Download - JAIRO E. HOYOS, MD MELANIA CIGALES, MD
JAIRO E. HOYOS, MDMELANIA CIGALES, MD
Instituto Oftalmológico HoyosBarcelona - SPAIN
J Hoyos
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
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
J Hoyos
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)
J Hoyos
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
J Hoyos
““CLINICAL HISTORY METHOD”CLINICAL HISTORY METHOD”
TCC: Sim K = 32.5 Central K= 30.6
CALCULATED = 30.1
POST-LASIKPOST-LASIK
J Hoyos
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
J Hoyos
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
J Hoyos
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
J Hoyos
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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