Comprehensive ophthalmology update最新文献

Sjögren syndrome is a chronic autoimmune disorder of the exocrine glands with associated lymphocytic infiltration of the affected glands. The exocrinopathy can be encountered alone (primary Sjögren syndrome or in association with other autoimmune disorders, the three most common ones being rheumatoid arthritis, systemic lupus erythematosus, and progressive systemic sclerosis (secondary Sjögren syndrome). A revised international consensus has been designed based on symptoms and objective signs. Recent studies have broadened our understanding of the etiopathogenesis and immunopathology of primary Sjögren syndrome. Systemic therapy includes treatment of the underlying systemic disorder with steroidal and nonsteroidal agents, disease-modifying agents, and cytotoxic therapy to address the extra glandular manifestations. Medical treatment of dry eye includes aqueous enhancement therapy, anti-inflammatory therapy, and secretagogues. The surgical treatment of dry eye includes punctal occlusion, tarsorrhaphy, and botulinum toxin-induced ptosis. This review highlights recent advances in understanding the underlying mechanisms of the disease as well as the therapeutic options.

Classic hypertensive retinopathy has been well known since the first categorization of retinal vascular changes with the ophthalmoscope made by Keith-Wagener and Barker. Clinicians were interested in using a noninvasive tool to show that severity of vascular hypertension was predictive of mortality. Recently, a microvascular etiology has been suggested to play an important role in the pathogenesis of vascular hypertension. The retinal vasculature can potentially be used to evaluate the role of the microcirculation and to provide new insights into the vascular etiology of vascular hypertension. In this review, we have focused the attention on the role of retinal imaging in the work-up of hypertensive subjects.

Pregnancy can cause multiple physiologic and non-physiologic changes throughout the body; the eye is no exception. Ocular changes during pregnancy can be physiologic or pathologic, or these changes can be an effect of a pre-existing condition. While many of theses changes are reversible, some may lead to lasting visual impairment. The aim of this review is to give an overview of the currently available literature on ocular changes during pregnancy.

The general ophthalmologist is most often the first responder in the care of severe open globe injuries, and in this review, we will outline the current thoughts on assessment and classification of open globe injuries. Basic medical and surgical management issues are reviewed, and relevant controversies and unresolved issues regarding the management of open globe injuries will be discussed.

Refractive procedures enjoy very high success rates and are among the most commonly performed elective surgeries in medicine. With better insights into preoperative screening, the overwhelming majority of cases have successful outcomes. Unfortunately, however, all refractive surgeons must appropriately manage unsuccessful cases. Unsuccessful refractive surgery procedures may relate to each step of the refractive surgery process: preoperative screening, surgical planning, intraoperative events, and postoperative biomechanical or healing anomalies. This paper reviews the management of unsuccessful laser-assisted in situ keratomileusis (LASIK) procedures, focusing on significant advances related to wavefront-guided therapeutic ablations.

In this review, we define characteristics of floppy eyelid syndrome, as well as related syndromes, such as lax eyelid syndrome. Presenting symptoms, ocular signs, and important clinical examination techniques are described, and associated ocular and systemic conditions, as well as corresponding pathophysiology are discussed. Significant new histopathologic findings in floppy eyelid syndrome and recent surgical developments are summarized. This review provides a critical update of floppy eyelid syndrome and aids the ophthalmologist in new methods of assessment and management.

Transient monocular visual loss may be caused by a variety of ophthalmic and systemic conditions. Management depends on identifying the cause. Embolic occlusions of arteries supplying the eye are a most important cause. Such emboli often arise from the heart, aorta, and internal carotid arteries. The most common embolic substances are white platelet-fibrin and red erythrocyte-fibrin thrombi, cholesterol crystals, and calcific particles. Retinal vasoconstriction is another important cause of transient monocular visual loss. The conditions that cause anterior ischemic optic neuropathy may occasionally cause transient visual loss. Transient monocular visual loss may also be related to conditions that cause papilledema and some conditions intrinsic to the eye, such as optic disk drusen and colobomas.