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Five Steps to Start Your Refractive Surgery: A Case-Based Systematic Approach
Mazen M Sinjab
STEP ONE: CORNEAL IMAGING
CHAPTER 1:
Topography and Tomography Science
MAIN TOMOGRAPHIC MAPS AND PROFILES
Corneal Parameters
Maps
The Anterior Curvature Sagittal Map
The Anterior Curvature Tangential Map
The Elevation Maps
Shape (BFS float mode)
The Difference between the Curvature and the Elevation Maps
The Pachymetry Map
Thickness Profiles
Corneal Topometry
TOPOGRAPHIC AND TOMOGRAPHIC FEATURES IN ECTATIC CORNEAL DISORDERS
Morphologic Classification
Tomographic Classifications
On the Sagittal Map
On the Elevation Maps
On the Pachymetry Map
On Thickness Profiles
Forme Fruste Keratoconus
Pellucid Marginal Degeneration (PMD) and Pellucid-Like Keratoconus (PLK)
Clinical Findings
Tomographic Findings
CHAPTER 2:
Wavefront Science
PRINCIPLES OF WAVEFRONT AND WAVEFRONT ANALYSIS
TYPES OF ABERRATIONS
Low Order Aberrations (LOAs)
High Order Aberrations (HOAs)
MEASUREMENT OF ABERRATIONS
Point Spread Function (PSF)
Strehl Ratio (SR)
Modulation Transfer Function (MTF)
Root Mean Square (RMS)
Zernike Coefficients (ZCs)
WAVEFRONT MAPS
The Acuity Map (AM)
Wavefront High Order Aberrations Map (WHOM) (Fig. 2.43)
Rx Correction High Order Aberration Map (CHOM) (Fig. 2.44)
Rx Correction all Aberrations Map (CAM) (Fig. 2.45)
CHANGES OF ABERRATIONS WITH AGE
Corneal Changes with Age
Crystalline Lens Changes with Age
Corneal/Internal Aberration Compensation
WAVEFRONT IN FFKC DETECTION
CHAPTER 3:
Optical Coherence Tomography (OCT)
INTRODUCTION
NORMAL ANTERIOR EYE
Anterior Chamber
Cornea and Angle
Pachymetry Map
CLINICAL APPLICATION OF ANTERIOR OCT
Diagnosis
Corneal Lesions
LASIK Flap Complications
Double Anterior Chamber
Keratoconus Detection
Pachymetry Map
Keratoglobus
Measuring Corneal Power and Pupil Diameter
Treatment
Guiding PTK
Photoablation Enhancement
Post Corneal Cross Linking Follow-up
Implantation of Phakic IOLs (PIOLs)
CHAPTER 4:
Corneal Biomechanics
INTRODUCTION
Definitions
Corneal Tissue
CLINICAL IMPACT OF CORNEAL BIOMECHANICS
Biomechanics and Myopic Treatment
Biomechanics and Hyperopic Treatment
Biomechanics and Postoperative Induced Irregularities
Biomechanics and Induced Ectasia
Biomechanics and Postoperative IOP Measurements
MEASURING CORNEAL BIOMECHANICS
Principle of ORA
The Waveform
Remarks
STEP TWO: MAIN REFRACTIVE OPTIONS
CHAPTER 5:
Main Refractive Options
PHOTO REFRACTIVE TREATMENT (PRT)
Types of PRT
Surface Ablation (SA)
Lamellar Ablation (LA)
Surface-Lamellar Ablation (SLA)
Pros and Cons
Potential Contraindications to PRT
PRT Profiles
Plain Ablation Profile
Optimized Ablation Profile
Aspheric (Q-Guided) Profile
Aspheric Aberration-Free Profile
Wavefront-Guided Treatment (WFGT)
SURFACE ABLATION COMBINED WITH CORNEAL COLLAGEN CROSS LINKING
Conditions
Recommendation
Contraindications
Considerations
PHAKIC IOL (PIOL)
Types
Indications
Conditions
Work up
Patient Education
Aspheric PIOL
REFRACTIVE LENS EXCHANGE (RLE)
Patient Selection and Criteria
Age
Myopia
Life Style and Personality
Preoperative Evaluation
Biometry
Corneal Tomography
Keratometry and IOL Power Calculation
Surgical Technique
Intraocular Lens Selection
Monofocal IOLs
Multifocal Lenses (MFIOLs)
Accommodative Lenses
STEP THREE: RULES AND GUIDELINES IN REFRACTIVE SURGERY
CHAPTER 6:
Rules and Guidelines in Refractive Surgery
THICKNESS RULES
RSB Rule 1
RSB Rule 2
RSB Rule 3
RSB Rule 4
RSB Rule 5
RSB Rule 6
RSB Rule 7
RSB Rule 8
RSB Rule 9
K-READING RULES
Flat K Rule
Steep K Rule
Average K (mean K or Km)
Astigmatism Rules
Myopic Astigmatism Rule
Hyperopic Astigmatism Rule
Mixed Astigmatism Rule
DISPARITY BETWEEN TOPOGRAPHIC ASTIGMATISM (TA) AND MANIFEST ASTIGMATISM (MA)
Etiology
Management
SUBOPTIMAL CORRECTION RULE
Q-VALUE RULE AND ASSIS NOMOGRAM
PUPIL CENTRE AND ANGLE KAPPA RULE
PUPIL DIAMETER CONSIDERATIONS
CYCLOTORSION
AMBLYOPIA
ENHANCEMENT CONCEPTS
Thickness Concept
K-readings Concept
Time Concept
Refraction Concept
WGT Concept
Multiple Enhancements
Enhancement by LA vs. SA
STEP FOUR: START OFF
CHAPTER 7:
Clinical Approach
PSYCHOSOCIAL APPROACH
MEDICAL APPROACH
Patient History
Social History
Ocular History
General History
Family History
EXAMINATION
Visual Acuity
Clinical Refraction
Pupillometry
Tear Film Tests
IOP Measurements
The Non-dominant Eye
Ocular Motility
Orbital and Eye Anatomy
External Examination and Slitlamp Biomicroscopy
Fundoscopy
CHAPTER 8:
Avoidable Refractive Surgery Complications
COMPLICATIONS RELATED TO PRT
Intraoperative and Early Postoperative Complications
Flap Complications
Flap-Interface Complications
Corneal Melting
Late Postoperative Complications
DES
Epithelial Ingrowth (Fig. 8.19)
Ectasia
Haze
Complications Related to PIOL
Intraoperative Complications
Postoperative Complications
COMPLICATIONS IN REFRACTIVE LENS EXCHANGE
STEP FIVE: CASE STUDY
CHAPTER 9:
Case Study
INTRODUCTION
READING AND INTERPRETING CORNEAL TOMOGRAPHY
Key Points
Steps of the Study
READING AND INTERPRETING WAVEFRONT
Key Points
Select your Goal
Steps of the Study
CASE 1
DISCUSSION
CASE 2
DISCUSSION
CASE 3
DISCUSSION
CASE 4
CONCLUSION
CASE 5
CASE 6
CASE 7
CASE 8
CASE 9
INDEX
TOC
Index
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