challenging cases · • schirmertest ods normal >10mm • anterior chamber depth...

 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: • Helen@laservision.gr

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