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CPG (Cataract) (crystalline lens)

Level ofEvidence

1 1 Foster A, Johnson GJ: Magnitude and causesof blindness in the developing world. IntOphthalmol 1990; 13:135-140. IAPB

C

..2537 752

2 , ..2537. 2539 10 2 125-134

3

3 Sommer A, Tielsch JM, Katz J et al: Racialdifferences in the cause-specific prevalence ofblindness in East Baltimore. N Engl J Med 1991;325:1412-1417.4 Klein BEK, Klein R, Linton KLP: Prevalence ofage-related lens opacities in a population. TheBeaver Dam eye study. Ophthalmology 1992;99:546-552.

C

B

() 5-8

5 Schwab L, Taylor HR: Cataract and deliveryof surgical services in developing countries. In:Duane TD, Jaeger ED, eds. ClinicalOphthalmology. Philadelphia: JB Lippincott Co;1988:5.6 Taylor HR, West SK, Rosenthal FS et al:Effect of ultraviolet radiation on cataractformation. N Engl J Med 1988; 319:1430-1433.7 Keeney AH: The eye and the work place:Special considerations. In: Duane TD, JaegerED, eds. Clinical Ophthalmology. Philadelphia:JB Lippincott Co; 1988:5.Luntz MH: Clinical types of cataracts. In: DuaneTD,8 Jaeger ED, eds. Clinical Ophthalmology.Philadelphia: JB Lippincott Co; 1988:1.Phelps CD: Examination and functionalevaluation of the crystalline lens. In: DuaneTD, Jaeger ED, eds. Clinical Ophthalmology.Philadelphia: JB Lippincott Co; 1988:1

D B D D D

Level ofEvidence

CPG file:///C:/Users/admin/Desktop/New folder (5)/okokokok_CPG ...

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1. 2. 3.

( ) visual acuity ( Snellen chart, ETDRS chart) slit-lamp

Level of

Evidence visual acuity,contrast sensitivity, glare disability, (visual functionalstatus indicies eg. VF-14) visual acuity9

9 Steinberg EP, Tielsch JM, Schein OD et al:The VF-14: an index of functional impairment inpatients with cataract. Arch Ophthalmol 1994;112:630-638.

3

Level ofEvidence

.. 1992 10-11Glare testing 33%Contrast sensitivity 7% Potential acuity measurement 37%Specular microscopy 19% glare V.A. contrast sensitivity/ glare testing glare disability macular opticN. function opthalmoscopy

10 Steinberg EP, Bass EB, Luthra R et al:Variation in ophthalmic testing before cataractsurgery: results of a national survey ofophthalmologists. Arch Ophthalmol 1994;112:896-902. 11 Principle and Practice of Ophthalmology, 2ndedition : P.1477-1486

C

D

glare glare testing 12

12 Pfoff DS, Werner JS: Effect of cataractsurgery on contrast sensitivity and glare inpatients with 20/50 or better Snellen acuity. JCataract Refract Surg 1994; 20:620-625.

potential acuity test visual acuity 1. (subjective) suprathreshold pinhole device, Maddox rod test, laserinterferometer, Guyton-Minkowski potential acuity test 2. (objective) electroretinography, visual evoke


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potential Potential acuity test specular microscopy corneal pachymetry endothelium ( Fuchs corneal dystrophy ) specular microscopy 13,14 slit lamp microscopy

13 Bourne WM, Nelson LR, Hodge DO:Continued endothelial cell loss ten years afterIOL implantation. Ophthalmology 1994;101:1014-1022.14 Bates AK, Cheng H: Bullous keratopathy: astudy of endothelial cell morphology in patientsundergoing cataract surgery. Br J Ophthalmol1988; 72:409-412.

B C

B-scan retina function retina

tonography

Level ofEvidence

nuclear sclerosis

riboflavin, niacin 15-17

15 Sper RD, Hu TS, Milton RC et al,. The linxiancataract studies. Arch Ophthalmol 1993;111:1246-1253.16 Perlman JAM, Klein BEK, Klein R, Ritter LL etal,. Relation between lens opacities and vitaminand mineral supplement use.Ophthalmol1994;101: 315-325.17 Seddon JM, Christen WG, Manson JE et al.The use of vitamin supplements and the risk ofcataract among US male physicians. AmericanJournal of Public Health 1994; 84: 788-792.

B B

Level ofEvidence

18-19 1. 2. phakomorphic glaucoma, phakolytic glaucoma 3.

18 MangioneCM, PhillipsRS, LawrenceMG,Seddon JM, Orav EJ, Goldman L.Improvedvisual function and attenuation of declines inhealth-related quality of life after cataractextraction. Arch Ophthalmol 1994;112:141919 Brenner MH, Curbow B, Javitt JC et al,Vision change and quality of life in the elderly:response to cataract surgery and treatment ofother chronic ocular conditions. ArchOphthalmol 1993; 111: 680-685

C B

1. 2. (visual aids)


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3. 4. 5. 6. 1. 20,21

2. 3. 4. 5. 6. 7.

20 Powe NR, Schein OD, Gieser SC et al.Synthesis of the literature on visual acuity andcomplications following cataract extraction withintraocular lens implantation.Arch Ophthalmol1994; 112 : 239-252.21 Christen WG, Ajani UA, Schaumberg DA,Glynn RJ, et al. Aspirin use and risk of cataracyin posttrial follow-up of physicianshealth studyI. Arch ophthalmol 2001; 119: 405-412.

A

A+B

1. 2. 3. NSAID cyclooxygenase inhibitors ketorolac,

fenoprofen, indomethacin, steroid CME 22

4.

22 Rossetti L, Chaudhuri, Dickersin. Medicalprophylaxis and treatment of cystoid macularedema after cataract surgery: the result ofd ameta-analyis. Ophthalmology 1998; 105:397-405.

A

Level ofEvidence

Designanalysis

retrobulbar topical23 peribulbar akinesia retrobulbar

23 Friedman DS, Bass EB, Lubomski LH,Fleisher LA, Kempen JH, Magaziner J, SprintzM, Robinson K, Schein OD: Synthesis of theliterature on the effectiveness of regionalanesthesia for cataract surgery. Ophthalmology2001, Mar, 108 (3) : 519-29

A

subtenon topical

topical ,

intracamera topical topical ,

(general anesthesia) mental retard uncontrollableneurological movement

monitor anesthesia care 24

24 Rosenfeld SI, Litinsky SM, Snydes DA et al :Effectiveness of monitores anesthesia cate incataract surgery. Ophthalmology 1999 ; 106 :1256-60

C


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1. Pre-op antibiotic, pre-op evaluation : nasolacrimal irrigate, blepharitis, conjunctivitis, hordeolum etc.2. Preparation : antiseptic solution, eye irrigation, one or two eyes, eye lashes3. Intraoperative antibiotic4. Post-operative antibiotic

Level of

Evidence

(conjunctival flush) normal saline

1-5% providine iodine solution conjunctivalsac 25

25 Speaker MG, Menikoff JA: Prophylaxis ofendophthalmitis with topical providineiodine.Ophthalmology 1991;98:1769-1775.Binder CA, Mino de Kaspar H et al: Preoperativeinfection prophylaxis with 1% polyvidon-iodinesolution based on the example of conjunctivalstaphylococci. Ophthalmologe1999;96:663-667.

B

cataract

Preoperative antiobiotic/antiseptic1. Intraoperative antibiotic2. Post-operative antibiotic3.

Preoperative antibiotics/antiseptics antiseptics large clinical trials post-cataract endophthalmitis

1. Topical antibiotica. bacteria eyelid conjunctiva

i. broad spectrum ATB : fluoroquinolone (USA), chloramphenical (UK, Australia),fusidic acid, tobramycin, trimethoprim-polymyxin B,neomycin/polymyxin/gramicidin

ii. Level of

Evidence ofloxacin eye drop tobramycin eye drop10 placebo bacteria conjunctiva lids control ( bacteria conjunctiva >lid)26

26 Kirsch LS et al. Perioperative ofloxacinversus tobramycin : efficacy in externalocular adnexal sterilization and anteriorchamber penetration. Can J Ophthalmol1995 Feb;30(1):11-20.

A

timethoprim-polymyxinB tobramycin lidconjunctiva S.epidermidis aqueous humor 27

27 Osher RH et al. Antimicrobial efficacy andaqueous concentration of preoperative andpostoperative topicaltrimethoprim/polymyxin B Sulfate versustobramycin. J Cataract Refract Surg1994;20:3-8.

A

fusidic acid eye ointment 4 7 control lid margin conjunctiva 28

28 Gray TB et al. Fusidic acid prophylaxisbefore cataract surgery : patient selfadministration. Aust N Z J Ophthalmol 1993May;21(2):99-103.

A

b. antibiotic MIC levels anterior chamber

i. ii. : vancomycin, fluoroquinolone iii. fluoroquinolone ofloxacin anterior chamber concentration

ciprofloxacin norfloxacin

Level ofEvidence


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vancomycin eye drop (50mg/ml) MIC level concentration ECCE c IOL29

29 Alster Y et al. Intraocularpenetration of vancomycin eye dropsafter application to the medial canthuswith closed lids. Br J Ophthalmol 2000Mar;84(3):300-2.

A

ciprofloxacin, norfloxacin ofloxacin aqueous humor inhibit 90% gramnegative bacteria proteus mirabilis and escherichiacoli. 67.5% ofloxacin 41% ciprofloxacin inhibit 90% ofstaphylococcus epidimidis norfloxacin ofloxacin streptococcus peumoniae pseudomonas aeruginosa30

30 Von Keyserlingk J, et al. Eur J ClinPharmacol 1997,53:251-255

A

norfloxacin eye drop control culture results aqueous 31

31 Chitkara DK et al. Lack of effect ofpreoperative norfloxacin on bacterialcontamination of anterior chamber aspiratesafter cataract surgery. Br J Ophthalmol1994 Oct;78(10):772-4

A

ofloxacin aqueous humor ciprofloxacin 4

ofloxacin aqueous humor ciprofloxacin (P

surgery. Ophthalmology 1989;96:289-92.38 Apt L et al. Chemical preparation of theeye in ophthalmic surgery:III. Effect ofpovidone-iodine on the conjunctiva. ArchOphthalmol 1984;102:728-9.

5% povidone-iodine endophthalmitis 39

39 Bohigian GM . A study of the incidenceof culture positive endophthalmitis aftercataract surgery in an ambulatory carecenter. Ophthalmic Surg Lasers1999;30:295-8.

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Intraoperative antibioticsIntracameral antibiotics controversial

1. (35%) (60%) Australia(8%) New Zealand(16%)2. vancomicin vancomycin + gentamicin3. contamination anterior chamber aspirates

4. carbapenem imipenem endophthalmitis 5. : low potential therapeutic index, potential for dosage errors, drug resistance

potential for cystoid macular edema bacterial contamination anterior chamber aspirates

Level ofEvidence

vancomycin ( 20 mg/L) gentamicin (8 mg/L) BSS microbial contamination anterior chamber aspirates 40

40 Beigi B et al. The effect of intracameral,preoperative antibiotics on microbialcontamination of anterior chamber aspiratesduring phacoemulsification. Eye1998;12:390-4

A

gentamicin irrigating solution organism anterior chamber aspirates

vancomycin irrigating solution effective concentration

culture result anterior chamber concentration

Level ofEvidence

vancomycin (20ugm/ml) gentamicin(8ugm/ml) irrigating solution phacoemulsification placebo post-opculture placebo 41

41 Ferro JF et al. Postoperativecontamination after using vancomycin andgentamicin during phacoemulsification ArchOphthalmol 1997 Feb;115(2):165-70.

A

vancomycin irrigating solution culture results ATB

gentamicin irrigating solution ATB positive culture rate 42

42 Gimbel HV et al. Anterior chamber fluidcultures following phacoemulsification andposterior chamber lens implantation. Opthalmic Surg Lasers 1996Feb;27(2):121-6.

A

gentamicin intracameral anterior chamber phacoemulsification bactericidal levels antibioticprophylaxis 43

43 Lehmann OJ et al. Half-life ofintracameral gentamicin afterphacoemulsification. J Cataract Refract Surg1997,23:883-8.

B

cystoid macular edema intracameral vancomycin. 44

44 Axer-Seigel R et al. Ophthalmol1999,106:1660-1664

A

Post-operative antibiotics

1. Post-op subconjunctival injectiona. post-op endophthalmitisb. anterior chamber conjunctival injection c. endophthalmitis

Level of


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Evidence subconjunctival steroid ATB significanthigher degree conjunctival injection anteriorchamber activities topical BCVA,corneal edema,CME, IOP infection 45

45 Sanders R et al. A comparison ofprophylactic, topical and subconjunctivaltreatment in cataract surgery. Eye1992;6(Pt1):105-10

A

2 endophthalmitis 36 37 subconjunctival antibiotics 46

46 Speaker MG,et al. Ophthalmology1991,98:1769-1775

C

2. Post-operative topical antibiotic

a. post-operative antibiotic post-operative endophthalmitis 24

b.

Level ofEvidence

5% povidone iodine bacteria broad spectrum ATB 47

47 Apt L et al. The effect of povidone-iodinesolution applied at the conclusion ofophthalmic surgery. Am J Ophthalmol1995;119:701-5.

B


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Current patterns of perioperative antibiotic use USA 48 Australia 49 Germany 50 New Zealand 51

Total surgeons 1300 510 311 101Topical antibioticspreoperative

96%( Ofloxacin 26%

Ciprofloxacin 19%Tobramycin 17%

Other 5%)

58%(chloramphenical

usually)

100%(aminoglycoside 46%fluoroquinolone 34%

polymyxin 9%other 11%)

26%

Antiseptic at surgery Non obtainable 53% 68%(povidone-iodine)

Non obtainable

Subconjunctivalantibiotics

31%(Cefazolin 44%Gentamicin55%

Other 17%)

75%(gentamicin 60%)

52%(aminoglycoside 90%)

61%

Intracameralantibiotics

35%(vancomycin 82%gentamicin 47%

other 3%)

8% 60%(aminoglycoside 85%

vancomycin 7%both5%)

16%

Postoperativeantibiotics

96%(Same as pre-op)

95%(usually

chloramphenicol)

Non obtainable(systemic 6.5%)

Non obtainable

Reference48 USA = Masket S : Preventing, diagnosing, and treating endophthalmitis. J Cataract Refract Surg1998,24:725-726. C49 Australia = Morlet N, Gatus B, Coroneo M : Patterns of perioperative prophylaxis of cataract surgery: a survey ofAustralian ophthalmologist. C Aust N Z J Ophthalmol 1998,26:5-1250 Germany = Schmitz S, Dick HB, krummenauer F , et al.: Endophthalmitis in cataract surgery: results of German survey.Ophthalmol C 1999,106:1869-187151 NewZealand = Elder M, Tarr K, Leaming D: The New Zealand cataract and refractive surgery survey 1997/1998. ClinExp Ophthl 2000,28: C 89-95 3 1. Intracapsular cataract extraction (ICCE)

5.4% 52 ( pc-IOL) posterior capsular opacification (PCO) subluxation lens

2. Extracapsular cataract extraction (ECCE) ( pc-IOL) ICCE PCO 53

3. Phacoemulsification (pc-IOL) capsular bag ICCE PCO

3 ICCE subluxation lens 2 3 ECCE Phacoemulsification 54 20/40 ECCE Phacoemulsification endophthalmitis, bullouskeratopathy, malposition IOL, zonule/posteriorcapsule rupture, PCO ECCE Phacoemulsification increase

52 Olsen G, Olson RJ: Update on along-term, prospective study of capsulotomyand retinal detachment rates after cataractsurgery. J cataract refract surg 2000; 26:1017-1021.53 Schaumberg DA, Dana MR, Christen WG,Glynn RJ: A systematic overview of theincidence of posterior capsule opacification.Ophthalmology 1998; 105: 1213-1221.54 Powe NR, Schein OD, Gieser SC, TielschJM, Luthra R, Javitt J, Steinberg EP:Synthesis of the literature on visual acuityand complications following cataractextraction with intraocular lens implantation.Arch Ophthalmol 1994; 112: 239-252.55 Laurell CG, Zetterstrom C, Philipson B,Syren NS: Randomized study of the bloodaqueous barrier reaction afterphacoemulsification and extracapsularcataract extraction. Acta ophthalmol scand1998; 76(5): 573-578.56 Chee SP, Ti SE, Sivakumar M, Tan DTH:Postoperative inflammation: Extracapsularcataract extraction versusphacoemulsification. J cataract refract surg

B B B A A


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IOP( closed angle), clinical CME, ECCE 55 Phacoemulsification ECCE wound gape/iris prolapse, iris trauma, vitreouis loss,postoperative inflammation 55,567 , retinaldetachment anterior chamber hemorrhage Phacoemulsification ECCE ECCE Phacoemulsification

1999; 25: 1280-1285.

Level ofEvidence

(Intraocular lens) (refractive error)

1. PMMA silicone

57 PMMA ECCE phacoemulsification 5 . silicone Acrylic 3.0 4.5 . silicone lens vitrectomy gas silicone oil capsule fibrosis, glare, posterior capsule opacity, YAG capsulotomy, ,

2. (unifocal multifocal) (multifocal IOL) , 1 2 steropsis contrast , best corrected V.A. , glares halo

3. bag bag sulcus scleral fix endothelium cell , anteriorchamber scleral fixation

4. FDA approve FDA (USA) IOL 2

5. uncontrolledactive uveitis

ViscoelasticViscoelastic () viscoelasticity, viscosity, pseudoplasticity,surface tension, cohesive VS. dispersive viscoelastic cornealendothelium capsule endothelial cell

57 Hollick EJ, Spalton DJ, Ursell PG et al.The effect of polymethylmethacrylate,silicone, And polyacrylic intraocular lenses onposterior capsular opacification 3 years aftercataract surgery Ophthalmology. 1991 ; 106: 49 54

A


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hyaluroric acid, chondroitin sulfate, hydroxy-proplymethylcellulose, polyacrylamide endothelium, , anterior chamber , anterior chamber maintainer

Level ofEvidence

post-operative endophthalmitis () expulsive suprachoroidal hemorrhage ( suprachoroidal) bullous keratopathy () cystoid macular edema () 20/40 90 95 58

58 Power NR, Schein OD, Gieser SC et al:Synthesis of the literature on visual acuityand complications following cataractextraction with intraocular lens implantation.Arch Ophthalmol 1994: 112:239-252.

B

59 60 ( shallow anterior chamber ) , , , choroidaldetachment, pupillary block, ciliary block suprachoroidal hemorrhage flat chamber air injection anterior chamber

59 John KJ,MD, Feder RS,MD, HamillMB,MD, Miller-Meeks MJ,MD, RosenfeldSI,MD, Perry PE,MD. Complications ofCataract Surgery. In: Basic and ClinicalScience Course. Section 11. Lens andCataract 2000-2001.60 Speath GL, MD. Ophthalmic Surgery,Principle and Practice. 1992

D D

( corneal edema ) 61, 62 Stromal epithelial edema mechanical

trauma, prolong intraocular irrigation, inflammation,, acute endothelial decompensation 4-6 3 penetrating keratoplasty

Brown-Mclean Syndrome peripheral cornealedema clear central cornea ICCE, punctate brown pigment corneal edema

Vitreocorneal adherence and persistent cornealedema ICCE, complicated ECCE retinal detachment

Corneal complication of phacoemulsification ultrasound power

Descemets membrane detachment air anterior chamber

Toxic solution ,subconjunctival injection

Corneal melting with ocular surface disease preexisting tear-film abnormalities keratoconjunctivitis sicca, Sjogren syndrome

61 Brown SI, McLean JM. Peripheral cornealedema after cataract extraction. A newclinical entity. Trans Am Acad OphthalmolOtolaryngol. 1969;73:465-470.62 Gothard TW, Hardten DR, Lane SS, et al.Clinical findings in Brown-McLean syndrome.Am J Ophthalmol. 1993;115:729-737.

C C

Capsular rupture capsular remnant support posterior chamber IOL anterior chamber IOL scleralfixation 63

63 Fishkind WJ. The torn posterior capsule:prevention, recognition, and management.In: Focal Points: Clinical Modules forOphthalmologist. San Francisco: AmericanAcademy of Ophthalmology; 1999: vol 17,no 4.

D

( hemorrhage ) Retrobulbar hemorrhage

64 Cionni R, Osher R. Retrobulbarhemorrhage. Ophthalmology.

C


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lateral canthotomy release pressure 64,65

Suprachoroidal hemorrhage or effusion hypertension, obesity, high myopia, anticoagulant, glaucoma, chronic ocular inflammation

Expulsive choroidal hemorrhage , red reflex, iris prolapse, lens vitreous suprachoroidal expulsive hemorrhage wound releasepressure suprachoroidal drainage

Delayed choroidal hemorrhage conservativetreatment

Hyphema surgical wound observe

1991;98:1153-1155.65 Morgan CM, Schatz H, Vine AK, et al.Ocular complications associated withretrobulbar anesthesia.Ophthalmology.1988;95:660-665.

C

Retinal light toxicity

viscoelasticmaterial , pupillary block 66,hyphema, ciliary block, endophthalmitis, retained lensmaterial, preexisting glaucoma, corticosteroids, peripheral anterior synechiae

66 Van Buskirk EM:Pupillary block afterintraocular lens implantation. Am JOphthalmol 1983;95:55-59.

C

Cystoid macular edema (CME) 2-6 Angiographic CME 40-60 % ICCE 1-11 %

ECCE CME FFA

Clinical CME 2-10 % ICCE 1-2 % ECCE NSAID

Retinal detachment 6 (posterior capsulotomy ) 2-3 % ICCE 0.5-2 % ECCE

Endophthalmitis 67 Acute 6 Chronic 6 EVS

VA HM vitreous tapping intravitreous antibiotics PPV VA HM PPV

Sterile endophthalmitis steriodChronic uveitis steroid

67 Endophthalmitis Vitrectomy Study Group.A randomized trial of immediate vitrectomyand of intravenous antibiotics for thetreatment of postoperative bacterialendophthalmitis. Arch Ophthalmol.1995;113:1479-1496.

A

Induced astigmatism ICCE ECCE stitch off keratotomy

Pupillary capture diplopia photophobia reposition IOL 68

68 John KJ,MD, Feder RS,MD, HamillMB,MD, Miller-Meeks MJ,MD, RosenfeldSI,MD, Perry PE,MD. Complications ofCataract Surgery. In: Basic and ClinicalScience Course. Section 11. Lens andCataract 2000-2001.

D

Ciliary block glaucoma angle-closureglaucoma

Iridodialysis & cyclodialysis manipulate resuture hypotony diplopia 69

69 John KJ,MD, Feder RS,MD, HamillMB,MD, Miller-Meeks MJ,MD, RosenfeldSI,MD, Perry PE,MD. Complications ofCataract Surgery. In: Basic and ClinicalScience Course. Section 11. Lens andCataract 2000-2001.

D

48 ( paper post-operative day 1) (wound leak) 4-7 4-6 [i] 14 1.


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2. 3. slit-lamp 90 6-12 ECCE 4 phacoemulsification manual phacofragmentation

Level ofEvidence

uncomplicated phacoemulsification ( 24 48 )

4 6 70-71

uncomplicatedphacoemulsification 1 30 1, 7 30

70 Kartan HM, Flynn HW, Pflugfelder SC,Robertson C, Forster RK : Nosocomialendophthalmitis survey ; current incidenceof infection after intraocular surgery.Ophthalmology 1991 ; 98:227 23871 Stern GA, Engel HM, Driebe WT : Thetreatment of postoperative endophthalmitis.Ophthalmology 1989; 96:62-67

C C

8 12 ECCE ICCE 4 72

72 Floyd G : Change in the corneal curvaturefollowing cataract extraction. Am JOphthalmol 1951 ; 34: 1525 1533Simsek S, Yasan T, Demirok A, et al: Effectof superior and temporal clear cornealincision on astigmatism after suturelessphacoemulsification. J Cataract Refract Surg1997 ; 23: 1164 1173

C

Post-operative Medication steroid / NSAID

Level ofEvidence

NSAID steroid 73

73 Flach AJ, Dolan BJ, Donahue ME :Comparative effect of Ketorolac 0.5% orDiclofenac 0.1% ophthalmic solution oninflammation after cataract surgery.Ophthalmology 1998 Sep ;105 (9): 1775 9

A

Level of

Evidence (functionallymonocular) 74,75 74,75

74 Javitt JC, Brenner MH, Curbow B, LegroMW, Street DA: Outcomes of cataractsurgery- improvement in visual acuity andsubjective visual function after surgery in thefirst, second, and both eyes. Arch Opthalmol1993; 111: 686-691.75 Javitt JC, Steinberg EP, Sharkey P et al:Cataract surgery in one eye or both: a billiondollar per year issue. Ophthalmology 1995;102:1583-1593. 76 Shields M.B, Another reevaluation ofcombined cataract and glaucoma surgery.

B B B A A


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(Ocularco-morbidity)

1. (2 stageapproach) (combinedsurgery)

1.1 (compliance) carbonicanhydrase inhibitor

1..2

1. 76,77

2. (2stage approach) 76(better long term IOP control) optic nerve 76,77

3. (combinedsurgery) 76-81 76

3.1

3.2

135

3.3

2.

scleral buckling 82

silicone vitrectomy gas silicone oil

3.

central cornealpachymetry 0.6 .

central corneal pachymetry 0.62 . triple operation 83

Am. J. Ophthalmol. 1993, 115 : 806-11.77 Paulsen AS, Petersen PB. Combinedcataract and glaucoma surgery. CurrentOpinion in ophthalmol. 2001, 12 : 41-6.78 Bobrow JC. Prospective intrapatientcomparison of extracapsular cataractextraction and lens implantation with andwithout trabeculectomy Am. J. Ophthalmol.2000, 129 : 291-6.79 E1 Sayyad FF, Helal MH, Khalil MM, E1 Maghraby MA. Phacotrabeculectomyversus two stage operation : a match study.Ophthalmic Surg lasers. 1999, 30 : 260-5.80 Gimble HV, Meyer D, Debroff Bm, RouxCW, Ferensowicz M. Intraocular pressureresponse to combined phacoemulsificationand Trabeculectomy ab externo versusphacoemulsification alone in primary openangle glaucoma. J. Cataract Refract Surg.1995, 21 : 653-60.81 Krupin T, Fetil ME, Bishop KI. Postoperative intraocular pressure rise inopen-angle glaucoma patients after cataractor combined cataract filtering surgery.Ophthalmology. 1989, 96 : 579-84. 82 Haller JA. Kerrison JB. Cataract extractionafter retinal detachment. Current opinion inOphthalmol. 1997; 8 (3) : 39-43. 83 Alldredge CD, Alldredge OC. Jr.Penetrating keratoplasty and cataractextraction. In : Krachmer JH, Mannis MJ,Holland EJ; eds. Cornea, surgery of thecornea and conjunctiva. St. Louis : Mosby1997 : 1593-601.

B A A C D

Level ofEvidence


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1. central lens opacity 3 2. VA 20/70 84

84 Wright KW, Kolin T, Matsumoto E. Lensabnormalities. In: Wright KW. PediatricOphthalmology and strabismus.Mosby,St.Louis 1995;367-392.

D

congenital cataract bilateral 84 unilateral cataract 85 2-3

85 Wright KW, Matsumoto E, Edelman PM.Binocular fusion and stereopsis associatedwith early surgery for monocular congenitalcataracts. Arch Ophthalmol 1992Nov;110(11):1607-9

C

primary posterior capsulotomy anteriorvitrectomy 18 Nd :YAG capsulotomy 86

86 Plager DA, Lipsky SN, Snyder SK,Sprunger DT, Ellis FD, Sondhi N. Capsularmanagement and refractive error in pediatricintraocular lenses. Ophthalmology 1997Apr;104(4):600-7146 Wilson ME. Management of aphakia inchildhood. Focal points. 1999 vol17 No 1

C

1. 1.1 bilateral aphakia1.2 unilateral aphakia patching therapy

contact lens

2. contact lens bilateral aphakia unilateral aphakia

2 contact lens unilateralaphakia VA IOL binocularfunction

3. intraocular lens PC IOL 2 rehabilitation 87

87 Simons BD, Siatkowski RM, Schiffman JC,Flynn JT, Capo H, Munoz M. Surgicaltechnique, visual outcome, andcomplications of pediatric intraocular lensimplantation. J Pediatr OphthalmolStrabismus 1999;36(3):118-24

C

amblyopia part time patching amblyopia , fusion stereopsis 88

88 Wright KW. Pediatric cataracts. Curr OpinOphthalmol 1997 Feb;8(1):50-5

D

Refractive clear lens extraction

Level ofEvidence

Clear lens extraction with IOL hyperopia hyperopia +3.00 D

clear lens extraction for high myopia - rapid and predictable visual rehabilitation 89

- stable refraction- IOL - no irregular astigmatism

retinal detachment clear lensextraction for high myopia 1.9 % follow up 2 8.1 % follow up 7 90

89 Colin J, Robinet A. Clear lensectomy andimplantation of a low-power posteriorchamber intraocular lens for correction ofhigh myopia: a four-year follow-up.Ophthalmology 1997 Jan;104(1):73-7

90 Colin J, Robinet A, Cochener B. Retinaldetachment after clear lens extraction forhigh myopia: seven-year follow-up.Ophthalmology 1999 Dec;106(12):2281-4

C C

retinal pathology phacoemulsification +IOL high myopia sutureless phacoemulsification and in-the-bag IOL retinal complication

clear lens extraction high myopia indirect ophthalmoscope retinal detachment 89


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