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Файл:Ординатура / Офтальмология / Учебные материалы / Section 13 Refractive Surgery 2015-2016.pdf
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- •Contents
- •General Introduction
- •Objectives
- •Introduction
- •1 The Science of Refractive Surgery
- •Corneal Optics
- •Refractive Error: Optical Principles and Wavefront Analysis
- •Measurement of Wavefront Aberrations and Graphical Representations
- •Lower-Order Aberrations
- •Higher-Order Aberrations
- •Corneal Biomechanics
- •Corneal Imaging for Keratorefractive Surgery
- •Corneal Topography
- •Corneal Tomography
- •Indications for Corneal Imaging in Refractive Surgery
- •The Role of Corneal Topography in Refractive Surgery
- •Corneal Effects of Keratorefractive Surgery
- •Incisional Techniques
- •Tissue Addition or Subtraction Techniques
- •Alloplastic Material Addition Techniques
- •Collagen Shrinkage Techniques
- •Laser Biophysics
- •Laser–Tissue Interactions
- •Fundamentals of Excimer Laser Photoablation
- •Types of Photoablating Lasers
- •Corneal Wound Healing
- •2 Patient Evaluation
- •Patient History
- •Patient Expectations
- •Social History
- •Medical History
- •Pertinent Ocular History
- •Patient Age, Presbyopia, and Monovision
- •Examination
- •Uncorrected Visual Acuity and Manifest and Cycloplegic Refraction
- •Pupillary Examination
- •Ocular Motility, Confrontation Fields, and Ocular Anatomy
- •Intraocular Pressure
- •Slit-Lamp Examination
- •Dilated Fundus Examination
- •Ancillary Tests
- •Corneal Topography
- •Pachymetry
- •Wavefront Analysis
- •Calculation of Residual Stromal Bed Thickness After LASIK
- •Discussion of Findings and Informed Consent
- •3 Incisional Corneal Surgery
- •Incisional Correction of Myopia
- •Radial Keratotomy in the United States
- •Incisional Correction of Astigmatism
- •Coupling
- •Arcuate Keratotomy and Limbal Relaxing Incisions
- •Instrumentation
- •Surgical Techniques
- •Outcomes
- •Complications
- •Ocular Surgery After Arcuate Keratotomy and Limbal Relaxing Incisions
- •4 Onlays and Inlays
- •Keratophakia
- •Homoplastic Corneal Inlays
- •Alloplastic Corneal Inlays
- •Epikeratoplasty
- •Intrastromal Corneal Ring Segments
- •Background
- •Instrumentation
- •Technique
- •Outcomes
- •Intacs and Keratoconus
- •One or Two Intacs Segments?
- •Complications
- •Ectasia After LASIK
- •Uses for Intrastromal Corneal Ring Segments After LASIK
- •Orthokeratology
- •5 Photoablation: Techniques and Outcomes
- •Excimer Laser
- •Background
- •Surface Ablation
- •LASIK
- •Wavefront-Optimized and Wavefront-Guided Ablations
- •Patient Selection for Photoablation
- •Special Considerations for Surface Ablation
- •Special Considerations for LASIK
- •Surgical Technique for Photoablation
- •Calibration of the Excimer Laser
- •Preoperative Planning and Laser Programming
- •Preoperative Preparation of the Patient
- •Preparation of the Bowman Layer or Stromal Bed for Excimer Ablation
- •Application of Laser Treatment
- •Immediate Postablation Measures
- •Postoperative Care
- •Refractive Outcomes
- •Outcomes for Myopia
- •Outcomes for Hyperopia
- •Wavefront-Guided and Wavefront-Optimized Treatment Outcomes for Myopia and Hyperopia
- •Re-treatment (Enhancements)
- •6 Photoablation: Complications and Adverse Effects
- •General Complications Related to Laser Ablation
- •Overcorrection
- •Undercorrection
- •Optical Aberrations
- •Central Islands
- •Decentered Ablations
- •Corticosteroid-Induced Complications
- •Central Toxic Keratopathy
- •Infectious Keratitis
- •Complications Unique to Surface Ablation
- •Persistent Epithelial Defects
- •Sterile Infiltrates
- •Corneal Haze
- •Complications Unique to LASIK
- •Microkeratome Complications
- •Epithelial Sloughing or Defects
- •Flap Striae
- •Traumatic Flap Dislocation
- •LASIK-Interface Complications
- •Visual Disturbances Related to Femtosecond Laser LASIK Flaps
- •Ectasia
- •Rare Complications
- •7 Collagen Shrinkage and Crosslinking Procedures
- •Collagen Shrinkage
- •History
- •Laser Thermokeratoplasty
- •Conductive Keratoplasty
- •Collagen Crosslinking
- •8 Intraocular Refractive Surgery
- •Phakic Intraocular Lenses
- •Background
- •Advantages
- •Disadvantages
- •Patient Selection
- •Surgical Technique
- •Outcomes
- •Complications
- •Refractive Lens Exchange
- •Patient Selection
- •Surgical Planning and Technique
- •IOL Power Calculations in Refractive Lens Exchange
- •Complications
- •Advantages
- •Disadvantages
- •Monofocal Intraocular Lenses
- •Toric Intraocular Lenses
- •Patient Selection
- •Planning and Surgical Technique
- •Outcomes
- •Complications Specific to Toric IOLs
- •Light-Adjustable Intraocular Lenses
- •Accommodating Intraocular Lenses
- •Multifocal Intraocular Lenses
- •Patient Selection
- •Surgical Technique
- •Outcomes
- •Adverse Effects, Complications, and Patient Dissatisfaction with Multifocal IOLs
- •Bioptics
- •Introduction
- •Theories of Accommodation
- •Nonaccommodative Treatment of Presbyopia
- •Monovision
- •Conductive Keratoplasty
- •Multifocal IOL Implants
- •Custom or Multifocal Ablations
- •Corneal Intrastromal Femtosecond Laser Treatment
- •Corneal Inlays
- •Accommodative Treatment of Presbyopia
- •Scleral Surgery
- •Femtosecond Lens Relaxation
- •Accommodating IOLs
- •Other IOL Innovations on the Horizon
- •10 Refractive Surgery in Ocular and Systemic Disease
- •Introduction
- •Ocular Conditions
- •Ocular Surface Disease
- •Herpesvirus Infection
- •Keratoconus
- •Post–Penetrating Keratoplasty
- •Ocular Hypertension and Glaucoma
- •Retinal Disease
- •Amblyopia and Strabismus in Adults and Children
- •Systemic Conditions
- •Human Immunodeficiency Virus Infection
- •Diabetes Mellitus
- •Connective Tissue and Autoimmune Diseases
- •11 Considerations After Refractive Surgery
- •IOL Calculations After Refractive Surgery
- •Eyes With No Preoperative Information
- •The ASCRS Online Post-Refractive IOL Power Calculator
- •Retinal Detachment Repair After LASIK
- •Corneal Transplantation After Refractive Surgery
- •Contact Lens Use After Refractive Surgery
- •Indications
- •General Principles
- •Contact Lenses After Radial Keratotomy
- •Contact Lenses After Surface Ablation
- •Contact Lenses After LASIK
- •Glaucoma After Refractive Surgery
- •12 International Perspectives in Refractive Surgery
- •Introduction
- •Global Estimates of Refractive Surgery
- •International Trends in Refractive Surgery
- •Basic Texts
- •Related Academy Materials
- •Requesting Continuing Medical Education Credit
Ocular Surgery After Arcuate Keratotomy and Limbal Relaxing Incisions
Arcuate keratotomy and LRIs can be combined with or performed after cataract surgery, surface ablation, or LASIK surgery. Better predictability can be obtained if astigmatic correction is performed after refractive stability is achieved. Penetrating keratoplasty can be done after extensive AK, but the wounds may have to be sutured before trephination, as discussed earlier for RK. A prerequisite for combining LRIs with cataract surgery is the use of astigmatically predictable phacoemulsification.
Bayramlar HH, Dağlioğlu MC, Borazan M. Limbal relaxing incisions for primary mixed astigmatism and mixed astigmatism after cataract surgery. J Cataract Refract Surg. 2003; 29(4):723–728.
Budak K, Yilmaz G, Aslan BS, Duman S. Limbal relaxing incisions in congenital astigmatism: 6 month follow-up. J Cataract Refract Surg. 2001;27(5):715– 719.
Faktorovich EG, Maloney RK, Price FW Jr. Effect of astigmatic keratotomy on spherical equivalent: results of the Astigmatism Reduction Clinical Trial. Am J Ophthalmol. 1999; 127(3):260–269.
Nichamin LD. Astigmatism control. Ophthalmol Clin North Am. 2006;19(4):485–493.
Price FW, Grene RB, Marks RG, Gonzales JS; ARC-T Study Group. Astigmatism Reduction Clinical Trial: a multicenter prospective evaluation of the predictability of arcuate keratotomy. Evaluation of surgical nomogram predictability. Arch Ophthalmol. 1995;113(3):277–282.
Rubenstein JB, Raciti M. Management of astigmatism: LRIs. Int Ophthalmol Clin. 2012; 52(2): 31–40.
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