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    Aspiring for zero tolerance of residual astigmatism

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


    Figure 17 illustrates the next patient with a central herpetic excavating scar. I first performed a Corneoplastique procedure to make the cornea measurable followed by implantation of a toric IOL in a staged cataract surgery (femto aphakia followed by toric IOL implantation) to bring the patient to emmetropia.

    The patient in Figure 18 demonstrates what should have been a simple diagnosis. Many patients who are referred to me have high astigmatism, and in this case, the referring surgeon should have looked under the upper lid rather than focusing on what the previous surgeon did wrong. Examination showed a suture deep under the conjunctiva superiorly that was the culprit causing the high astigmatism, in this case 7.1 D. Removing the suture led to immediate recovery of 20/20 vision within minutes in the office. Surgeons should look for the culprit causing the astigmatism in each case and then approach it from that direction instead of first considering their surgical options.

    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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