Presentation on theme: "ESCRS 2006 LONDON. Cornea3 Femtosecond laser- PKP both for the eye and for the donor. Can cut in any shape chosen- Tophat, mushroom, Zigzag In LKPL can."— Presentation transcript:
Cornea3 Femtosecond laser- PKP both for the eye and for the donor. Can cut in any shape chosen- Tophat, mushroom, Zigzag In LKPL can be used both for cutting the horizontal cut. This saves endothelial cells. The patient has to be moved from the laser institute to the hospital. So now they leave some of the periphery attached or they will leave the deepest layer uncut.
The Morrfields experience with DSEK- using visionblue to stain the endothelium so as not to leave any endothelial islands. Use an everted Sinsky hook. Prepare a scleral tunnel. Prepare the graft and fold it 40-60 with some OVD in the middle so it helps recognize the endothelial side. Put air and then gas. 9/11 dislocations, 6/11 clear grafts, but significant decrease in endothelial cell count. Excellent refraction but lower VA
Kerry Solomon- after tearing the descemt’s- pulls it out with I&A. 30% dislocations and also fluid in the interface. In the beginning the VA is very good, later decreases but still better than after PKP
Saudi Arabia- cut the graft with the microkeratome 70-80%, so that 160 microns are left. Then trephine the graft (in the artificial chamber). Even if there is fluid in the interface it clears by itself
IFIS Packard- IFIS was first described by Chand and Campbell in 4/05 Flomax=Tamsulosin=alpha antagonist, but also other alpha antagonists (as in psychiatric meds) to a lesser extent Floppy iris + undilatind pupil. Do not dilate pupil mechanically! Inject phenylephrine even several times during surgery to dilate pupil. No systemic side effects. It gives the iris tone and dilates pupil. Helpful- Healon5, iris hooks Discontinuing the med before Sx doesn’t help but possibly does.
Depends on the period of drug usage. If started just a month before there will be no effect In pathology- no difference in iris thickness Arshinoff- make small cuts into the eye, inject Xylocaine intracameral and wait a full minute, put Viscoat on iris periphery and healon5 in the center, make rhexis smaller than pupil and work in the bag, keep parameters low, add Healon5 as needed. Consider using Boris Malugin’s pupil dilator
RLX With the ReStor IOL- N VA better with smaller pupil and with a dilated pupil D VA is better With ReZoom viceversa Combining the two IOLs in 2 eyes can give a wider depth of focus because reZoom is better for the intermediate range Conservative ways to get rid of the glasses after lens surgery- ATR astigmatism aids reading, monovision (test the patient for 2 weeks with CL to make sure understands) RLX in myopes makes the object seen larger, while in hyperopes- smaller! That is why in hyperopes there is a chance for loosing BCVA In hyperopes- no RD but- CME
In RLX remember that the patient looses acommodation In high myopia there no multifocal IOLs for the proper power With multifocal IOLs- give the patient bifocal CL, preferably diffractive (worse VA), to explain them that vision will not be perfect after Sx. Important with low myopes. The hypeopes are usually happy. The high myopes either cannot get the proper power or are happy
Pearls Vasavada- In very hard nuclei sometimes not possible to hydrodissect- after the groove is prepared- internal hydrodissection ICR- works in KC. Even just one segment. Trial ongoing for collagen cross-linking + ICR Tehrani- computer program that demonstrates how the ICL (mainly Artisan, Artiflex, Verisyse….) will be positioned in the A/C
New Acrysof IQ– aspheric- thinner, less aberrations New Acrysof angle-supposted phakic refractive IOL- easy to implant, sits well in angle, fits itself to the size, no need for PI, 5 or 6 mm optic and 2 different length sizes Agreed that measuring w to w is not accurate. Improved measurements with new imaging instruments Artisan position is not relying on the IOL but on the surgeon. Significant endothelial cell loss
Ozil- torsional phaco- more efficient, less endothelial cell damage. No repulsion Akahoshi- square tip Trypan blue lowers endothelial cell count Suturing of IOLs with Prolene 9-0, Dacron 8-0 Endophthalmitis ESCRS study- more than 5% reduction with Cefurxime I.C. Live Sx Video competition