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    Repairing, preparing the cornea as vision rehabilitative platform

    Second in two-part article addresses surgical approach to decoding corneal scars

     

    Take-home

    In the second of a two-part series, Arun C. Gulani, MD, reviews how to repair or prepare the cornea from any situation to present it for final corneal reshaping—straight to 20/20.

     

    Jacksonville, FL—As in each column, let us first begin with our mindset. I’d like to present the cornea as an elegant, optically powerful, and visually focused organ, easily accessible for shape modification that translates directly to unaided visual acuity.

    Let us presume also a mindset that thinking about performing a penetrating keratoplasty (PKP) is akin to giving up, losing the battle, or not even venturing to design vision in the patient’s best interests. Unless there is a through-and-through corneal pathology/perforation from whatever cause (trauma, infection, surgical complications, degeneration, etc.), a penetrating corneal transplant should be the last resort of corneal rehabilitative techniques.

    As I have said before, PKP can be compared with opening the entire abdomen as opposed to elegantly approaching individual structures with the least interventional attitude. It does not matter how the penetrating transplant is performed—i.e., femtosecond laser, microkeratome, or even a kitchen knife—what matters is how it is put back together (since shape translates to vision and hand stitching of the transplant leads to astigmatism and vision distortion).

    Using the 5S system, most corneas that are structurally abnormal, unstable, or compromised should undergo an elegant thought process using Corneoplastique principles (brief, topical, aesthetically pleasing, visually promising) to rehabilitate that cornea with the least interventional approach for that patient and present it as a vision rehabilitative platform for laser PRK surgery. (See Part 1, “Decoding corneal scars: Straight to 20/20.” Ophthalmology Times, Feb. 15, 2014, Pages 6, 9, and 12)

    Arun C. Gulani, MD
    Dr. Gulani is director of refractive surgery and chief, cornea & external disease, as well as assistant professor, department of ...

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