JAIRO E. HOYOS, MDMELANIA CIGALES, MD

Instituto Oftalmológico HoyosBarcelona - SPAIN

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THE TOPOGRAPHY THE TOPOGRAPHY OVER-ESTIMATESOVER-ESTIMATES CORNEAL POWER AFTER CORNEALCORNEAL POWER AFTER CORNEAL REFRACTIVE SURGERYREFRACTIVE SURGERY

THE TOPOGRAPHY THE TOPOGRAPHY OVER-ESTIMATESOVER-ESTIMATES CORNEAL POWER AFTER CORNEALCORNEAL POWER AFTER CORNEAL REFRACTIVE SURGERYREFRACTIVE SURGERY

UNDERCORRECTION IOL CALCULATIONUNDERCORRECTION IOL CALCULATIONUNDERCORRECTION IOL CALCULATIONUNDERCORRECTION IOL CALCULATION

RESULT = RESULT = HYPEROPIAHYPEROPIARESULT = RESULT = HYPEROPIAHYPEROPIAJ Hoyos

METHODS TO CALCULATE CORNEAL METHODS TO CALCULATE CORNEAL POWER POST-REFRACTIVE SURGERYPOWER POST-REFRACTIVE SURGERY

1- HOLLADAY REFRACTIVE HISTORY1- HOLLADAY REFRACTIVE HISTORY2- HARD CONTACT LENS2- HARD CONTACT LENS3- CORNEAL TOPOGRAPHY3- CORNEAL TOPOGRAPHY4- KERATOMETRY4- KERATOMETRY

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KMSG KMSG HOT LINEHOT LINE

kmsg@intercom.eskmsg@intercom.es

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KMSG KMSG HOT LINEHOT LINE

TO CALCULATE CORNEAL CURVATURETO CALCULATE CORNEAL CURVATURE““HOLLADAY REFRACTIVE HISTORY METHOD”HOLLADAY REFRACTIVE HISTORY METHOD”

PRE-OP KERATOMETRYPRE-OP KERATOMETRY

OBTAINED CORRECTION (Corneal Plane)OBTAINED CORRECTION (Corneal Plane)

CORNEAL POWER POST-R.S.CORNEAL POWER POST-R.S.

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KMSG KMSG HOT LINEHOT LINE

SRK-TSRK-T (>26 (>26 mmmm)) HolladayHolladay (24.5 – 26 mm)(24.5 – 26 mm)

Hoffer Q Hoffer Q (>22 mm)(>22 mm)

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POST-LASIK CENTRAL CORNEA IS THINNER =POST-LASIK CENTRAL CORNEA IS THINNER = BIOMETRY ERROR: INDENTATION USING BIOMETRY ERROR: INDENTATION USING APPLANATION [IMMERSION BEST]APPLANATION [IMMERSION BEST]

KMSG KMSG HOT LINEHOT LINE

IS IMPORTANT TO HAVE THEIS IMPORTANT TO HAVE THEPREOPERATIVE AXIAL LENGTHPREOPERATIVE AXIAL LENGTH

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AXIAL LENGTH CAN INCREASE DUE AXIAL LENGTH CAN INCREASE DUE TO A GLOBE INGROWTH.TO A GLOBE INGROWTH.

PRE-LASIKPRE-LASIK:: (40 years) (40 years)Refraction: -16 - 4 x 170º Refraction: -16 - 4 x 170º Sim K: (46.3 x 42.4)Sim K: (46.3 x 42.4)Axial length : 31.9 mmAxial length : 31.9 mm 3 YEARS POST-LASIK3 YEARS POST-LASIK::

CATARACTS

POST-LASIK POST-LASIK :: Refraction: -0.50Refraction: -0.50Sim K (32.7 x 32.3)Sim K (32.7 x 32.3)

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In the corneal plane: In the corneal plane: -14.75-14.75

2- 2- Post-LASIK REFRACTION Post-LASIK REFRACTION :: -0.50 -0.50

3- 3- CORNEAL PLANE CORRECTION :CORNEAL PLANE CORRECTION :

1- 1- Pre-LASIK REFRACTION Pre-LASIK REFRACTION :: -16 - 4 x 170 -16 - 4 x 170

Spherical equivalent : -18Spherical equivalent : -18

= = -14.25-14.25-14.75-14.75 (-0.5)(-0.5)--

““CLINICAL HISTORY METHOD”CLINICAL HISTORY METHOD”

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5- 5- Post-LASIK CORNEAL POWER :Post-LASIK CORNEAL POWER :

= = 30.1030.10

3- 3- CORNEAL PLANE CORRECTION CORNEAL PLANE CORRECTION :: -14.25-14.25

4- 4- Pre-LASIK KERATOMETRY Pre-LASIK KERATOMETRY :: 42.4 x 46.3 42.4 x 46.3

Mean Keratometry: Mean Keratometry: 44.3544.35

-44.3544.35 14.2514.25

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““CLINICAL HISTORY METHOD”CLINICAL HISTORY METHOD”

TCC: Sim K = 32.5 Central K= 30.6

CALCULATED = 30.1

POST-LASIKPOST-LASIK

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PRE-LASIKPRE-LASIK:: Refraction: -16 - 4 x 170ºRefraction: -16 - 4 x 170º

Axial length: Axial length: 31.9 mm31.9 mm

POST-LASIK (3 years)POST-LASIK (3 years):: CataractCataract

Axial length: Axial length: 31.06 mm31.06 mm

AXIAL LENGTH =AXIAL LENGTH = 31.9 mm31.9 mm

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CORNEAL POWER = CORNEAL POWER = 30.1 D30.1 DAXIAL LENGTH = AXIAL LENGTH = 31.9 mm31.9 mmFORMULA CALCULATION = FORMULA CALCULATION = SRK/TSRK/T

RESULTRESULT

ACRYSOF (MA60BM) A const 118.80: ACRYSOF (MA60BM) A const 118.80: +16.5+16.5

Predict refraction Predict refraction -0.74-0.74Final refraction Final refraction 0.000.00

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-2 -2

-1-1

-2.5-2.5

-0.5-0.5

Post-OPPost-OP

--3.53.5

-2.75-2.75

--22

-2.75-2.75

-9 -9

-8.25-8.25

-21.25-21.25

-18-18

Pre-OPPre-OP

--2121

-18.5-18.5

-18-18

-16.5-16.5

CATARACTS CATARACTS

Post-KM in situPost-KM in situ

Post-LASIKPost-LASIK

7 Cases7 Cases

1 Case1 Case

CORNEALCORNEALPOWERPOWER

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31.331.3

31.931.9

31.531.5

30.430.4

30.330.3

36.536.5

29.829.8

36.536.5

Central-KCentral-K

32.27 ± 2.6932.27 ± 2.69

K-CalculatedK-Calculated

32.21 ± 3.0732.21 ± 3.07

Sim-KSim-K

35.41 ± 2.0035.41 ± 2.00

30.2530.25

32.6332.63

30.3730.37

3030

30.130.1

3737

30.3530.35

3737

35.935.9

3535

37.0537.05

33.8533.85

32.532.5

37.8537.85

33.633.6

37.637.6

Refractive History Refractive History TCCTCC TCCTCC

RESULTSRESULTS

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SSRRKK//TT

ObtainedObtainedrefractionrefraction

-0.31 ± 1.03-0.31 ± 1.03

DesiredDesiredrefractionrefraction

-0.75 ± 0.38-0.75 ± 0.38

IOL POWERIOL POWER

16.87 ± 1.4516.87 ± 1.45

+16.5+16.5

+15.0 +15.0

+16.5 +16.5

+17.5+17.5

+18.5 +18.5

+15 +15 +17 +17

+19+19

0 0

-1 -1

0 0

-1-1

-2 -2

0 0 +1.5+1.5

00

-0.75-0.75

-1.25-1.25

-1 -1

-0.55-0.55

-1 -1

-0.62-0.6200

-1-1

3-POSSIBILITY OF INDENTATION 3-POSSIBILITY OF INDENTATION BIOMETRIC ERRORBIOMETRIC ERROR

2-FORMULA CALCULATION : 2-FORMULA CALCULATION : SRK/TSRK/T

1-CORNEAL CURVATURE CALCULATION1-CORNEAL CURVATURE CALCULATION

Clinical History Method Clinical History Method (If Unknown, use flattest K)(If Unknown, use flattest K)

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Refraction: OD_____________________ OS _____________________Keratometry: OD__________________ OS __________________Axial Length: OD__________________ OS___________________

PRE-REFRACTIVE SURGERY DATESPatient___________________________Surgery______________Date_________

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