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Challenging cases:
Theory and clinical practice
ISRS FORUM
Kanellopoulos, MD www brilliantvision com
2
High topo cylinder (2D), 0 on Rx
Now with 2D cyl….
-5.50 -1.50 @110 and @ 75
After treatment of blepharitis!
-7.5D, 23 y/o, 545um
Other eye -6.5 -3 @100
20y/o male -3.25D OU, 500um wants to be a helicopter pilot
Pachymetry distribution confirmation by OCT
Normal pachymetry distribution
KCN?
KCN
KCN OD, OS normal?
OS not normal
-8.00 -6.oo X 90,530 microns: LASIK?
2 months after femto-assisted AK; LASIK with 100um flap
IOP adjustment?
PRK and CXL
email from US ? best Tx: 21y/o -1.25 -1.50@20
Normal pachymetry distribution
Best Tx?
Other eye
6months post TopoPRKCXL
32y/o LASIK regression after 2 years; PRK Vs LASIK
-5.5D myope 44y/o female
-5.5D myope 44y/o female
• Could I have an opinion on possible refractive surgery in this young woman?
• She went to different doctors with different opinions regarding refractive surgery.
• Female 26y old / Contactlens intolerant / Stable reaction > 2years
• BCVA OD 20/20 -11 OS 20/20 -11 • Mesopic pupildiameter : OD 7.46mm OS 7.34mm
(OPD-scan) • Pachymetrie : OD 618µ OS 631µ • Keratometry • OD 45.75 x 46.50 OS 46.00 x 46.75 (normal cornea) • Schirmertest ODS normal >10mm • Anterior chamber depth (endothelium-lens) OD
3.34mm OS 3.40mm • Biomicroscopy normal • Fundoscopy normal • At this moment she wears glasses and has also
peripheral distortion due to the high level of correction. • -> Is LASIK or Femto-LASIK an option in this young
woman with high myopia and thick cornea. However she has large mesopic pupils (>7mm.).
• -> Would you rather be in favoutr for a Phakic IOL? • -> Would you rather not treat this patient?
Steep but thick: KRS?
What is this procedure?
• Would you treat this patient? • Female 43y • 13/12/2007 LASIK OD +4.50 (-0.50x160)
OZ 6.50 TZ 8.90 74µm 13/12/2007 LASIK OS +4.00(-0.50 x 5) OZ 6.50 TZ 8.90 66µm
• XP-keratome 9.5/120µ • 04/2011 Irregular regression with
residual hyperopic astigmatism • BCVA OD 20/20 +3(-1.75x120°) OS
20/20 +2.5(-1.5x55°) • Patient is too young for multifocal IOL in
my opinion. She would loose her accomodation and difficult IOL-calculation. She does not want to wear glasses.
• Is enhancement an option in this rather steep cornea?
• Enclosed pre- & post-op Pentacam.
AAO/ISRS meeting in Athens!
• December 3rd & 4th • The ISRS didactic course • Live surgery and commentary in LASIK,
Athens Protocol, CXL and femto cataract surgery
• Please contact: • [email protected]
Kanellopoulos MD
Special CXL neeting at the AAO
• Saturday October 22nd • 630-800AM • Chairs: • Theo Seiler, MD & A. John Kanellopoulos, MD • Cases and dicussion: • CXL, topo-guided and CXL, ICRS, Phakic
IOLs
Kanellopoulos MD
Kanellopoulos, MD www brilliantvision com
Thank you