IOL Selection in patients with prior Corneal & Refractive Surgery
Corneal refractive surgery
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Transcript of Corneal refractive surgery
Corneal Physiology
Transparent, dome shaped, outermost layer that covers the front of the eye.
Provides greatest amount refractive power to the eye. Avascular, relies on atmosphere for oxygen and aqueous humor
for its nutritional needs. Corneal surface is kept smooth by
constant moistening action of tears.
Layers of CorneaEpithelium (55µm). It evenly distributes the nutrients to other layers. It maintains stromal dehydration.
Stroma (470µm) Collagen fibers arrangement are responsible
for corneal strength, optical characters.
Endothelium (5µm). It stretches to cover the dead cells,
which reduces the cell density and impact
on fluid regulation. It pumps the excess fluid from stroma.
Shape of Cornea Slightly oval Horizontal & vertical dimensions are 11mm & 12 mm app. Pupil diameter ranges from 2mm to 6mm, which reduces optical
zone of cornea to its central 6mm. Peripheral cornea is thicker than central cornea.
Pachymetry It is the process of measuring the thickness of the cornea. Corneal Pachymetry is essential prior to a LASIK procedure for
ensuring sufficient corneal thickness to prevent abnormal bulging of the cornea, a side effect known as ectasia.
Ultrasonic & Optical pachymetry. It also helps in finding the development of glaucoma when
combined with standard measurement of IOP. Corneal thickness is 560 microns.
Corneal Topography It is a process of mapping the surface curvature of the
cornea. It is to produce a detailed description of the shape
and power of the cornea because shape determines the visual ability.
LASIK
Advantages: Pain free recovery. Quick restoration of eyesight. Better result for severe
short sight.
Disadvantages: Dry eyes. Halos, starburst. Loss of contrast sensitivity. Thick corneal flap (100-180 microns).
Photorefractive Keratectomy
Used to correct mild to moderate Myopia. Hyperopia. Astigmatism.
Advantages: Highly accurate for myopia. 80% patients have 20/20 vision
Disadvantages: Mild discomfort including minor
eye irritation. Dry eyes.
LASEKAdvantages: No flap complications. Causes less dry eyes than
LASIK. Finer trephine blade is used
instead of microkeratome. Good for patient with
thin cornea.
Disadvantages: May cause more pain and
discomfort than LASIK. Dry eyes. Longer recovery time than
LASIK.
Epi-LasikAdvantages: Less complications to corneal nerves.Disadvantages: Dry eyes. Poor night vision.
Intrastromal Corneal Implants
Used to treat Myopia. Keratoconus. It has two semicircular rings made of PMMA.
Advantages: Easily removable. Small incision.
Disadvantages: Vision disorder. Problem with night vision.