Cataract and Refractive Surgery

by Kohnen, Thomas; Koch, Douglas D.

• ISBN13: 9783540763789
• ISBN10: 3540763783
• Edition: 1st
• Format: Hardcover
• Copyright: 2009-02-03
• Publisher: Springer Verlag

Summary

The topic of the third volume of the series in "Essentials in Ophthalmology" is cataract and refractive surgery, a realm of ophthalmic care that has undergone revolutionary changes in the past 10 years. Worldwide, the removal of the opaque crystalline lens is the most frequently performed surgical intervention in the human body, and refractive surgery encompasses an increasing array of procedures with rapidly growing surgical volumes. The goal of the editors of this book has been to provide up-to-date clinically relevant overviews and to highlight the most interesting fields of research and controversy. Many of these topics pertain also to cataract surgery, indicating the merging of technologies that is occurring in these two major ophthalmic subspecialties. Topics include: IOL complications Accommodation research Micro incisional lens surgery Toric IOLs Wavefront-modified IOLs OVD's for difficult cataract surgery Capsular tension rings Manipulating HOA with corneal laser surgery Femtosecond technology for refractive surgery Excimer laser profiles Correcting presbyopia Intraocular refractive surgery Anterior segment imaging for refractive surgery

Table of Contents

Anterior Segment Imaging
Introduction	p. 1
Placido-Disc Based Imaging	p. 2
Slit-Scanning Imaging	p. 2
Scheimpflug Imaging	p. 2
Arc-Scanning Ultrasound	p. 3
Optical Coherence Tomography Imaging	p. 4
Comparison of Imaging Capabilities	p. 4
Pachymetry	p. 4
Refractive Surgery	p. 7
Biometry	p. 8
Lamellar Corneal Surgery	p. 8
References	p. 9
Microincisional Lens Surgery
Introduction: The Trends Towards Microincision Cataract Surgery	p. 11
MICS Definition	p. 12
Indication for MICS Surgery	p. 12
Our Surgical Technique Step by Step	p. 13
MICS Anesthesia	p. 13
MICS Incision	p. 13
MICS Capsulorhexis	p. 13
MICS Hydrodissection, Hydrodelineation	p. 14
MICS Prechopping	p. 14
MICS Phacoemulsification and Removal Section	p. 15
Flat Instruments Concept	p. 17
Fluidics in MICS	p. 17
Irrigation and Aspiration: Creating a Balanced Fluidics Environment	p. 19
Is MICS Worthwhile?	p. 20
Clinical Outcome	p. 20
Outcome of the Incision	p. 20
Astigmatism Control with MICS	p. 21
Corneal Aberration Control with MICS	p. 21
End of the Surgery	p. 23
Future of MICS	p. 24
References	p. 24
Capsular Tension Rings
History of the Concept	p. 27
Applications and Designs	p. 28
Impact of a CTR on IOL Positioning and Refraction	p. 28
The CTR as a Surgical Tool	p. 29
Localized Zonular Dehiscence	p. 29
Generalized Zonular Weakness	p. 29
Posterior Capsulorhexis	p. 30
Combined Cataract and Vitreous Surgery	p. 30
Modified CTR for Special Purposes	p. 31
CTRs for Iris Defects	p. 31
CTRs for Sulcus Suture Fixation	p. 32
Capsular Tension Segments	p. 33
The CTR as a Measuring Gauge	p. 34
Quantification of the Diameter of the Evacuated Capsular Bag	p. 34
Quantification of Bag Diameter Changes During Capsular Shrinkage	p. 34
CTRs and After-Cataract Formation	p. 35
The Capsular Bending Ring	p. 36
Full-Circle Capsular Bending Rings	p. 38
'Tailed' Capsular Bending Ring	p. 38
Foldable Closed Ring	p. 38
Surgical Technique	p. 40
Timing of Ring Insertion	p. 40
Insertion Techniques and Instruments	p. 40
Sizing of the Capsulorhexis	p. 41
Complications, Prophylaxis and Management	p. 41
Intraoperative Complications	p. 41
Postoperative Complications	p. 41
Capsular Contraction	p. 41
(Sub-) Luxation of CTR-IOL-Bag Complex	p. 42
References	p. 42
Intraocular Lens Complications and Management
Introduction	p. 45
IOL Complications	p. 45
Presentation	p. 45
Causes	p. 48
Management of the Malpositioned IOL	p. 49
General Principles	p. 49
IOL Repositioning: Surgical Principles	p. 50
Capsular Fixation	p. 51
Scleral Sutured Repositioning	p. 54
Iris Sutured Repositioning	p. 58
IOL Explantation and Exchange - Surgical Principles	p. 60
Conclusion	p. 63
References	p. 65
Toric Intraocular Lenses for Correction of Astigmatism in Primary Cataract Surgery
Background	p. 67
Astigmatism	p. 67
Incidence of Astigmatism in the Cataractous Population	p. 67
Surgical Correction of Astigmatism	p. 70
Toric IOL Technology	p. 70
Concepts of TIOL for Primary Cataract Surgery	p. 70
Advantages and Disadvantages of TIOL	p. 70
Handling of TIOL	p. 71
Preoperative Measurements	p. 71
TIOL Calculation	p. 72
Implantation of TIOL	p. 72
Follow-Up	p. 76
Discussion	p. 76
Rotational Stability	p. 76
Residual Astigmatism	p. 79
Visual Acuity	p. 79
References	p. 79
Wavefront-Modified IOLs
Introduction	p. 81
Aspheric IOLs	p. 81
Corneal Spherical Aberrations	p. 81
Aspheric IOLs	p. 82
Custom Selection of Aspheric IOLs	p. 84
Custom Selection of Aspheric IOLs in Normal Eyes	p. 84
Custom Selection of Aspheric IOLs in Eyes Following Myopic-PRK	p. 85
Custom Selection of Aspheric IOLs in Eyes Following Hyperopic LASIK/PRK	p. 86
Decentration/Tilt of Aspheric IOL	p. 87
Depth of Focus with Aspheric IOLs	p. 89
Clinical Outcome of Aspheric IOLs	p. 90
Conclusion	p. 92
References	p. 92
How Should We Manipulate Higher-Order Aberrations After Refractive Surgery?
Refractive Surgical Procedures Induce Higher-Order Aberrations, and Higher-Order Aberration Correction Can Induce Spherical Refractive Error (Aberration Interaction)	p. 95
Role of Higher-Order Aberrations After Refractive Surgery on Visual Performance	p. 96
Methods to Optimize the Wavefront Error Post Refractive Surgery	p. 96
Wavefront-Guided Laser Profiles	p. 97
Aspheric ("Wavefront-Optimized") Laser Profiles	p. 97
Improved Treatment Registration: Dynamic Rotational Sensible (Active) Eyetrackers	p. 97
Improved Keratomes: Femtosecond Laser LASIK	p. 97
Current and Future State of the Art LASIK and Lenticular Surgery	p. 97
References	p. 98
Current State of Accommodation Research
Introduction	p. 101
Accommodation	p. 101
Presbyopia	p. 101
The Mechanism of Accommodation	p. 101
Anatomy of the Accommodative Apparatus	p. 101
Ciliary Muscle	p. 101
Zonular Fibers	p. 102
Lens and Lens Capsule	p. 102
The Helmholtz Mechanism of Accommodation	p. 102
Far-to-Near Accommodation	p. 102
Near-to-Far Accommodation (Disaccommodation)	p. 102
Proposed Alternative Mechanisms of Accommodation	p. 102
Neural Control of Accommodation	p. 103
Parasympathetic Innervation	p. 103
Sympathetic Innervation	p. 103
Pseudo-Accommodation	p. 104
Presbyopia	p. 104
Development of Presbyopia	p. 104
Theories About the Etiology of Presbyopia	p. 104
Lenticular Origin	p. 104
Extralenticular Origin	p. 105
Multifactorial Origin of Presbyopia	p. 106
Experimental Studies of Accommodation In Vivo	p. 106
Surgical Restoration of Accommodation in the Presbyopic Eye	p. 107
Pseudo-Accommodative Procedures	p. 107
Procedures Intended to Restore Accommodation	p. 107
Scleral Expansion	p. 107
Accommodative Intraocular Lenses	p. 107
Experimental Procedures	p. 107
Evaluation of Surgical Procedures to Restore Accommodation	p. 107
References	p. 108
Corneal Approaches to the Treatment of Presbyopia
Introduction	p. 111
Monovision Approach to Presbyopia Correction	p. 111
Introduction	p. 111
Patient Selection	p. 112
Monovision LASIK	p. 112
Monovision Photorefractive Keratectomy	p. 112
Multi-focal Presbyopic LASIK	p. 114
Introduction	p. 114
Outcome	p. 114
Intracorneal Inlays	p. 115
Acufocus ACI 7000 Corneal Inlay	p. 115
Intracorneal Hydrogel Lenses	p. 116
Conductive Keratoplasty	p. 116
Introduction	p. 116
Outcome	p. 117
Conclusion	p. 118
References	p. 118
Index	p. 119
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