dr. nicolas pereira presentation at the mediphacos user meeting 2013
DESCRIPTION
Challenging Cases With Keraring SI-6TRANSCRIPT
TOTAL KERATOCONUS SOLUTION 2013Keraring Global User Meeting
Challenging Cases With Keraring SI-6
Nicolas Cesário PereiraHospital Oftalmológico de Sorocaba
Banco de Olhos de Sorocaba
Diferences KeraringSI-5 and SI-6
Keraring SI-6
Indications
� Mesopic Pupil diameter > 5mm
� Low paquimetry in 5mm optical zone to implant SI-5
� Periferic ectasias (PMD and post LASIK)
� Plan of a secundary refractive procedure (PRK and/or phakic IOL)
Keraring SI-6
Surgical Plan
� Use same nomogram as SI-5
� Add 50μm to the selected segments?
� If the selected arch length is 160, substitute for 150
Keraring SI-6
Surgical Technique
� Manual: Use 6mm marquers and tunelizers
� Femtosecond laser: Channel diameter 5,8 and 7,0
Case 1Keratoconus with low corrected VA and CL intolerant OS
VA n/c OS CF 2mOS -5,75 -0,50 150 20/60-2
SI6 150/300
SI6 90/250
VA n/c OS 20/30Rx OS -1,75 -1,50 180 20/20
Case 2:
GAC, 46y
Keratoconus
ICRS OD 3y; PK OS 5y
Low VA and halos OD
OD AV s/c 20/160 and CL intolerant
Rx OD +0,50 -3,50 120 20/50p
Case 2:
Plan: Explant segments OD e reprogram implant after 3 months
Case 2:
PO
VA n/c 20/30Rx +0,50 -1,00 a 90 20/20p Implant SI-6 150/250
SI6 - 150/250
SKF, 41y
LASIK 9y
Low corrected VA OU
CL intolerant OU
Case 3
VA OD n/c 20/600,00 -3,50 a 110 20/30p
SI6 - 150/200
POVA n/c 20/20
0,00 - 1,00 10 20/15p
VA OS n/c 20/160-0,50 -5,50 110 20/40p
SI6 - 150/250
POVA n/c 20/15plano 20/15
SI6 - 150/250
AOC, 82y
Low VA AO 5y
No other comorbity
Case 4
SI6 - 150/250
Case 4
OSOD
Periferic Marginal Degeneration (Senile)Cataract +/IV
SI6 - 150/250
Case 4 ODVA OD n/c 20/200
+4,75 -3,25 a 70 20/40p
SI6 - 150/250
Case 4 OSVA n/c 20/400+6.25 -8.00 a 95 20/120
SI6 90/200
SI6 150/250
SI6 - 150/250
Case 4 OSVA n/c 20/40+2.50 -0.50 a 95 20/30
SI6 - 150/250
Cataract surgery 3 months later
VA n/c OD 20/40 OS 20/25
OD +0.50 -2.50 a 70 20/20pOS +0.75 -0.75 a 95 20/20
Case 4
Keraring SI-6
� Good previsibility - similar to SI-5
� Less central flattening; good regularization
� Less halos e glare – Mesopic pupils > 5mm
� Plan of a secundary refractive procedure (PRK and/or phakic IOL)
� ICRS surgery is ajustable
� Good results in challenging cases
Thank You!