Comprehensive ophthalmology update最新文献

Dry eye is one of the most common complications after laser-assisted in situ keratomileusis (LASIK). The clinical signs of post-LASIK dry eye include positive vital staining of ocular surface, decreased tear film breakup time and Schirmer test, reduced corneal sensitivity, and decreased functional visual acuity. The symptoms and signs last at least 1 month after LASIK. Although the mechanisms for developing post-LASIK dry eye are not completely understood, loss of corneal innervation by flap-making may affect the reflex loops of the corneal-lacrimal gland, corneal-blinking, and blinking-meibomian gland, and blinking-meibomian gland, resulting in decreased aqueous and lipid tear secretion and mucin expression. As LASIK enhancement by flap-lifting induces less dry eye symptoms and signs than first surgery, it is suggested that other factors rather than loss of neurotrophic effect may be involved in the mechanisms of post-LASIK dry eye. The treatments of dry eye include artificial tears, topical cyclosporine, hot compress, punctal plugs, and autologous serum eye drops. For patients with severe preoperative dry eye, a combination of punctal plugs and serum eye drops is required to be used before surgery.

The term optic neuritis denotes primary inflammation of the optic nerve. When the clinical history and examination suggest optic neuritis and the optic disk appears normal, the term retrobulbar optic neuritis is used. Critical elements in establishing the diagnosis are a detailed history and an accurate examination. For this reason, the ophthalmologist must be familiar with the clinical profile of optic neuritis.

The etiology, diagnosis, sequelae, and management of ocular hypotony are discussed in this review. Hypotony from decreased production of aqueous is often due to inflammation, medications, or proliferative vitreoretinopathy. Hypotony from aqueous loss may be external, such as following surgery or trauma, or internal, as in cyclodialysis cleft or retinal detachment. Treatment of hypotony is most effective if the underlying cause can be addressed, either surgically or medically. Marked improvement in vision may be achieved if hypotony is reversed.

The ocular ischemic syndrome is a progressive disorder that results from chronic hypoperfusion to the eye and orbit, occurring most often from ipsilateral internal carotid or ophthalmic artery occlusion, or severe stenosis. It may also result from other causes of reduced blood flow to the eye and orbit, such as systemic vasculitis. As such, it is associated with a significant risk of both cardiovascular and cerebrovascular disease. The aim of management is to prevent further ocular damage as well as the secondary prevention of systemic co-morbidities. This review discusses the spectrum of clinical presentations in ocular ischemic syndrome, its etiology, and the current status of both ocular and systemic management.

Basal cell carcinoma is the most common malignancy in humans, and it is also the most frequent periocular malignancy. Although a slow-growing tumor, it can lead to significant morbidity in the periocular region as a result of orbital invasion. As clinical presentation can be very variable, biopsy is recommended for all suspicious lesions. Management needs to be individualized, taking into account patient factors, tumor characteristics, and histological subtype. Several treatment modalities have been proposed, but surgical excision with monitoring of excision margins has the highest cure rate. As a certain percentage of tumors will recur regardless of treatment modality, careful patient counseling and/or long-term follow-up is recommended. In this review, we discuss the risk factors, pathology, molecular biology, clinical features, and management of eyelid basal cell carcinoma.

Multiple sclerosis is a common demyelinating disorder of the central nervous system, and neuro-ophthalmologic manifestations occur in the majority of patients. This article provides a review of the pathogenesis, epidemiology, and classification of multiple sclerosis. Neuro-ophthalmologic abnormalities associated with multiple sclerosis, including acute demyelinating optic neuritis and internuclear ophthalmoplegia, are described in detail. Current and emerging technologies designed to assess visual function in multiple sclerosis are discussed. A summary presents the appropriate evaluation and management of patients with optic neuritis and other first demyelinating events (also referred to as clinically isolated syndromes).

Branch retinal vein occlusion is a common retinal vascular condition characterized by sectoral intraretinal hemorrhages, retinal ischemia, retinal exudates, and macular edema. The site of occlusion usually occurs in the vicinity of arteriovenous crossing sites, and is predisposed by various systemic and local factors. Complications of branch retinal vein occlusion include macular edema, capillary nonperfusion, retinal neovascularization, vitreous hemorrhage, and tractional retinal detachments that often result in loss of vision. Until recently, laser photocoagulation was the only therapy recommended for eyes with branch retinal vein occlusion. New medical and surgical treatment options aimed at reducing macular edema have been evaluated in recent years, and include intraocular injections of steroids and anti-vascular endothelial growth factor agents, sustained drug release devices, vitrectomy, and sheathotomy.