“Refractive
PRK for Corneal Scars
to 20/20 vision”
Financial Disclaimer: Dr. Gulani has no financial interest in this presentation
Gulani AC
Gulani AC
Gulani “5S” Classification System
Sight
Improv
No Impro
Scar
Clear
Shape
Scar
Irreg
Strength
Reg
Thin
Thick
Site
Central
Periph
Myopia
superficial
Deep
CL over RX
Hyperopia
Astigmatism
Using this 5S system, we see that the Sight( vision), Scar, Shape (Irregular)
& Site (central) are affected. This algorithm makes any complex case scenario
Simple to understand and effectively treat.
So in this case, since strength is normal, we need to peel off the scar with
simultaneous Laser refractive ablation (not PTK) so we can measure the actual
refractive error. The present ref error is a play of the corneal scar.
Once we have the true ref error then we can accurately correct it.
Gulani AC
Gulani “Corneal Scar” Laser PRK Algorithm
Depth
In
Cornea
Refraction
On
Cornea
>20/30
<20/40
Pach
>400
Topography
<250
Reg
Irreg
Pattern
Diffuse
Focal
LK
Laser PRK
Hard CL Rx
>20/30
Laser PRK
LK +AMT
DLK
Laser PRK
NI
PKP
2 Staged Laser PRK
Corneal Scar Pre-Laser
Patient referred with corneal scar following
Excimer Laser x 2 to correct Multifocal lens
surprise. Best corrected Vision: 20/200.
Using Corneoplastique ™ principles, I peeled
off her corneal scar under the Laser and
simultaneously ablated her cornea in a PRK
mode.
Upon healing, this resulted in a Clear Cornea
with a measurable, true refractive error of
+6.00 D -0.50 x 170 and best corrected vision
of 20/25.
Clear Cornea Post-Laser
Corneal Scar Pre-Laser: Vsc 20/200
Piggy-back lens on ReStor
Laser Scar Peel + PRK
Post Laser + Piggy-back IOL: Vsc 20/20
Gulani AC
THANK YOU