By American Academy of Ophthalmology, M. Bowes Hamill MD
Significant revision for 2014-2015!
Covers the technological know-how of refractive surgical procedure, accommodative and nonaccommodative therapy of presbyopia, and sufferer overview. Examines particular techniques in refractive surgical procedure and their power issues, in addition to refractive surgical procedure in ocular and systemic affliction. This year's significant revision good points new pictures and up-to-date details on lens implants utilized in the U.S. and different countries.
Upon finishing touch of part thirteen, readers will be capable to:
Identify the overall sorts of lasers utilized in refractive surgeries
Explain the stairs together with clinical and social background, ocular exam and ancillary trying out in comparing no matter if a sufferer is a suitable candidate for refractive surgery
For incisional keratorefractive surgical procedure, describe the background, sufferer choice, surgical ideas, results, and complications
Explain fresh advancements within the program of wavefront know-how to floor ablation and LASIK
Describe the different sorts of IOLs used for refractive correction
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Extra resources for 2014-2015 Basic and Clinical Science Course (BCSC): Section 13: Refractive Surgery
14 • Refractive Surgery Corneal Biomechanics The cornea consists of collagen fibrils arranged in approximately 200 parallel lamellae that extend from limbus to limbus. The fibrils are oriented at angles to the fibrils in adjacent lamellae. This network of collagen is responsible for the mechanical strength of the cornea. The fibrils are more closely packed in the anterior two-thirds of the cornea and in the axial, or prepupillary, cornea than they are in the peripheral cornea. ) Structural differences between the anterior and posterior stroma affect the biomechanical behavior of the cornea.
Axial Power Figure 1-15 Topographic maps showing small optical zone after excimer laser ablation (A) and decentered ablation (B). /Courtesy of J. ) The Role of Corneal Topography in Refractive Surgery Corneal topography is one of the key evaluative technologies in refractive surgery, crucial not only in preoperative screening but also in postoperative evaluation of patients with unexpected results. Topographic analysis should be undertaken in all patients being considered for refractive surgery in order to identify patients who should not undergo the procedure.
The Munnerlyn formula highlights some of the problems and limitations of laser vision correction. The amount of ablation increases by the square of the optical zone, but the complications of glare, halos, and regression increase when the optical zone decreases. To reduce these adverse effects, the optical zone should be 6 mm or larger. With surface ablation, the laser treatment is applied to the Bowman layer and the anterior stroma, whereas LASIK combines an initial lamellar incision with ablation of the cornea, typically in the stromal bed (see Chapter 5 for further details of surgical technique).