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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

    Take-home message: In this second part of a four-part column, Arun C. Gulani, MD, places the spotlight on staged cataract surgery. The first part of the series discussed the concept and approach to designing primary cataract surgery. Part one can be found here.

    In this second part of a four-part column on approaches to cataract surgery, the spotlight is on staged cataract surgery. Cataract surgery is an opportunity and avenue to manipulate the internal optics of the eye because the cataract (lens) itself is a powerful and important optical element.

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    Taking full advantage of this opportunity, which is a once-in-a-lifetime event for the patient, adjusting the internal optics allows surgeons to design our patients’ individual outcomes as a single or staged goal.

    Having performed numerous permutations and combinations, I have summarized staged cataract surgery into two simple strategies: Inside-out and outside-in staged surgery.

    Inside-out staged concept

    To put it simply, the inside-out approach in most cases has a potentially measureable cornea (to determine the IOL power as accurately as possible) and the IOL placement presents the refractive endpoint for the most needed laser ablation profile, i.e., myopic/hyperopic (PRK mode) to then correct the corneal pathology as well as result in emmetropia simultaneously.

    Next: Outside-In approach

    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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