management of post cataract surgery astigmatism

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Management of post cataract surgery Astigmatism. H.R.Ziai MD. Since phaco became routine procedure, Ast. is not an important problem, however, it needs to disccused about . Sources of post op. Astimatism. Pre-existing Astimatism Incision induced Astimatism Suture induced Astimatism - PowerPoint PPT Presentation

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Page 1: Management of  post cataract surgery  Astigmatism
Page 2: Management of  post cataract surgery  Astigmatism

Management of post cataract surgery

Astigmatism

H.R.Ziai MD

Page 3: Management of  post cataract surgery  Astigmatism

Since phaco became routine procedure, Ast. is not an important problem, however, it needs to disccused about.

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Sources of post op. Astimatism • Pre-existing Astimatism• Incision induced Astimatism• Suture induced Astimatism• Wound burn

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Incision induced Astimatism

Any incision, relaxates meridian which is vertical to the incision

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Suture induced Ast.

Any tight suture, steepens it’s own meridian

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• Any loose suture (wound gap) flattens it’s own meridian

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• Any none radial suture, induces irregular Ast. (None predictable)

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• Vertical mismatch, induces predictable astigmatism:

- Deep corneal to superficial scleral bite, flattens corneal curvature

- Superficial corneal to deep scleral bite, steepens corneal curvature

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Wound burn:

It induces irregular wound & irregular Ast. , that often can not be compensated.

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How to manage it?

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Management:

• Preoperative• Interaoperative• Post operative

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Preoperative:

• PHACO, Except for difficult or impossible cases.

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Interaoperative:

• Incision (main incision & relaxing incision)

• Suture• Avoiding wound burn

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Main incisionBoth phaco & ECCE• More posterior incision Ast.• Smaller incision Ast.• Three-plane incision Ast.

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Site of incision:• Temporal approach incision,

induces less Ast. , because it’s farthest from the visual axis.

• Although small incision of phaco, induces minimal cylinder, it is better to make incision on the steep meridian.

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• Relaxing incision (Astigmatic Keratotomy, AK)

• If, pre-existing cylinder is more than 1.75D, relaxing incision on steep meridian is necessary for Ast. correction.

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• Relaxing incision, also can be made on limbus, which is more effective ( LRI ).

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• Suturing:- Horizontal- Vertical- RotationalMisalignment, induces Ast. , and

so, have to be avoided.

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Post operative:• Selective suture removed• Glasses• Relaxing incision (AK)• Laser (PRK, LASIK)

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Glasses:

• ECCE: 1m after suture removed

• Phaco: 2w after surgery

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AK & Laser• For ECCE >6m• For phaco >6w

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