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    Premium cataract surgery: Correcting complications and side effects

    Keys to unfolding the specific surgical plan of action


    Case scenarios

    These case scenarios represent the application of logic-based principles of Corneoplastique, in applying the least interventional, brief, topical, elegant, and visually promising techniques to achieve the best visual potential (BVP) while striving in most cases to honor the original surgeon’s standing and choice of technology.

    Case 1 was that of a patient who was referred to me after undergoing implantation of a multifocal IOL with a poor and unsatisfactory visual endpoint. The patient’s surgery after implantation of a multifocal lens had resulted in an IOL surprise. It followed with multiple laser and LASIK enhancements that ended in corneal scarring with a final vision of 20/200. In addition, this patient also underwent YAG capsulotomy. The patient was extremely angry with her surgeon and concerned as a result of the surgeries and poor visual outcome.

    Following my 5S system, I first wanted a “measurable” cornea and hence performed laser PRK with scar peel (on-cornea scar) to correct the scarring and achieved a clear measurable cornea that refracted to a hyperopic endpoint of +6.00 diopters with best-corrected vision of 20/25.

    Now, as planned, I was aiming to correct this measurable and accurate refractive error so a lens-based correction was the path that I zeroed down to. Considering the fact that this patient had undergone a YAG capsulotomy and therefore this lens implant could not be exchanged without detrimental maneuvers, I planned a piggyback lens implant (the Corneoplastique principles were maintained: brief, topical, aesthetically pleasing, least interventional, and visually most promising) and brought this patient to 20/20 unaided for distance and near vision.

    Case 2

    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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