2011-2012 Basic and Clinical Science Course, Section 13: by Christopher J. Rapuano MD

By Christopher J. Rapuano MD

This up-to-date quantity covers a few subject matters, from the technological know-how of refractive surgical procedure to accommodative and nonaccommodative remedy of presbyopia, from sufferer evaluate to foreign views. It examines particular tactics in refractive surgical procedure, in addition to refractive surgical procedure in ocular and systemic sickness. significant revision 2011-2012.

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Additional resources for 2011-2012 Basic and Clinical Science Course, Section 13: Refractive Surgery (Basic & Clinical Science Course)

Example text

1989;5(6);400-408. Post-penetrating keratoplasty Corneal topography is very helpful in managing posto perative astigmatism following penetrating ke ratoplasty (PKP). Complex peripheral patterns may result in a refractive axis of astigmatism that is not aligned with the topographiC axis. It is important to remove all the sutures in the graft prior to performing refractive surgery, as th e presence of sutures may affect the refract ive error. It is also important to operate on the appropriate axis in this situation; otherwise, an unexpected result may occur.

It is important to try to standardize pupil size measurements as much as possible. Large pupil size may be one of the risk factors for postoperative glare and halo symptoms after refractive surgery. Other risk factors for postoperative glare include higher degrees of myopia or astigmatism. As a rule, pupil size greater than the effective optical zone (usually 6-8 mm) increases the risk of glare, but large pupil size is not the only determinant of glare. When asked, patients often note that they had glare under dim-light conditions even before refractive surgery.

And Ocular Anatomy Ocular motility should also be evaluated. Patients with an asymptomatic tropia or phoria may develop symptoms after refractive surgery if the change in refraction causes the motility status to break down. If there is a history of strabismus (see Chapte r 10) or a concern regard ing ocular alignment postoperatively, a trial with contact lenses before surgery CHAPTER 2: Patient Evaluation. 35 should be considered. A sensory motor evaluation can be obtained preoperatively if strabismus is an issue.

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