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    Premium cataract surgery: Correcting complications and side effects

    Keys to unfolding the specific surgical plan of action


    Case 4

    Case 4 was that of a 60-year-old patient with keratoconus who underwent implantation of a monofocal IOL with his surgeon a couple of years previously and then sought my consult for his poor resultant vision of 20/200.

    On presentation, he had a well-placed monofocal lens implant, deep anterior chamber, open posterior chamber with healthy endothelium, and keratoconus with hyperopia and astigmatism along with steep keratometry and anterior corneal scarring.

    Following my 5S system, I wanted to correct the following issues: hyperopia, astigmatism, central scarring, and high keratometry.

    The single surgery that could correct all of these is myopic-astigmatic laser ASA, so in order to perform that surgery, I first had to make his refraction myopic with a planned piggyback IOL and after 1 month measured him and proceeded with laser ASA in myopic mode to correct his refractive errors while flattening his keratometry and clearing the central scar (in-cornea scar) as a welcome side effect to unaided 20/20 vision.

    His vision worsened after piggyback IOL implantation as planned since optical end point was my goal not vision and then we took him from there straight to 20/20 vision.

    Thus, we made his own lens implant work and honored his surgeon’s desire and corrected their relation and trust in each other. This patient now has pursued his once lost passion—to fly!

    He excitedly emailed me just this week with the news that he recertified his license to fly and is 20/20.

    Case 5

    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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