JAIRO E. HOYOS, MD MELANIA CIGALES, MD Instituto Oftalmológico Hoyos Barcelona - SPAIN.

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IN THE NAME OF GOD.

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Presentation transcript:

JAIRO E. HOYOS, MD MELANIA CIGALES, MD Instituto Oftalmológico Hoyos Barcelona - SPAIN

J Hoyos

 THE TOPOGRAPHY OVER-ESTIMATES CORNEAL POWER AFTER CORNEAL CORNEAL POWER AFTER CORNEAL REFRACTIVE SURGERY REFRACTIVE SURGERY  THE TOPOGRAPHY OVER-ESTIMATES CORNEAL POWER AFTER CORNEAL CORNEAL POWER AFTER CORNEAL REFRACTIVE SURGERY REFRACTIVE SURGERY UNDERCORRECTION IOL CALCULATION RESULT = HYPEROPIA J Hoyos

METHODS TO CALCULATE CORNEAL POWER POST-REFRACTIVE SURGERY 1- HOLLADAY REFRACTIVE HISTORY 2- HARD CONTACT LENS 3- CORNEAL TOPOGRAPHY 4- KERATOMETRY J Hoyos

KMSG HOT LINE J Hoyos

KMSG HOT LINE TO CALCULATE CORNEAL CURVATURE “HOLLADAY REFRACTIVE HISTORY METHOD” PRE-OP KERATOMETRY OBTAINED CORRECTION (Corneal Plane) CORNEAL POWER POST-R.S. J Hoyos

KMSG HOT LINE  SRK-T (>26 mm )  Holladay (24.5 – 26 mm)  Hoffer Q (>22 mm) J Hoyos

 POST-LASIK CENTRAL CORNEA IS THINNER = BIOMETRY ERROR: INDENTATION USING BIOMETRY ERROR: INDENTATION USING APPLANATION [IMMERSION BEST] APPLANATION [IMMERSION BEST]KMSG HOT LINE IS IMPORTANT TO HAVE THE PREOPERATIVE AXIAL LENGTH J Hoyos  AXIAL LENGTH CAN INCREASE DUE TO A GLOBE INGROWTH. TO A GLOBE INGROWTH.

PRE-LASIK: (40 years) Refraction: x 170º Sim K: (46.3 x 42.4) Axial length : 31.9 mm 3 YEARS POST-LASIK: CATARACTS POST-LASIK : Refraction: Sim K (32.7 x 32.3) J Hoyos

In the corneal plane: Post-LASIK REFRACTION : Post-LASIK REFRACTION : CORNEAL PLANE CORRECTION : 3- CORNEAL PLANE CORRECTION : 1- Pre-LASIK REFRACTION : x 170 Spherical equivalent : -18 = (-0.5) (-0.5) - “CLINICAL HISTORY METHOD” J Hoyos

5- Post-LASIK CORNEAL POWER : = CORNEAL PLANE CORRECTION : Pre-LASIK KERATOMETRY : 42.4 x 46.3 Mean Keratometry: J Hoyos “CLINICAL HISTORY METHOD”

TCC: Sim K = 32.5 Central K= 30.6 CALCULATED = 30.1POST-LASIK J Hoyos

PRE-LASIK: Refraction: x 170º Axial length: 31.9 mm POST-LASIK (3 years): Cataract Axial length: mm AXIAL LENGTH = 31.9 mm J Hoyos

 CORNEAL POWER = 30.1 D  AXIAL LENGTH = 31.9 mm  FORMULA CALCULATION = SRK/T RESULT ACRYSOF (MA60BM) A const : Predict refraction Final refraction 0.00 J Hoyos

Post-OP Pre-OP CATARACTS Post-KM in situ Post-LASIK 7 Cases 1 Case

CORNEALPOWER J Hoyos Central-K ± ± 2.69K-Calculated ± ± 3.07Sim-K ± Refractive History TCCTCC

RESULTS J Hoyos SRK/T Obtainedrefraction ± ± 1.03 Desired Desiredrefraction ± ± 0.38 IOL POWER IOL POWER ±

3-POSSIBILITY OF INDENTATION BIOMETRIC ERROR BIOMETRIC ERROR 2-FORMULA CALCULATION : SRK/T 1-CORNEAL CURVATURE CALCULATION Clinical History Method (If Unknown, use flattest K) J Hoyos

Refraction: OD_____________________ OS _____________________ Keratometry: OD__________________ OS __________________ Axial Length: OD__________________ OS___________________ PRE-REFRACTIVE SURGERY DATES Patient___________________________ Surgery______________Date_________ J Hoyos