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    Optimizing individual outcomes through staged cataract surgery

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


    (Case 4) This patient had keratoconus with a very thin, unstable cornea, central scarring, and cataracts. Following my 5S system, I performed a hand lamellar keratoplasty. After the cornea stabilized, measurements for an IOL were performed and the patient achieved an excellent visual outcome with cataract surgery.

    (Case 5) This patient had Fuchs’ dystrophy with a central scar and advanced cataract. Descemets stripping endothelial keratoplasty and cataract removal were performed simultaneously. A toric IOL was implanted. Myopia was achieved as planned. Laser advanced surface ablation was used to then address central corneal scarring and the residual myopia to achieve emmetropia.

    (Case 6) An aphakic patient with a scarred, decentered epikeratophakia 17 years previously. According to the 5S system, the epikeratophakia lenticule was removed and when the cornea was measurable and clear, an IOL was implanted. The patient achieved 20/25 uncorrected vision.

    (Case 7) A patient with an aggressive and advanced pterygium up to the pupillary apex. Using the sutureless amniotic technique, the pterygium was removed and the corneal divot was filled with extended amniotic membrane. After healing, the patient had an excellent visual outcome. Three years postoperatively, the patient underwent cataract surgery, during which a multifocal IOL (AcrySof ReSTOR, Alcon Surgical) was implanted with the goal of myopia. Laser PRK was performed to treat myopic astigmatism and correct residual scar in pupillary axis, and 20/20 vision was achieved.

    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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