By Christopher J. Rapuano MD
This up-to-date quantity covers a few subject matters, from the technological know-how of refractive surgical procedure to accommodative and nonaccommodative therapy of presbyopia, from sufferer review to overseas views. It examines particular systems in refractive surgical procedure, in addition to refractive surgical procedure in ocular and systemic illness. significant revision 2011-2012.
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Additional info for 2011-2012 Basic and Clinical Science Course, Section 13: Refractive Surgery (Basic & Clinical Science Course)
Early keratoconus, pellucid marginal degeneration (Fig 2-5), and contact lens warpage should be considered as possible causes of visually Significant irregular astigmatism. Irregular astigmatism secondary to contact lens warpage usually reverses over time, although it may take months. Figure 2-5 A corneal topograph ic map of t he typica l irregu lar against-the-rule astigmatism that is seen in eyes with pel lucid marginal degeneration. Note that the steepening nasally and temporally connects inferiorly.
A 40 • Refractive Surgery certain lower limit of corneal thickness. If LASIK is performed and results in a relatively thin residual stromal bed-for example around 250 ~m-future enhancem ent surgery that furthe r thins the stromal bed may not be possible. If there is a question of endothelial integrity causing an abnormally thick cornea, specular microscopy may be helpful in assessing the health of the endothelium. Price FW Jr, Koller DL, Price Mo. Central corneal pachymetry in patients undergoing laser in situ keratomileusis.
A tra nsition zone of ablated cornea is necessary to blend the edge of the optical zone with the peripheral cornea. Care must be taken to ensure that adequate stromal tissue remai ns after ablation and creation of the LA SIK flap to maintain an adequate corneal structure. The historical standard has been to leave a minimum of 250 ~m of tissue in the stromal bed, although the exact amount of remaining tissue required to ensure biomechanical stability is not known and likely varies among individuals.
2011-2012 Basic and Clinical Science Course, Section 13: Refractive Surgery (Basic & Clinical Science Course) by Christopher J. Rapuano MD