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    Staged cataract surgery: Art of optimization to individual outcomes

    How to apply the inside-out and outside-in techniques to move toward emmetropia


    Case 4 (slide 4) was characterized by diffuse herpetic central scarring and cataracts. Because the lens power was difficult to measure, I applied laser to the cornea through the scar that resulted in good clarity and a measurable cornea. This was followed by cataract surgery and implantation of a monofocal lens to achieve emmetropia. In this case, the laser corrected the previous astigmatism and cleared the cornea before cataract surgery.

    In case 6 (slide 6), the patient had post-LASIK ectasia with dense central epithelial ingrowth. I lifted the LASIK flap and the epithelial ingrowth was removed. The LASIK flap was tacked down like a lamellar keratoplasty and anchored with selective topo-guided sutures. After this, the cornea was measurable and once stability was determined, cataract surgery was performed and an excellent visual outcome was achieved.

    Go on to part three of the four-part column.


    • Gulani AC. Femtosecond Laser in Refractive Lens Exchange: Surgical Treatment for Presbyopia. Wang M, ed.; Slack Inc., Thorofare, NJ); 2016;109-115.

    • Gulani AC. Corneoplastique: Art of LASIK & cataract surgery. Ind J Ophthalmol 2014;62:3-11.

    • Gulani AC. Evaluating the impact of femto laser-assisted capsulotomy. Cataract Refract Surg Today Europe 2014;9:36-50.

    • Gulani AC. Shaping the future and reshaping the past: the art of vision surgery. Chapter 98. In: Copeland and Afshari’s Principles and Practice of Cornea. New Delhi, India: Jaypee Brothers Medical Publishers, 2013;2:1252-73.

    • Donnenfeld E, Gulani AC. Astigmatism correction during cataract surgery. In: Garg H, Alió JL, eds. Femtosecond Laser: Techniques and Technology. 1st ed. Miami; JayPee Highlights Medical Publishers; 2012;21:155-161.

    • Gulani, AC. Vision à la carte: Designing vision. Ophthalmology Times. 2013;38:31-33.

     • Gulani AC.  Corneoplastique. Techniques in Ophthalmology 2007;5:11-20.


    Arun C. Gulani, MD, is founding director and chief surgeon of the Gulani Vision Institute, Jacksonville, FL. Dr. Gulani has no financial interests to declare.


    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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