Mazen M Sinjab MD MS CAB (Ophth) PhD
Professor of Ophthalmology in Damascus University Damascus, Syria Senior Consultant in Anterior Segment and Refractive Surgery Senior Consultant in Oculoplastic Surgery
7Preface
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Five Steps to Start Your Refractive Surgery: A Case-Based Systematic Approach
First Edition: 2014
9789350909874
Printed at
5Dedicated to
My wounded country, Syria
All the rebellious people who are seeking freedom in this biased world
The martyrs who irrigate homeland by their blood for us to live free.
My dear Father Mahamed (may God rest his soul),
who planted in my soul the love of excellence.
I will mention his name with my name all my life.
My Mother Almasah (may God rest her soul),
who planted in my heart the love of poor and helping others
My Wife Ruba (may God save her),
whose unwavering support was critical for this book
Refractive surgery is one of the major fields in ophthalmology. It is a rapidly growing and developing field. A better understanding of corneal biomechanics, etiology of complications and pathophysiology has added a lot to this field in terms of improving diagnostic devices, laser profiles, surgical techniques and IOL technology; but above all, a better approach of the candidate.
The reader will find in this book a modern perspective on this field. A five-step systematic approach is applied in this book.
Step one consists of chapters 1 to 4 dealing with corneal imaging and its clinical application in refractive surgery. It deals with corneal topography, tomography, wavefront science and anterior OCT. What is new and unique in this regard is that any information is presented in relation to its clinical application in terms of diagnostic, avoiding complications or management purposes. To achieve this purpose, abundant images of high quality are included.
Step two consists of chapter 5, which deals with major refractive procedures. Laser procedures, phakic IOL implantation and refractive lens exchange were discussed in terms of new technologies, new laser ablation profiles, surgical techniques, indications, conditions, contraindications, advantages, pitfalls in addition to clinical hints and pearls. This chapter is supported with a high number of tables that compare between refractive options and aid the reader to take the right decision.
Step three consists of chapter 6. This step was designed to be a step before approaching the candidate. All rules, laws and recommendations in the refractive field were assembled, supported with examples and presented in a manner that is easy to access and easy to apply.
Step four is the start-off step. It includes chapters 7 and 8. Chapter 7 presents a thorough detailed approach of the candidate in relation to refractive applications, clinical and surgical aspects, and avoiding complications. Chapter 8 presents complications that can be avoidable. It discusses every complication in terms of etiology, predisposing factors, symptoms and signs, and management. This chapter is supported with high quality and informative images.
Finally, step five that consists of chapter 9 is a clinical case study. Nine clinical examples were carefully selected. They are presented in a practical method, and discussed in a systematic critical thinking in order to build in readers the skills that are necessary in their practice.
It is my hope that readers will find in this book the requisite links between the science and practice of refractive surgery. The surgical outcomes and quality of life of patients undergoing refractive surgery has steadily improved. The promise of refractive surgery rests in our singular focus on our patients' quality of life and quality of vision. Continued improvements in our field are dependent on enhanced technologies and superior training. To this end, I offer this book as a complement in order to assist ophthalmologists in becoming better educated about the ever-developing field.
Although this book is aimed at all those who need some initial assistance in starting their refractive surgery, this book is also aimed at providing current and future refractive surgeons with up-to-date information.
There are sure to be some errors, as the ophthalmology editor, I take full responsibility for these and look forward to being further educated.
Mazen M Sinjab
9Acknowledgments
I would like to acknowledge ophthalmology residents in Damascus University who encouraged me to write this book and have had a great role in selecting some of the topics that have been written in this book.
I would like to acknowledge Al Zahra Medical Center in Damascus, for providing me with most figures included in the book.
15Abbreviations
AB:
Asymmetric bowtie
ACA:
Anterior chamber angle
ACD:
Anterior chamber depth
ACV:
Anterior chamber volume
AD:
Ablation depth
AM:
Acuity map
AMD:
Age-related macular degeneration
AOD:
Angle opening distance
ArF:
Argon-fluoride
Astig.:
Astigmatism
ATR:
Against-the-rule
BCL:
Bandage contact lens
BFS:
Best fit sphere
BFTE:
Best fit toric ellipsoid
BSS:
Balanced salt solution
CA:
Cycloplegic astigmatism
CAM:
Correction all aberration map
CCT:
Central corneal thickness
CDVA:
Corrected distance visual acuity
CET:
Central epithelial thickness
CH:
Corneal hysteresis
CHOM:
Correction high order aberration map
CL:
Contact lens
CNV:
Choroidal neovascularization
CR:
Cycloplegic refraction
CRF:
Corneal resistance factor
CS:
Cycloplegic sphere
CT:
Computed tomography
CTK:
Central toxic keratitis
CWF:
Corneal wavefront
CXL:
Corneal crosslinking
D:
Diopter
DALK:
Deep anterior lamellar keratoplasty
DCC:
Dynamic cyclotorsion compensation
DES:
Dry eye syndrome
DOF:
Depth of focus
EffRP:
Effective refractive power
Epi-LASIK:
Epipolis LASIK
FFKC:
Forme Fruste keratoconus
HCL:
Hard contact lens
HOA:
High order aberration
ICR:
Intra corneal ring
Irr:
Irregular
I-S:
Inferior–Superior
IS:
Inferior steep
IT-SN:
Inferiotemporal–Superionasal
IWF:
Internal wavefront
K1:
flat K
K2:
Steep K
K-avg:
Average K
KC:
Keratoconus
Kf:
Flat K reading
Km:
Mean K
K-max:
Maximum K
Ks:
Steep K reading
LA:
Lamellar ablation
LASEK:
Laser sub epithelial keratomileusis
LASIK:
Laser in situ keratomileusis
LOA:
Low order aberration
MA:
Manifest astigmatism
MD:
Macular degeneration
MFIOL:
Multifocal intraocular lens
MMC:
Mitomycin C
MMK:
Mechanical microkeratome
MR:
Manifest refraction
MRI:
Magnetic resonance imaging
MRSE:
Manifest refractive spherical equivalent
MS:
Manifest sphere
MTF:
Modulation transfer function
NSAID:
Non-steroidal anti-inflammatory drugs
O:
Oval
OCT:
Optical coherence tomography
ORA:
Ocular response analyzer
OWF:
Ocular wavefront
OZ:
Optical zone
PCI:
Partial coherence interferometry
PCO:
Posterior capsule opacification
PET:
Peripheral epithelial thickness
PIOL:
Phakic intraocular lens
PISK:
Pressure induced interface stromal keratitis
PMD:
Pellucid marginal degeneration
16PMT:
Post mydriatic test
PRK:
Photo refractive keratectomy
PRT:
Photo refractive treatment
PSF:
Point spread function
PTK:
Photo therapeutic keratectomy
R:
Round
RD:
Retinal detachment
RGP:
Rigid gas permeable
RLE:
Refractive lens exchange
RK:
Radial keratotomy
RMS:
Root mean square
RSB:
Residual stromal bed
SA:
Surface ablation
SB:
Symmetric bowtie
SBCs:
Sub-Bowman calcifications
SBK:
Sub-Bowman keratomileusis
SCC:
Static cyclotorsion compensation
SCL:
Soft contact lens
SLA:
Surface lamellar ablation
SND:
Salzman's nodular degeneration
SR:
Strehl ratio
SRAX:
Skewed radial axis
SS:
Superior steep
TA:
Topographic astigmatism
TBUT:
Tear film break up time test
TE-PRK:
Transepithelial photorefractive keratectomy
TISA:
Trabecular iris space area
UBM:
Ultrasound biomicroscopy
UDVA:
Uncorrected distance visual acuity
VA:
Visual acuity
WFGT:
Wavefront guided treatment
WHOM:
Wavefront high order aberrations map
WTR:
With-the-rule
ZC:
Zernike coefficient