures. This article discusses two approaches of varying technological sophistication, beginning with surgically induced astigmatism and continuing through enhanced monovision. Sometimes simple solutions are the best, and the technological innovation in cataract and refractive surgery has met with unrivalled success in the last three decades.

The authors present their detailed technique for the correction of presbyopia with pseudoaccommodative cornea laser in situ keratomileusis. A detailed commentary of the procedure is presented along with the authors' views about the present state and future of multifocal corneal surgery. Sample cases with suggested nomogram calculations are presented.