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Enhancement in Irregular Topography Case |
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A NEW message,"Re: The question posted by, George Rozakis, MD<gwr@rozakis.com>,USA, was sent by:
- Gabriel Oliveros, MD (Colombia)
- Mariano Fernandez, MD (Guatemala)
- Raul Suarez, MD (Mexico)
- Jorge Cazal, MD (Spain)
- Gabriel Quesada, MD (El Salvador)
Wewould appreciate your reply if you have any comments about this subject.
Please, send to me a copy of the answer (cc), as we are going to publish all the questions and answers received.
Sincerely.
Jairo Hoyos-Chacon, MD
KMSG Hot Line coordinator
George Rozakis, MD
gwr@rozakis.com
CC:kmsg2007@kmsg.org
Web address:
http://www.kmsg.org |
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The question read as follow:
Dear Group,
This patient had Lasik for -2.00 -6.75 x 90
Uncorrected 20/40
His refraction is now +.25 -1.00 x 90 20/20 (good endpoint)
Take a look at his topography.
Will the ablation help him?
Best Regards,
George W. Rozakis, MD
USA |
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George:
Ive seen a couple of cases similar to this one. Before doing anything, why dont you tell us how is the patiet seeing right now without correction? how unconfortable is she or he?? with the actual vision?
Mariano Fernandez, MD
Guatemala
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| Dear Jorge
Your patient has less astigmatism than preop but now he (she)has an irregular astigmatism as I can see on the post op topography (something happens when the ablation went trough) your refraction showsthe axis on 90` and the topography show it at 51` so if you do conventional laser it willgave you a not accurate correction regarding the difference on the axis cylinder.
I will suggest a cicloplegic refraction to verify the positive sphere especially if the patient is young an will make a PRK withcustom ablation. I will not lift the original flap because probable the irregular astigmatism isdoto it.
Saludos
Raul Suarez, MD (Mexico) |
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Dear George:
With these pieces of the puzzle, I am not confident that this case was a previously myopic Regular Against The Rule Astigmatism,either I wouldnt treat him/her without a Ocular Tomography Scheimpflug Based + Ocular Response Analyzer Screening, beside a very goodhistory of refractive stability.
Right now of course this patient has probably ghost images (highly comatic anterior corneal surface -see Zernike Mapor Elevation Map)
Depending on elevation data this should fit for a Topography guide ablation Vs WF guided Ablation dependig of Pancorneal Pachymetry (limbus -limbus)
We can not disregard that this cases also respond very well to ICRS or CK to reduces corneal astigmatism in cases where Substractive Refractive Surgery are contraindicated.
Best
Jorge Cazal,MD
Barcelona
1: Pokroy R, Levinger S, Hirsh A.
Single Intacs segment for post-laser in situ keratomileusis keratectasia.
J Cataract Refract Surg. 2004 Aug;30(8):1685-95.
2: Knorz MC, Jendritza B.
Topographically-guided laser in situ keratomileusis to treat corneal
irregularities.
Ophthalmology. 2000 Jun;107(6):1138-43
3: Hersh PS, Fry KL, Chandrashekhar R, Fikaris DS.
Conductive keratoplasty to treat complications of LASIK and photorefractive
keratectomy.
Ophthalmology. 2005 Nov;112(11):1941-7. Epub 2005 Sep 12
In this case in particular, the pachymetry and posterior corneal
topography are very important before doing anything.
With that vision I probably wouldnt do any more surgery
Gabriel Quesada MD
Centro Panamericano de Ojos
El Salvador |
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