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    Optimizing individual outcomes through staged cataract surgery

    Case studies illustrate inside-out and outside-in techniques in move toward emmetropia


    Noteworthy cases

    The previous column highlighted a few case scenarios of patients who were considered to be complex cases referred to me from around the world. The following case studies outline with images and videos my thought process and journey toward their best vision potential using the outside-in and the inside-out approaches.

    (Case 1) This patient had with a dense central corneal scar with multiple RK incisions with cataracts. First, the scar was peeled along with simultaneous laser to a clear and measurable cornea. Cataract surgery then was performed with implantation of toric IOL to reach emmetropia.

    Multiple Salzmann’s nodules with cataracts were present in case 5 (slide 5). The nodules were peeled and Prokera (Bio-Tissue) was used along with laser to clarity and a measurable cornea. The patient is currently waiting to undergo cataract removal.

    (Case 2) PostLASIK ectasia and asymmetric Intac segments were placed to stabilize the cornea and decrease the astigmatism from 7.4 to 0.6 D for improved vision. Cataract surgery was then performed with implantation of a toric IOL. An excellent visual outcome was achieved to 20/20.

    (Case 3) Ectasia following anterior lamellar keratoplasty with corneal instability and cataract in this patient with his only seeing eye. Asymmetric Intacs were implanted to stabilize the cornea and decrease the astigmatism from 10.1 to 2.7 D. With the cornea now measurable, the patient can undergo cataract surgery. The comparative topography illustrates the drop in astigmatism (and keratometry) from preoperatively to after placement of Intacs and before cataract surgery.

    More cases

    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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