LONDON 2006 ESCRS
Cornea3
Femtosecond laser- PKP both for the eye and for
the donor. Can cut in any shape chosen- Tophat,
mushroom, Zigzag
In LKPL can be used both for cutting the horizontal
cut. This saves endothelial cells.
The patient has to be moved from the laser
institute to the hospital. So now they leave some
of the periphery attached or they will leave the
deepest layer uncut.
The Morrfields experience with DSEK- using
visionblue to stain the endothelium so as not to
leave any endothelial islands. Use an everted
Sinsky hook. Prepare a scleral tunnel. Prepare
the graft and fold it 40-60 with some OVD in the
middle so it helps recognize the endothelial side.
Put air and then gas.
9/11 dislocations, 6/11 clear grafts, but significant
decrease in endothelial cell count. Excellent
refraction but lower VA
Kerry Solomon- after tearing the descemt’spulls it out with I&A.
30% dislocations and also fluid in the
interface. In the beginning the VA is very
good, later decreases but still better than
after PKP
Saudi Arabia- cut the graft with the
microkeratome 70-80%, so that 160
microns are left. Then trephine the graft (in
the artificial chamber).
Even if there is fluid in the interface it clears
by itself
IFIS
Packard- IFIS was first described by Chand and Campbell
in 4/05
Flomax=Tamsulosin=alpha antagonist, but also other alpha
antagonists (as in psychiatric meds) to a lesser extent
Floppy iris + undilatind pupil.
Do not dilate pupil mechanically!
Inject phenylephrine even several times during surgery to
dilate pupil. No systemic side effects. It gives the iris
tone and dilates pupil.
Helpful- Healon5, iris hooks
Discontinuing the med before Sx doesn’t help but possibly
does.
Depends on the period of drug usage. If started
just a month before there will be no effect
In pathology- no difference in iris thickness
Arshinoff- make small cuts into the eye, inject
Xylocaine intracameral and wait a full minute,
put Viscoat on iris periphery and healon5 in the
center, make rhexis smaller than pupil and work
in the bag, keep parameters low, add Healon5
as needed. Consider using Boris Malugin’s pupil
dilator
RLX
With the ReStor IOL- N VA better with smaller pupil and
with a dilated pupil D VA is better
With ReZoom viceversa
Combining the two IOLs in 2 eyes can give a wider depth of
focus because reZoom is better for the intermediate
range
Conservative ways to get rid of the glasses after lens
surgery- ATR astigmatism aids reading, monovision (test
the patient for 2 weeks with CL to make sure
understands)
RLX in myopes makes the object seen larger, while in
hyperopes- smaller! That is why in hyperopes there is a
chance for loosing BCVA
In hyperopes- no RD but- CME
In RLX remember that the patient looses
acommodation
In high myopia there no multifocal IOLs for the
proper power
With multifocal IOLs- give the patient bifocal CL,
preferably diffractive (worse VA), to explain them
that vision will not be perfect after Sx. Important
with low myopes. The hypeopes are usually
happy. The high myopes either cannot get the
proper power or are happy
Pearls
Vasavada- In very hard nuclei sometimes not
possible to hydrodissect- after the groove is
prepared- internal hydrodissection
ICR- works in KC. Even just one segment. Trial
ongoing for collagen cross-linking + ICR
Tehrani- computer program that demonstrates how
the ICL (mainly Artisan, Artiflex, Verisyse….) will
be positioned in the A/C
New Acrysof IQ– aspheric- thinner, less
aberrations
New Acrysof angle-supposted phakic refractive
IOL- easy to implant, sits well in angle, fits itself
to the size, no need for PI, 5 or 6 mm optic and 2
different length sizes
Agreed that measuring w to w is not accurate.
Improved measurements with new imaging
instruments
Artisan position is not relying on the IOL but on the
surgeon. Significant endothelial cell loss
Ozil- torsional phaco- more efficient, less endothelial cell damage. No
repulsion
Akahoshi- square tip
Trypan blue lowers endothelial cell count
Suturing of IOLs with Prolene 9-0, Dacron 8-0
Endophthalmitis ESCRS study- more than 5% reduction with Cefurxime
I.C.
Live Sx
Video competition