Ординатура / Офтальмология / Английские материалы / Jaypee Gold Standard Mini Atlas Series CORNEALTOPOGRAPHY_Agarwal, Jacob_2009

MINI ATLAS SERIES: CORNEAL TOPOGRAPHY

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FIGURE 3.9: Wavescan S/P custom cap treatment

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CHAPTER 3: CTWA: COMPLEMENTARY TOOLS

CASE 2: NIGHT VISION COMPLAINTS S/P LASIK

Patient WR presented with complaints of “terrible night vision, starbursts and halos” after LASIK in 2000. Preoperatively, she was –2.50 DS. Postoperatively, she refracted to –1.00 + 0.25 × 160, with a BVA of 20/30 OD, her dominant eye. Figure 3.10A shows her topography, revealing central irregularities. WaveScan, found in Figure 3.10B, revealed coma and trefoil. We suspected the

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MINI ATLAS SERIES: CORNEAL TOPOGRAPHY

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CHAPTER 3: CTWA: COMPLEMENTARY TOOLS

central irregularities were exaggerated by her dry eye, and treated her aggressively with punctual occlusion, Restasis BID, and Liqugel nightly. Her symptoms improved slightly, and she is waiting for more advanced custom treatment.

CASE 3: COMPLAINT OF MULTIPLE

IMAGES AFTER HYPEROPIC LASIK

Patient TD presented complaining of light sensitivity, ghosting, halos and starbursts at night. Preoperatively she was +4.50D OU. Postoperatively she refracted to PL, 20/25 + OD, + 0.25 + 0.50 × 150, 20/25 + OS. Despite her unaided 20/20Snellen acuity, she complained bitterly about her quality of vision. Topography found a smaller optical zone OS with greater steepening in the dominant left eye, as shown on the axial map in Figure 3.11A) WaveScan found significant spherical aberration (Fig. 3.11B). Note the spherical aberration is negative due to the hyperopic treatment. We have prescribed Alphagan P in an attempt to decrease the pupil size and minimize the night vision issues, and fit the patient with gas permiable lenses.

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MINI ATLAS SERIES: CORNEAL TOPOGRAPHY

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MINI ATLAS SERIES: CORNEAL TOPOGRAPHY

CASE 4: DOUBLE VISION WITH LOSS OF BEST

CORRECTION S/P LASIK

Patient RD presented for evaluation of double vision S/P Lasik, even with glasses. Preoperatively, he was –4.75 + 0.75 × 105, with a BVA of 20/20. After his original surgery, he underwent two enhancements and AK in the affected eye, leaving him –2.00 with a best corrected acuity of. He was fit with an RGP, which he reported did not resolve the diplopia, so he rarely wore the lens. Clinical notes from the fitting doctor report BCCLVA of 20/25. The topography was surprisingly regular in the pupillary zone despite the repeated corneal surgery. Wavefront analysis found significant COMA and trefoil, and can be seen in Figure 3.12. We attribute this to early lenticular changes, and elected to monitor rather than proceed with corrective ablation.

CASE 5: HYPEROPIC KERATOREFRACTIVE

SURGERY RESULTS IN STEEP CORNEA

A 19-year-old female presented for Lasik evaluation. Manifest refraction was +1.75+05.0 x 25 OD (20/40) and +0.75 OS (20/25). Cycloplegic found latent hyperopia: +4.25 OD (20/50) and +1.50 (20/40) OS. Her preoperative topography was normal, and is shown in Figure 3.13A. After considerable discussion, she elected to undergo Lasik

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