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    Aspiring for zero tolerance of residual astigmatism

    Case examples highlight tools, techniques toward quest for excellent visual endpoint


    Figure 6 shows a Pentacam study of a case of epikeratophakia with residual high myopia and astigmatism and corneal scar.

    By performing laser PRK (without removing the epikeratophakia lenticle), the patient can achieve emmetropia despite the previous epikeratophakia surgery.

    Figure 7 illustrates how Descemet’s stripping automated endothelial keratoplasty and other posterior transplant procedures—including Descemet’s stripping endothelial keratoplasty, Descemet’s membrane endothelial keratoplasty, and pre-Descemet’s endothelial keratoplasty—should all be performed with a refractive mindset (Gulani REFEK techniques) by which surgeons perform sutureless small corneal incisions and deliver the posterior corneal transplant.

    I also place relaxing incisions anteriorly to simultaneously release interface fluid based on the topographic images and to correct astigmatism to achieve emmetropia. In addition, in these cases, toric IOLs also can be implanted with high confidence to reach emmetropia.

    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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