Ординатура / Офтальмология / Английские материалы / Hyperopia and Presbyopia_Tsubota, Boxer Wachler, Azar_2003
.pdfContributors
Renato Ambro´sio, Jr., M.D. Department of Ophthalmology, University of Washington, Seattle, Washington, U.S.A., University of Sa˜o Paolo, Sa˜o Paolo, and Department of Cornea and Refractive Surgery, Clinica e Microcirurgia Oftalmolo´gica Renato Ambro´sio, Rio de Janeiro, Brazil
Penny A. Asbell, M.D. Mount Sinai Medical Center, New York, New York, U.S.A.
Dimitri T. Azar, M.D. Corneal and Refractive Surgery Services, Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, and Harvard Medical School, Boston, Massachusetts, U.S.A.
Georges Baı¨koff, M.D. Clinique Montecelli, Marseille, France
Hiroko Bissen-Miyajima, M.D., Ph.D. Department of Ophthalmology, Tokyo Dental College, Suidobash Hospital, Tokyo, Japan
Brian S. Boxer Wachler, M.D. Boxer Wachler Vision Institute, Beverly Hills, California, U.S.A.
Fabrizio I. Camesasca, M.D. Department of Ophthalmology, Istituto Clinico Humanitas, Milan, Italy
Maria Regina Chalita, M.D. Department of Refractive Surgery, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
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Contributors |
Margaret Chang, M.S. Corneal and Refractive Surgery Services, Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, and Harvard Medical School, Boston, Massachusetts, U.S.A.
Arturo S. Chayet, M.D. Codet Aris Vision Institute, Tijuana, B.C., Mexico
Moonyoung S. Chung, M.D. Pepose Vision Institute, Chesterfield, Missouri, U.S.A.
Leo T. Chylack, Jr., M.D. Department of Ophthalmology, Harvard Medical School and Center for Ophthalmic Research, Brigham and Women’s Hospital, Boston, Massachusetts, U.S.A.
Lavinia C. Coban-Steflea, M.D. Department of Ophthalmology, Bucharest University Hospital, and Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Jonathan Davidorf, M.D. Davidorf Eye Group, West Hills, and Maloney Vision Institute, Los Angeles, California, U.S.A.
Ivo John Dualan, M.D. Mount Sinai Medical Center, New York, New York, U.S.A.
Michael J. Endl, M.D. Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A.
Paul Erickson, O.D., Ph.D. Cooperative Research Centre for Eye Research and Technology, The University of New South Wales, Sydney, New South Wales, Australia
Viviana Fernandez, M.D. Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Medical School, Miami, Florida, U.S.A.
I. Howard Fine, M.D. Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, U.S.A.
Hideharu Fukasaku, M.D. Fukasaku Eye Centre, Yokohama, Japan
Damien Gatinel, M.D. Fondation Ophthalomogique Adolphe de Rothschild and Bichat Claude Bernard Hospital, Paris, France
Adrian Glasser, Ph.D. College of Optometry, University of Houston, Houston, Texas, U.S.A.
Liane Clamen Glazer, M.D. Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, and Harvard Medical School, Boston, Massachusetts, U.S.A.
Laura Gomez, M.D. Codet Aris Vision Institute, Tijuana, B.C., Mexico
David L. Guyton, M.D. Department of Ophthalmology, The Wilmer Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Contributors |
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Peter Hersh, M.D. Cornea and Laser Vision Center, Teaneck, New Jersey, U.S.A.
Arthur Ho, M.Optom., Ph.D. Cooperative Research Centre for Eye Research and Technology, The University of New South Wales, Sydney, New South Wales, Australia
Janie Ho, M.D. Department of Ophthalmology, University of California at San Francisco, San Francisco, California, U.S.A.
Thanh Hoang-Xuan, M.D. Fondation Ophthalomogique Adolphe de Rothschild and Paris University, Paris, France
Richard S. Hoffman, M.D. Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, U.S.A.
Michael S. Insler, M.D. Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A.
Sandeep Jain, M.D. Corneal and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, and Harvard Medical Schoool, Boston, Massachusetts, U.S.A.
Carolyn E. Kloek, B.A. Corneal and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, and Harvard Medical School, Boston, Massachusetts, U.S.A.
Stephen D. Klyce, Ph.D. Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A.
Tommy S. Korn, M.D. University of California–San Diego, and Sharp Rees-Stealy Medical Group, San Diego, California, U.S.A.
Ronald R. Krueger, M.D. Department of Refractive Surgery, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
Franc¸ois Malecaze, M.D. Hoˆpital Purpan, Toulouse, France
Vasavi Malineni, M.D. Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A.
Robert K. Maloney, M.D. Maloney Vision Institute, Los Angeles, California, U.S.A.
Edward E. Manche, M.D. Stanford University School of Medicine, Palo Alto, California, U.S.A.
Fabrice Manns, Ph.D. Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Medical School, Miami, and Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, Florida, U.S.A.
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Contributors |
Marguerite B. McDonald, M.D. Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A.
Shahzad I. Mian, M.D. Corneal and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, and Harvard Medical School, Boston, Massachusetts, U.S.A.
Mark Packer, M.D. Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, U.S.A.
Jean-Marie Parel, Ph.D. Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Medical School, Miami, Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, Florida, U.S.A., and University of Liege, CHU Sart-Tilman, Liege, Belgium
Jay S. Pepose, M.D., Ph.D. Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, and Pepose Vision Institute, Chesterfield, Missouri, U.S.A.
Chris B. Phillips, M.D. Department of Ophthalmology, Hermann Eye Center and University of Texas Health Science Center at Houston Medical School, Houston, Texas, U.S.A.
George M. Salib, M.S., M.D. Department of Ophthalmology, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.
Kimberly Sippel, M.D. Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, and Harvard Medical School, Boston, Massachusetts, U.S.A.
Michael K. Smolek, Ph.D. Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, U.S.A.
Kazuo Tsubota, M.D. Department of Ophthalmology, Tokyo Dental College, Ichikawa City, Chiba, Japan
Rasik B. Vajpayee, M.D. Corneal and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, and Harvard Medical School, Boston, Massachusetts, U.S.A.
Paolo Vinciguerra, M.D. Department of Ophthalmology, Istituto Clinico Humanitas, Milan, Italy
Steven E. Wilson, M.D. Department of Ophthalmology, University of Washington, Seattle, Washington, U.S.A.
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Richard W. Yee, M.D. Department of Ophthalmology, Hermann Eye Center and University of Texas Health Science Center at Houston Medical School, Houston, Texas, U.S.A.
Samiah Zafar, M.B.B.S. Corneal and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Schepens Eye Research Institute, and Harvard Medical School, Boston, Massachusetts, U.S.A.
1
Introduction
KAZUO TSUBOTA
Tokyo Dental College, Ichikawa City, Chiba, Japan
SUMMARY
A new era of refractive surgery is on the horizon in the field of hyperopia and presbyopia correction. Corneal intervention, corneal implants, corneal rings, intraocular lenses, and scleral intervention are the major treatment strategies. Although this field is new and some of the novel surgeries may not endure into the future, this book covers all of the clinical and basic research activities available as of the year 2003.
A. OVERVIEW
Refractive surgery is currently evolving toward a new stage. Although high myopia and irregular astigmatism cannot be corrected fully, laser-assisted in situ keratomileusis (LASIK) for myopia and myopic astigmatism has already become an established technology, with millions of patients benefiting from LASIK every year all over the world. The next challenge will be the correction of hyperopia and presbyopia. In most advanced countries, life spans have been increasing annually and have now passed the 80-year mark. Baby boomers in the United States, Japan, Europe, and other countries are getting older, with an expected mean age of 50 to 60 years by the year 2005. Although the ratio of hyperopia cases is lower at younger ages, hyperopia becomes increasingly significant in the later stages of life. It has been estimated that around 20% of the U.S. population are hyperopic at the age of 40, and the rate is above 60% at age 65. Even in Japan, where myopia is the dominant refractive error, the ratio increases from 15% at age 40 to 30% at age 65. People may develop cataracts, possibly indicating phacoemulsification and intraocular lens implantation, but the majority of the elderly still do not have cataract
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Tsubota |
Table 1 Medical and Surgical Correction of Hyperopia |
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Medical correction |
Surgical correction |
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Glasses |
Photorefractive keratectomy (PRK) or laser- |
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assisted in situ keratomileusis (LASIK) |
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Contact lenses |
Phakic intraocular lenses (IOLs) |
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Clear lens extraction with IOLs |
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Laser thermal keratoplasty (LTK) |
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Conductive keratoplasty (CK)
Diode laser keratoplasty
Corneal implant
Intracorneal ring (ICR) modification
surgery. It is well known that nearly everyone develops presbyopia with age. Thus, in an aging society, correction of hyperopia and presbyopia is anticipated to become more important than it currently is.
This book covers the current medical and surgical treatments for the correction of hyperopia and presbyopia. An effort is also made to cover new technologies, although these are still preliminary and controversial. In this sense, this is no ordinary textbook based only on authority and established principles. Rather, it is a new comprehensive information book introducing current technology and developmental trials. The emerging innovation of thermal or conductive keratoplasty as well as corneal implants for hyperopic correction now provide exciting potential. Furthermore, the new Schachar theory of presbyopia is now attracting attention as a strategy for the treatment of presbyopia. Scleral relaxation, using a diamond knife or laser, and scleral expansion rings are also potential technologies. All of the established as well as the new medical and surgical treatments are described in this book, with the relevant theoretical backgrounds, clinical results, and possible complications indicated (Tables 1 and 2, Figs. 1 and 2).
Table 2 Medical and Surgical Correction of Presbyopia
Medical correction |
Surgical correction |
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Bifocal and multifocal glasses |
Monovision by LASIK |
Bifocal and multifocal HCL |
Multifocal LASIK |
Bifocal and multifocal SCL |
IOL with multifocal |
Bifocal disposable SCL |
Hinged IOL |
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Scleral expansion ring |
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Scleral incision |
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Scleral relaxation by laser |
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Small-diameter corneal lens |
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Key: HCL, hard contact lens; SCL, soft contact lens; LASIK, laser-assisted in situ keratomileusis; IOL, intraocular lens.
Introduction |
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Figure 1 Surgical correction of hyperopia.
Figure 2 Surgical correction of presbyopia.
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Tsubota |
B.HISTORY OF MEDICAL AND SURGICAL CORRECTION OF HYPEROPIA
The most commonly used corrective devices for hyperopia are glasses and contact lenses. Since surgical correction is still in its preliminary stages, most patients around the world still use glasses or contact lenses. Before discussing the current technology, let us broadly review some older ideas. In the history of surgical correction, there have been several methods that are no longer popular. One technology was keratomileusis as originally proposed by Jose Barraquer in Colombia (1–3). He developed a technique in which a central lamellar keratectomy is performed and a resected disk is shaped using a Barraquer cryolathe (4). The shaped disk is then sutured in place. For hyperopic correction, more tissue is removed from the periphery of the disk, producing a steepening of the central portion of the cornea (5,6). In order to minimize the complexity of the procedure, a donor disk is also used. This is called keratophakia. The corneal lenticule is obtained from a donor cornea, frozen, and shaped with a cryolathe into a refractive disk with central thickness (2). A lamellar flap is made on the host cornea, the disk is inserted intrastromally, and the lamellar cut is replaced. Kaufman and Werblin further developed this technique of epikeratoplasty (7,8). Donor corneal tissue is prelathed into the proper shape and sutured onto a recipient, de-epithelialized cornea in which Bowman’s layer and the stroma are intact. This technique is described by the term living contact lens. The change in curvature of the anterior surface produced by the lenticule provides the refractive correction. First, the corneal epithelium of the host cornea is removed and an annular keratectomy is performed. A partial lamellar dissection peripheral to the trephine is used as a groove for lenticule suturing. Interrupted and running 10–0 nylon sutures are used to secure the tissue and are removed 10 weeks later (Figs. 3 and 4). This technique was originally developed for aphakia and keratoconus (7,9). The results were slightly disappointing relative to predictions, and the technique was abandoned. (10)
Hexagonal keratotomy is another refractive procedure formerly employed for hyperopia. The procedure consists of making a series of paracentral incisions in a hexagonal pattern with subsequent steepening of the central cornea (11). This curvature change is due to weakening of the central cornea, which has been incised and separated from the peripheral cornea, resulting in bulging of the center due to intraocular pressure. The initial results seemed promising, but this procedure was later found to frequently be associated with glare, photophobia, fluctuating vision, and irregular astigmatism (12). Thus, this
Figure 3 Diagram of epikeratophakia. Donor corneal lens is placed on the Bowman’s layer with stromal pockets sutured with 10–0 nylon.