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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 8) In this patient with previous radial keratotomy surgeries, the cataract surgery can be performed to manipulate the internal optics that resulted in planned ametropia. Laser ablation profile (myopic or hyperopia) then can be applied to reshape the cornea (flatten or steepen respectively) along with central clearance and enlarging optical zone to emmetropia.

    (Case 9) Anterior corneal dystrophy with cataracts, myopia, and irregular astigmatism. A lamellar keratectomy with cataract surgery was performed with myopia as the goal. Laser PRK myopic astigmatism ablation followed to achieve a clear cornea and emmetropia.

    (Case 10) This patient had peripheral corneal scars and high irregular astigmatism with cataracts. Because the patient did not want to go through scar surgeries first, I designed her through cataract surgery by overcorrecting with toric IOL implantation so her flat axis (the one on which the VISX laser will work) will be away from her scars and therefore this caused the final axis for treatment to be between the scars rather than on the scars. The laser was then used to correct myopic astigmatism in clearing the center and reaching complete emmetropia.

    (Case 11) This patient had high hyperopia and astigmatism with presbyopia and cataract after radial keratotomy. Cataract surgery was planned with implantation of a ReSTOR IOL with the goal of myopia as residual ametropia. Laser PRK was the next surgical step to correct the residual ametropia, myopia, astigmatism, and central irregularities including enlarging the optical zone and the patient had an excellent visual outcome to 20/20 unaided.

    Patient/surgeon team

    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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