Uday Devgan MD Private Practice, Devgan Eye Surgery, Los Angeles
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1 Irregular Astigmatism & honing your K incision Uday Devgan MD Private Practice, Devgan Eye Surgery, Los Angeles
2 Uday Devgan MD Current Disclosures: Aaren Scientific: consultant Accutome Inc: royalties Alcon Laboratories: consultant Bausch + Lomb: consultant Gerson Lehman Group: consultant LensGen: consultant, stockholder Omeros: consultant Optimedica: consultant Slack / OSN: speaker Specialty Surgical: stockholder Former Relationships: AMO / Abbott: consultant, speaker Allergan: consultant, speaker Eyeonics: consultant, stockholder Haag-Streit: speaker Hoya Surgical Optics: consultant Ista Pharma: consultant itherapeutix: trial, travel support Optos: speaker Staar Surgical: consultant,speaker Zeiss / Carl Zeiss: speaker My presentation may include OFF-LABEL use of devices and/or medications. This talk represents my personal opinion as a surgeon.
3 Even 1D of Astigmatism degrades image quality
4 Irregular Astigmatism Can I fix it during cataract surgery?
5 Fix the irreg. astig. BEFORE cataract surgery
6 Remove Pterygium months BEFORE Cataract Surgery
7 9 Diopters of Induced Irregular Astigmatism from the Pterygium!
8 EBMD / Map-Dot-Fingerprint Scrape Epithelium and wait! Scrape Epithelium Wait for K to stabilize (months) Now plan Cataract Surgery
9 Epithelial Ingrowth after LASIK poor vision: 90% ingrowth + 10% cataract Lift LASIK flap + remove cells Suture flap and wait and wait
10 Dry Eye Syndrome Punctate Keratitis causes irregular topography!
11 Address irreg. astig. AFTER cataract surgery
12 Do NOT touch the cornea during phaco Consider scleral tunnel phaco incision Keratoconus with dense cataract Address KC with RGP CL, CXL. or Surgery later
13 Traumatic Corneal Injury + Cataract Fix the cataract first, address corneal issues later Consider scleral tunnel phaco incision Seidel check the cornea after phaco
14 Old Corneal Scar cataract surgery alone may be enough
15 Highly Irregular (K 72 x 42)
16 You re not going to be able to fix this RGP contact lenses may be helpful 32 cut RK too irregular, too unstable
17 You re not going to be able to fix this RGP contact lenses may be helpful 32 cut RK too irregular, too unstable
18 Decentered LASIK ablation Now with PSC cataract No way to fix this with an IOL
19 Do NOT attempt to fix astigmatism if it s: Very Irregular Centrally Asymmetric Unstable Pellucid Marginal Degeneration
20 Sometimes the best surgery is no surgery at all.
21 Fix the irreg. astig. AT TIME OF cataract surgery
22 Regular, Symmetric Astigmatism is easily treated during cataract surgery Symmetric Regular Stable
23 LRI to treat regular, symmetric astig.
24 Toric IOL for regular, symmetric astig.
25 Look at the central cornea
26 If the central cornea is relatively symmetric, then a toric IOL can be reasonable
27 Look at Central K on topo Some K irregularity But regular within pupil zone
28 Central K: regular Peripheral K: irregular Prior CK
29 Case Example 1 FFKC Forme Fruste Keratoconus
30 Referring Doc s Mom / FFKC Hx of monovision in soft toric contact lenses (was doing goal of plano OD and OS) x x090 20/60 BCVA 20/70 BCVA (20/20 BCVA 10 yr old records 20/25- BCVA)
31 1.5 D K cyl OU / some irreg OS Screening test shows inferior steepening OS
32 OD looks good => use Toric IOL 1.5 D of WTR K cyl OD Regular, symmetric
33 OS has inferior steepening but is reasonable in pupil zone 1.5 D of WTR cyl OS Inferior Steepening OS
34 Asymmetric K Astigmatism / FFKC K x 90 / OD (clean mires) K x 100 / OS (slight inferior distortion of mires) Keep same monovision arrangement Use Toric IOLs to address astigmatism
35 Asymmetric K Astigmatism / FFKC OD: Rx of plano achieved = 20/20- sc x090 = 20/20 OS: Rx of achieved = J1 sc x100 = 20/25
36 Case Example 2 Prior RK 8-cut radial keratotomy
37 Prior 8-cut RK, now cataracts
38 Prior 8-cut RK, now cataracts
39
40 Prior 8-cut RK, look at topo Look at central K on topo
41 Reasonable Symmetry in Pupil Zone
42 Reasonable Symmetry in Pupil Zone
43 Toric IOL Calcs
44 Phaco incision between RK cuts
45 POD 1: looks great
46 After 1 week 20/25 UCVA
47 After 1 month MRx sph
48 If you remember just ONE thing
49 Look at the K topo in the pupil zone If treatable pre-op condition, address it first If K is highly irregular or unstable, don t touch it If central K zone is ok, toric IOL is reasonable
50 Thank you
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You will start medications 4 hours after your procedure.
Dear Valued Patient, Dr. Roberts and staff welcome you to Shady Grove Ophthalmology. We appreciate your selection of our office for your refractive procedure. We have prepared this packet to help you make
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