Current Concepts in Refractive Surgery: Comprehensive Guide for Decision Making & Surgical Techniques Jeewan S Titiyal, Manpreet Kaur, Sridevi Nair
INDEX
ABCDEFGHIJKLMNOPQRSTUVWXZ
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer table.
A
Aberration 42
analysis 47
chromatic 42
flap-induced 116
free eye 44
higher-order 42
lower-order 42, 43f, 114
postoperative 224
reveal 44
Aberrometers 42
classification of 46fc
sequential ray-tracing 46
Aberrometry
and wavefront analysis 42
device, expensive 113
ray-tracing 47f, 47t, 48f, 190f
Ablation
algorithm 74
decentered 81
deeper 71
depth of 74
ray tracing-based 119
topography guided 118t
wavefront-guided 113f, 114, 115
wavefront-optimized 111
Abrasions, peripheral small 141
Abrupt corneal curvature changes 31
Acanthamoeba 102
ACD See Anterior chamber depth
Acquired immunodeficiency syndrome 58
Age-related macular degeneration 33
Allergic keratoconjunctivitis 61
Amblyopia 58
Ambrósio relational thickness 31
maximum 61
Ambrósio-enhanced ectasia display 26
Ametropia 225
AMG See Amniotic membrane graft
Aminoglycosides 56
Amniotic membrane graft 107
AMO VISX hyperopia 196
Anisometropic amblyopia 221, 222
Anterior chamber
air bubbles 97
depth 64, 155–157
Anterior chamber gas bubbles 97
prevention 98
risk factors 97
treatment 98
Anterior corneal
curvature 18
keratotomy incisions 3
stroma 213
surface 229
Antiglaucoma medications 104
Anti-inflammatory therapy 107
Aphakia 200
Arc length 237
Arcuate keratotomy 237t
ArF excimer laser 90
Argon fluoride 4, 90
laser 90
ARS See Adjustable refractive surgery
Artificial intelligence, role of 40
Artiflex toric 153
Artisan iris claw lens 4
Artisan toric 153
ART-MAX See Ambrosio relational thickness maximum
Aspheric ablation profile 111
Aspheric shape 111
Astigmatic correction, magnitude of 237
Astigmatic keratotomy 236, 237
incisions 236
indications 237
principle 236
surgical technique 237
Astigmatism 4, 75, 84
low-to-moderate 238t
post-operative 225
SMILE for 132
surgically-induced 168
Asymmetrical technique 197
Athens protocol 217
Azar flap technique 73
Azar technique 73
B
Bacterial endotoxins 146
BAD-D See Belin ambrosio enhanced ectasia display deviation value
Bandage contact lens 78, 79, 94, 99, 101, 232
Barraquer’s technique 4
Basal epithelial cells, elongation of 12
Bausch and Lomb keratometer 18, 19
BCL See Bandage contact lens
BCVA See Best-corrected visual acuity
Beam profile 91
Beam’s homogeneity 75
Belin-Ambrósio deviation index 31, 213
Belin-Ambrósio enhanced ectasia 29f, 35, 61
display 28t, 31t
Best spectacle corrected visual acuity 61, 118, 173, 175, 210
Best-corrected visual acuity 142, 198, 209
Best-fit sphere 23, 23f, 25
concept of 23, 26
enhanced 29f
BFS See Best-fit sphere
Bi-aspheric multifocal corneal surface 196
Bioptics 65, 207, 207t
classification of surgical techniques of 207
differed 208, 209
reverse 209
surgical approaches in 210t
surgical techniques of 208t
Black spots 136, 137f
clinical significance 137
incidence 136
mechanism 136
predisposing factors 137
prevention 137
Blepharitis 61
Bowman’s layer 188
Brillouin frequency 40
Brillouin microscopy 40
Bruch’s membrane 56
BSCVA See Best spectacle corrected visual acuity
C
Camellin technique 73
Cap and side-cut tears 140
incidence 140
management 140
predisposing factors 140
prevention 140
Cap cut 130
Cap diameter 128
Cap edema 138
Cap lenticular adhesion 139f
Cap microstriae 142, 143
incidence 143
management 143
pathophysiology 143
predisposing factors 143
Cap parameters 128
Cap side-cut 128, 130
Cap tear 140f
Cap thickness 128
Cap-lenticular adhesions 126, 139
Capsular bag 190
Carriazo pendular microkeratome 85
Cataract 65, 163, 164f, 222, 224
development of 164
incidence 163
management 164
morphology 164
pathophysiology 164
predisposing factors 164
secondary 162
surgery 46, 238
Causative organisms 100
CBI See Corvis biomechanical index
CDVA See Corrected distance visual acuity
Center keratoconus index 26
Central cornea 4
thickness 34, 158, 207
Central islands 82
Central keratometry 23
Central myopic refraction 119
Central presbyLASIK 195
Central toxic keratopathy 100, 104, 105t
clinical diagnosis 104
Chemical de-epithelialization 72
Chilled balanced salt solution 78
Choroidal neovascular
complex 56
membrane 54–56
Chronic uveitis and inflammation 163, 166
CHRPE See Congenital hypertrophy of retinal pigment epithelium
Chung’s swing technique 131
Ciliary body 192
Ciliary muscle, electrostimulation of 199
Ciliary sclerotomy, anterior 192
Circle technique 182
CL See Contact lens
Collagen
cross-linking 142
fibers 79, 229
lamellae 11
peripheral 187
vascular disorders 235
Confocal microscopy 13, 79, 101
Conic intrastromal relaxing incisions 209
Conjunctival chemosis 95
Conjunctival goblet cells 106
Connective tissue disorder 58, 59
Contact glass 129
Contact lens 101, 119, 129, 187
history of 58, 143
Continuous curvilinear lenticulerrhexis 132
technique 131
Cornea 11, 22, 23, 26, 46, 48f, 62, 85, 95, 119, 192, 218, 219
anatomy of 11, 12f
locations of 111
movement of 33
normal 29f, 119, 229
Scheimpflug imaging of 24
Corneal ablation 91f, 111, 112fc, 117, 187, 189, 226
complications of flap-based 94
conventional 194
customized 111, 120
excimer laser platforms for 91t
flap-based 71
minimal 196
platforms 114t
procedures 69
Corneal ablative procedures, retreatment after 175fc
Corneal and intraocular procedures 209
Corneal applanation 55
Corneal astigmatism, irregular 118
Corneal backscattered light 38
Corneal biomechanical
assessment 33, 34f, 62
parameter 31
properties 33, 40
response 111
strength 92
Corneal biomechanics 33, 62, 92, 126
Corneal biopsy 101
Corneal carving 4
Corneal collagen 103
cross-linking 65, 101, 210, 211, 213, 217, 217t, 218, 219
plus 217
Xtra 213
efficacy of 108
Corneal curvature, actual 23
Corneal decompensation 163, 166
Corneal deformation 35
stages of 35
Corneal densitometry 38
Corneal diagnostics, advancements in 3, 4
Corneal ectasia 33, 108, 219
management of 230
postoperative 221
Corneal ectatic disorders 61, 219
Corneal endothelial cell density 61
Corneal endothelium 162
Corneal epithelial
cells 11
defect 99
Corneal epithelium 11
Corneal flaps 84
create 84, 86t
Corneal flattening 229
concept of 3
Corneal haze 76, 78–80, 144
persistent 80
Corneal hysteresis 34
Corneal incision 3, 158
Corneal infiltrates 82
Corneal inlays 188, 200, 200t, 203
advantage of 203
history of 200
Corneal irregularity measure 20
Corneal laser
ablation 174t
retreatment after 173
based procedures 225
refractive surgery 67f
treatment 5
Corneal light reflex 129
Corneal necrosis 200
Corneal nerve
fiber, sub-basal 14f
regeneration 13
Corneal onlays 204
Corneal pachymetry 62, 71
Corneal power, redistribution of 235
Corneal refractive
procedures 203
surgeries 214t, 222
Corneal relaxing incisions 236
Corneal reshaping inlays 200
Corneal resistance factor 34, 216
Corneal rigidity 33
Corneal scrapings 101
Corneal sphere 50
Corneal stability 35
Corneal stroma 34
Corneal suction 55
Corneal surface 85
anterior and posterior 18
application, intraoperative 75f
Corneal thickness 31, 156, 218
increased 229
spatial profile 29, 30f
Corneal tissue 195
Corneal topography 18, 62, 108f, 119, 120, 193, 231f
accurate 18
Corneal transparency 15
Corneal vertex centration 145
Corneal visualization scheimpflug technology 34, 38
Corneal wavefront, fourier analysis of 50t
Corneal wound 13, 14
healing 11, 12fc, 13–15, 222
clinical relevance of 15
comparative evaluation of 15t
elements of 12f
Corrected distance visual acuity 107, 174, 195, 202
Corticosteroids, prolonged topical 164
Corvis biomechanical index 61, 108, 213
laser vision correction 174
CORVIS-ST See Corneal visualization scheimpflug technology
Crystalline lens 4, 156, 158, 168
exchange, bioptics with 211
CT See Corneal thickness
CTD See Connective tissue disorder
Curvature map
anterior 25
axial 18
Custom Q
ablations 119
treatments 119, 198
Customized corneal ablation, types of 111, 112t
CXL See Corneal collagen cross-linking
Cystic retinal tufts 53
Cystoid macular edema 55
Cytokine 16
D
DALK See Deep anterior lamellar keratoplasty
Decentered treatment 142, 145
incidence 145
management 145
predisposing factors 145
prevention 145
DED See Dry eye disease
Descemet’s membrane 188
Deviation index 28
Diabetes mellitus 59, 99, 144
Diffuse lamellar keratitis 12, 16, 65, 78, 89, 90, 98, 100, 101, 103, 103f, 105t, 107, 142, 146, 177
clinical diagnosis 103
development of 146
incidence 146
management 146
pathophysiology 146
predisposing factors 146
prevention 146
risk factors 103
treatment 104
Dilated fundus examination 52, 174
Distance vision 119, 196, 197, 202
Distance visual acuity 146, 159, 192, 222
Distortions 167
DLK See Diffuse lamellar keratitis
DM See Diabetes mellitus
Docking 129
Docosahexaenoic acid 16
Dry eye 67, 78, 101, 142
assessment 60
disease 5, 61, 101, 106
pre-existing 61
mild 143
postoperative 5, 16, 82, 135, 143
severe 143
symptoms 16
transient 132
Dynamic corneal response 38t
Dysfunctional lens syndrome 193, 193fc
Dysphotic symptoms 81, 145
E
EBM See Epithelial basement membrane
EBMD See Epithelial basement membrane dystrophy
ECC See Endothelial cell count
ECM See Extracellular matrix
Ectasia 67, 68, 82, 101, 142, 146
incidence 146
management 146
pathophysiology 146
postoperative 5, 33, 58
postsurgical 58
preclinical 62
predisposing factors 146
red indicates 29
subclinical 35
Ectatic cornea 26
Ectatic disorders, family history of 58
Ectatic eye 40
EDOF See Extended depth of focus
Elastography 40
Elevation maps, anterior and posterior 25
Emerging technologies 40
Endophthalmitis 162, 168
etiology 168
incidence 168
management 168
Endothelial cell 151, 222
count 61, 64, 156, 157
loss 65, 163, 166, 167, 211
Endothelial corneal dystrophies 58
Endothelial decompensation 156
Endothelial perforation 233
Enhanced Athens protocol 217
Epipolis-laser in situ keratomileusis 74, 80
Epiretinal membrane formation 54
Epithelial
cells 13, 144
changes 11
debridement 81
drag 238
hyperplasia 14, 216
injury 13
removal, technique of 72, 72t, 78
Epithelial basement membrane 11, 12, 12f, 15
dystrophy 59, 61, 63, 99
regeneration 13
Epithelial defect 141
healing of 15
incidence 141
intraoperative 99
prevention 100
risk factors 99
treatment 100
large central 141
management 141
predisposing factors 141
Epithelial flap 81
related complications 81
Epithelial healing 15
delayed 79, 81
Epithelial ingrowth 87, 101, 105, 142, 144, 144f
clinical diagnosis 106
incidence 144
management 144
pathophysiology 144
predisposing factors 144
risk factors 106
risk of 97
treatment 106
Epithelial thickness 223
mapping 175
Epitheliotoxic medication predispose 99
Epithelium
peripheral 13
removal, method of 75
Erbium-doped yttrium aluminum garnet 192
Ergonomics 91
Excimer ablation time 224
Excimer laser 90
ablation 74, 90, 187, 193, 219
calibration 74
function 222
monovision 195f
platforms 92
evolution of 91f
procedures 194fc
technology 90
evolution of 90
treatment 213
Extended depth of focus 63f, 64
Extracellular matrix 12, 12f, 15
Extreme ametropia 207
Eye 132, 161
bleed in 99
blurred 197
both 197
deep-set 95
displacements of 92
dominant 196, 197
nondominant 196
optical aberrations of 115
refractive power 18
rubbing 102
symptom 106
tracker 92, 115
conventional 92
response time 91
speed 91
tracking, passive 74
F
Facial deformities 221
FECD See Fuchs’ endothelial corneal dystrophy
Femtosecond 90
flaps 87
Femtosecond laser 84, 85, 89, 94
application 129
created flaps 89
delivery 98f
flap 89, 96t
lentotomy 191
role of 191
platform 85, 86t
settings and technique 87
systems 87
technology 4
Femtosecond laser-assisted
astigmatic keratotomy 238t
nomogram 238t
cataract surgery 163f, 165f, 239
corneal
ablative 6
flaps 89t
flap 55
creation 85, 88f
in situ keratomileusis 35, 65
planar flap 89f
procedures 209
Femtosecond lenticule extraction 4, 125, 139
Femtosecond technique 232
Ferrara ring 230
Fibroblast 15
growth factor 13
Fixation and eye trackers 74
Flap
architecture 87
buttonholes 95
centration of 85
characteristics 89
dislocation 100
incomplete 94
irregular 94
macrostriae 103f
recutting 176
related complications 87, 89, 94
stroma, ablation of 175
Flap striae 100, 102
clinical diagnosis 102
prevention 103
risk factors 102
treatment 103
Flap tears 99
prevention 99
risk factors 99
treatment 99
Flapless refractive surgery 93
Flapless surgery 146
Flaporhexis 176
Flatter periphery 18
Flexivue microlens corneal inlay, design of 202f
Fluoroquinolones 102
Fortified antibiotics 102
Fourier analysis 50
Fourier transform 115
Free cap 95
Fruste keratoconus 107
FS-LASIK See Femtosecond laser-assisted in situ keratomileusis
Fuchs’ endothelial corneal dystrophy 59, 61
G
Galilei dual scheimpflug analyzer 24
GAT See Goldmann applanation tonometry
Giant cell 219
Giant retinal tear 168
Glaucoma 33, 65, 164, 165, 165t, 224
postoperative 166f
secondary 162
steroid-induced 222
Goldmann applanation tonometry 38
Goldmann-correlated intraocular pressure 34
Gonioscopy 60
Good near vision 197
Gram-positive bacteria 102, 146
H
Hartmann-Shack aberrometer 44, 115
Haze 67
clinical evaluation of 79
postoperative 15
Heparan sulfate proteoglycans 11
Herpes simplex virus keratitis 82
Hexagonal keratotomy 236
Higher order aberration 42, 43f, 44t, 50, 62, 89, 111, 112, 128, 174, 175, 223
HOA See Higher order aberration
Hormone replacement therapy 59
HPMC See Hydroxypropyl methylcellulose
Human cornea 33, 111
Human eye, monochromatic aberrations of 42t
Hydroexpression 131
Hydrophilic acrylic
lens 191
optic 152
Hydroxypropyl methylcellulose 217
Hyperopia 4, 5, 75, 80, 84, 116, 153, 155, 221, 225, 237
bioptics for 211
correction of 5, 222
high 155
refractive surgery for 22, 223t
SMILE for 132
Hyperopic corneal ablation 223
principle of 222
profiles 16
Hyperopic correction 223
diopter of 223
Hyperopic shift, mild 202
I
ICL See Implantable collamer lens
ICRS See Intrastromal corneal ring segments
Implantable collamer lens 65, 151, 157, 157t, 158, 161, 165, 209, 211, 222
evolution of 155f
hyperopic visian 155
Implantable phakic contact lens 191
Implants, characteristics of 231
Incisional refractive surgery 235
role of 238
Incisions, intersection of 236
Infectious keratitis 82, 100, 105t, 142, 146
causative agents 146
incidence 146
management 147
Infectious keratoconjunctivitis, postoperative 103
Inflammatory cells 146
Initial intracorneal rings 229
Intentional anisometropia, creation of 195f
Interface epithelial cell 144f
Interface haze 141, 142
incidence 141
management 143
pathophysiology 141
predisposing factors 141
prevention 143
Interface infiltrates, incidence of 146
Interface irrigation 102
Interpreting videokeratograph maps 18
Intracameral gas bubbles 98f
Intracorneal ring segment 229, 231f
characteristics of 230t
evolution of 229f
implantation 218
selection for 230t
Intralamellar stromal keratitis 104
pressure-induced 104
Intraocular lens 4, 47, 63, 63f, 64, 187, 193, 209, 210
accommodative 190
dual-optic 190
hyperopic phakic 224
multifocal 226
premium 46
Intraocular pressure 34, 38, 85, 89, 104, 129, 162, 163, 165t
accuracy of 33
corneal compensated 34
raised 82, 164
Intraocular procedures 161
Intraocular structures 119, 162
damage to 161
Intrastromal corneal lenticule 125
Intrastromal corneal ring 233
segments 142, 209, 210, 229, 230
complications of 233t
Intrastromal femtosecond laser 187
Intrastromal gas 146
Intrastromal refractive 125
Intrastromal small incision lenticule extraction, creation of 129f
Intrastromal tunnels 232
Intravitreal antibiotics 168
Invasive radial keratotomy 236
IOL See Intraocular lens
IOP See Intraocular pressure
Iridectomy, peripheral 157, 164
Iridocorneal angle 162
Iridotomy, peripheral 154, 157, 165
Iris 161, 162
chafing 166f
claw 157, 159
lens 152
registration 97
Irregular astigmatism 81, 145
index 23
Irregular topography 142, 145
incidence 145
management 145
predisposing factors 145
J
Javal and Schiotz keratometer 18, 19
Jeweler’s forceps 73
K
Kamra corneal inlay 200, 201
complications 202
design of 201, 201f
principle 201
technique 201
Keraring 355 230
Keratoconic eyes 35
Keratoconus 21f, 59, 116, 213, 230
bioptics for 211
classification index 23
index 26
mild-to-moderate 119
prediction index 23
progressive 219
severity index 23
subclinical 5
Keratocytes 11
density of 11
Keratometry 18, 128, 223, 224
maximum 217
Keratomileusis, concept of 4
Keratoplasty 217
conductive 187
Keratorefractive
procedures 125
surgeries 11, 12fc, 13, 15, 16, 46, 235, 239
Keratoscopy 18
L
Lamellar keratoplasty 79, 230
deep anterior 101
Lamellar plane, anterior 130
Lamellar separation, posterior 130
Laser blended vision 193
Laser epithelial keratomileusis 76t, 81
Laser flaps, customization of 87
Laser in situ keratomileusis 46
epithelial 76t
Laser keratome 129
Laser presbyopia reversal 192
Laser programming 74
Laser refractive surgery, contraindications for 59t
Laser settings 127
Laser subepithelial keratomileusis 71, 73
Laser vision correction 6, 38, 175
Laser-assisted in situ keratomileusis 3f, 4f, 5, 12, 13, 14f, 15t, 58, 63, 63f, 79, 84, 86t, 92–94, 99f, 100t, 114, 117,151, 136, 146, 173, 176, 176t, 179, 188, 193, 195, 196f, 207, 209, 210, 221, 225, 230, 237
complications with 216
flap 85t
creation 84
relift 177
multifocal 198
myopic 224t
postoperative complications after 100
retreatment after 176
simultaneous 201
surgery 201
thin-flap 180, 181, 181f
wavefront-guided 115
Laser-assisted sub-epithelial keratectomy 175
Laser-blended vision 195, 197, 197f
principle of 197
Laser-in situ keratomileusis 135
Laser-related complications 5
LASIK See Laser-assisted in situ keratomileusis
Latent hyperopia 222
Lattice degeneration 53
LBV See Laser blended vision
Lens 46, 48f, 156
and cornea 207
based procedures 64, 222
decentered 163, 167
dislocated 163, 167
single-piece 151
Lens-based procedures, history of 4
Lenticular accommodation 115
Lenticular astigmatism 117, 118
Lenticular opacities 5
pre-existing 164
Lenticular side-cut dissection 131
Lenticule
cut 129, 130
diameter 128
dissection 130f, 138
and extraction 130
forceful 140
extraction
difficult 138, 139
flap-based 125
procedures 6
intrastromal keratoplasty 6
irrigation 131
minimum thickness of 128
planes
lower 132
upper 132
side-cut 130
Limbal bleed 98
prevention 98
risk factors 98
treatment 98
Limbal centration 115
Limbal region, peripheral 22
Lindstrom nomogram, modified 237t
Lipid layer thickness 62
LK See Lamellar keratoplasty
Local anesthesia 55, 157
Low refractive errors 139
Lower energy femtosecond laser platform 86
Lower-frequency excimer lasers 174
LVC See Laser vision correction
M
Machine and laser settings 126
Macular diseases 54
Macular hemorrhage 54–56
Macular hole 55, 56
Manifest refraction spherical equivalent 114, 179
MCA See Mutual comparative analysis
McDonald technique 73
Mean toric keratometry 22
Medennium phakic lens 154, 157
Meesmann dystrophy 76
Meibomian gland
dysfunction 107
function 62
secretions 146
Meniscus sign 130, 139
Merocel sponges 73
Mesopic pupil size, large 167
MFIOL See Multifocal intraocular lens
Microbial keratitis 100, 222
Microkeratome 84, 85, 87, 89, 89t, 90, 99
and femtosecond laser flaps
complications to 98
creation, comparison of 87
evolution of 84
systems 85t
types of 84
Microkeratome flap 4, 87, 89, 102
complications 94, 94t
prevention of 96
creation 84, 86f
Mid-peripheral laser pulses 119
Minimal dysphotic symptoms 192
Mini-radial keratotomy 236
Mitomycin C 12, 71, 75, 75f, 80, 142, 180, 216
intraoperative 173
MK See Microkeratome
MMC See Mitomycin C 79
Modern-day
keratometers 18, 19t
phacoemulsification 226
Monovision 194, 195
limitations of 194
MPL See Medennium phakic lens
MRSE See Manifest refraction spherical equivalent
Multifocal cornea 188
ablation 196f
Multifocal intraocular lens 63f, 64, 189
implantation 190f
Multifocal laser vision correction 194
Multifocal transition profile 194
Multipass technique 75
Mycobacteria, atypical 102
Myofibroblasts 13, 14
Myopes, anterior chamber of 210
Myopia 5, 56, 80, 84, 152, 153, 157, 159, 197
bioptics for 210
correction of high 154
high 75, 200
low-to-moderate 159
mild 230
moderate-to-high 151
reduction of 155
small 152
treatment of 71
moderate-to-high 159
Myopic correction 80
higher 173
Myopic errors, treatment of 222
Myopic eyes 56
Myopic maculopathies 55
Myopic regression 11
N
Natural ocular growth 221
NCT See Non-contact tonometry
ND:YAG See Neodymium-doped:yttrium aluminum garnet
Near vision 190
Neodymium-doped:yttrium aluminum garnet 101, 106, 144, 157
Nerve regeneration 15
Neuroadaptation, postoperative phase of 68
Nidogens 11
Night vision 81
disturbances 46
symptoms 5
Nocardia 100
Nomograms 237
refinement of 173
Non-contact tonometry 38
Non-pupillary block glaucoma 165
Nonsteroidal anti-inflammatory drug 75, 78, 79
Nonvision-threatening complications 66, 67
NSAID See Nonsteroidal anti-inflammatory drug
O
OBL See Opaque bubble layer
Ocular
adnexal assessment 60
biomechanics 33
biometry 61, 62
comorbidities 58
contraindications 59
dominance 61
history 58, 59
response analyzer 33, 34f, 34t
structures, iatrogenic damage to 162
Ocular aberration 45t, 114, 115
assessment of 111
Ocular surface 60, 81
assessment 61
disease 235
index 132
staining 61
Ocular wavefront 44, 114
analysis 62
technology 111
Opaque bubble layer 87, 90, 96, 98, 98f, 128, 136, 137, 142
clinical outcomes 138
clinical significance 138
incidence 137
management 98, 138
mechanism 137
predisposing factors 138
prevention 98
risk factors 98
Ophthalmic viscosurgical device 157, 165
Optic diameter 153
Optical aberrations 44, 142, 145
incidence 145
management 145
predisposing factors 145
Optical system 42, 198
Optical zone 74, 174, 175, 217
Oral antiviral prophylaxis 58
Oral doxycycline 105
OZ See Optical zone
P
Pachymetry
data 28
evaluation 29
map 24, 25
progression index 31
Pain, postoperative 78
Pannus 99
Panoptix lens transmits 189
Paracentral flattening 82
Parachute centering technology 154
Pellucid marginal degeneration 59
Penetrating keratoplasty 101, 142, 230
Pentacam maps, evaluating 25
Pentacam random forest index 40
Pentacam topometric index 28
Periodic fundus screening 54
Peripheral cornea
exhibits 11
relaxing incisions, nomogram for 238t
vascularization 99
Peripheral retinal
breaks 53t
degeneration 53
types of 53t
lesions, types of treatable 53
screening, preoperative 52fc
tears 53
Persistent focal tissue 99
Phacoemulsification 189
Phakic eye 151
Phakic intraocular lens 54, 58, 65, 151, 157, 159, 159f, 161, 162f, 165f, 165t, 166f, 167f, 217, 221
angle-supported 151, 152f
broken 161
chamber 156, 207
chipped 161
complications of 161
implantation of 65, 157t, 168
iris
claw 153t
fixated 168f
supported 152
surgeries 66f, 163t
complications of 161t
types of 151
Phoric posture 61
Photoablative de-epithelialization 72
Photorefractive keratectomy 3f, 4, 4f, 11, 12f, 15t, 58, 71, 72f, 72t, 75, 75f, 76t, 80, 80f, 81f, 82, 136, 142, 175, 180, 193, 213, 217, 217t, 230, 237
Phototherapeutic keratectomy 218
Pigment dispersion 163, 166
PIOL See Phakic intraocular lens
Piston aberration 43
PKP See Penetrating keratoplasty
Placido-based systems 116
Placido-disk
system 24
topographer 24
Plasma, rapid expansion of 137
PMD See Pellucid marginal degeneration
Polyhydroxyethyl methacrylate 155
Polymethylmethacrylate 151
Polymorphonuclear cells 13
Post-LASIK 53, 105f, 105t, 108f
infectious keratitis 101f
Post-cataract surgery astigmatism 3
Posterior chamber phakic intraocular lens 153, 154t, 158f, 164f, 167f
Posterior corneal
astigmatism 117, 118
incisions 3
Posterior polymorphous corneal dystrophy 59
Post-keratoplasty 225
astigmatism 116
cases 221
refractive
error 225
surgery in 225
Post-LASIK
clinical staging for 106t
corneal ectasia 107
clinical diagnosis 107
prevention 108
risk factors 107
treatment 108
development of 33
dry eye 106
clinical diagnosis 106
pathophysiology 106
prevention 107
risk factors 106
treatment 107
ectasia 108, 116, 217
infectious keratitis 89, 100, 104
causative organisms 100
clinical diagnosis 101
risk factors 101
treatment 101
management of 102t, 104t, 107t
surface ablation 175
Post-phacoemulsification
ametropia 226
refractive surgery 226
Post-phakic IOL endophthalmitis 168
Post-PRK
LASIK 177
patients 173
Post-radial keratotomy 25
Post-refractive surgery 15, 16
ectasia 230
evaluation 35
vitreoretinal complications 54
wound healing 11
Post- SMILE
infections 146
retreatment 180fc
PPCD See Posterior polymorphous corneal dystrophy
Preoperative keratorefractive 71
workup 84
PresbyLASIK, peripheral 195
PresbyMAX software 196
Presbyond laser-blended vision 188, 197, 197f
Presbyopia 154, 185, 187, 193, 193fc, 195f, 219
correction of 188f, 189, 194fc, 197, 198
corneal approach to 194
laser correction of 194
multifocal approach 196
pathophysiology of 191, 192
procedures for 192
refractive surgery for 187
surgical correction of 187t, 191
treatment 91
Presbyopic corneal ablation 6
techniques of 195t
Presbyopic excimer laser ablation techniques 193
Presbyopic laser vision 194
Presbyopic phakic intraocular lens 65, 191, 191f
Presbyopic procedures 68
Present-day excimer laser platforms 90
Present-day femtosecond laser platforms 85
Present-day microkeratome systems 84
PRK See Photorefractive keratectomy
Promote re-epithelialization 81
Prophylactic laser 56
therapy 54
Prophylactic treatment 54
Pseudomonas 102
Pseudophakia, refractive surgery in 226
Pseudophakic monovision 189
Pseudo-small incision lenticule extraction 125
PTA See Percentage tissue altered
PTK See Phototherapeutic keratectomy
Pupil 62, 68
and limbus tracking 91
based centration 115
camera, frontal 24
natural 115
ovalization 151, 162, 163
periphery 119
size 115
Pupillary block glaucoma 165
postoperative 157
Pupillary dilation 140
Push-up and push-down technique 131
Q
Quadrifocal diffractive technology 189
Quantifying irregular astigmatism 50
Q-value represents 25
R
Rabinowitz-McDonnell index, modified 23
Radial corneal incisions 235
Radial keratotomy 3, 107, 230, 235
incisions, mechanism of action of 235f
principle 235
prospective evaluation of 236
surgical technique 235
Rainbow corneal inlay, design of 203f
Raindrop corneal inlay 200, 203
Rapid strides 6
Refraction, planning target 221
Refractive correction 5, 44, 71, 108, 119, 146
amount of 13
range of 154
Refractive display 27f
Refractive error 52, 58, 63, 179, 192
high magnitude of 164
higher 143, 144, 213, 221
low-to-moderate 71
mild-to-moderate 180
range of 224
total correction of 207
type of 15
Refractive index 154
variability 117
Refractive inlays 200, 202
Refractive lens 154
exchange 193, 225
Refractive lenticule extraction 125
Refractive map 20, 22f
Refractive optic inlays 202
design 202
principle 202
Refractive outcomes 92
Refractive power 22f
map 24
Refractive predictability 216
Refractive procedures 68
complications with 65t
lens-based 64fc
Refractive regression 15
Refractive stability, lack of 221
Refractive surgeries 3, 3f, 4f, 5, 6, 33, 34, 40, 46, 50t, 55, 60, 63f, 84, 155, 198, 207, 213, 221
adjustable 209
clinical examination of 60t
clinical history of 59t
complications of 55
cornea-based 55
lens-based 56
contraindications for 54
cornea- and lens-based 55t
corneal based 63fc
current trends in 5
evaluation of 35
evolution of 3
field of 58
pediatric 222
procedures, cornea-based 187
role of 54
screening 35
technique 50, 211
timing of 54
type of 62
Regression, risk of 133
Regular astigmatism 27f
Relifting flap, advantages and limitations of 176t
Relifting LASIK flap 176
Residual ametropia 226
Residual error 66, 67
Residual myopic error 210
Residual refractive error 68, 173, 226
Residual spherical equivalent 209
Residual stromal bed thickness 59, 61, 63, 63f, 64, 128, 142, 173, 175, 176, 180
Retained lenticule 139
clinical outcomes 140
fragments 140f, 145
incidence 139
management 140
predisposing factors 139
prevention 139
Retina 45
Retinal breaks 54
development of 54
Retinal complications 55, 168
Retinal detachment 53, 55, 65, 67
unrepaired 54
Retinal lesions, management of treatable 52
Retinal nerve fiber 55
layer changes 55
Retinal phlebitis 55
Retinal pigment epithelium, congenital hypertrophy of 53
Retinal spot diagram 46
Retinal tear and detachment 55
Retinal vein occlusion 55
Retinal vessels 53
Retroillumination techniques 140
Rhegmatogenous retinal detachment 53, 54, 168
Riboflavin solution 213
Rigid gas permeable contact lens 59, 65
RK See Radial keratotomy
RLE See Refractive lens exchange
Root mean square
error 44
values 47f
RSBT See Residual stromal bed thickness
RSE See Residual spherical equivalent
S
Scanning-slit lasers 75
Scheimpflug camera 24
Schirmer’s test 60, 61
Schlemm’s canal 97
Schwind eye-tech-solutions 84
Scleral expansion surgeries 192
Sclerociliary complex 192
Scotopic conditions 81
SE See Spherical equivalent
Sequential bioptics 208, 209
Shimmer sign 139
Side cut tears 141f
Silicone gel 190
Simultaneous accelerated corneal collagen 214t
Simultaneous bioptics 208, 209
Sinskey-hook-assisted dissection 131
Skewed radial axes 23
Slit illumination 140
Slit-lamp
assessment 61
evaluation 61
examination 60, 102
Slit-scanning
based topography 24
methods 155
Small aperture inlays 200
Small incision lenticule 129
intrastromal keratoplasty 6
Small incision lenticule extraction 3, 3f, 4f, 11, 14, 34, 59, 63, 123, 125, 126, 126f, 128t, 132, 136t, 137f, 138f, 142t, 143f, 144f, 179, 189, 213, 221, 225
circle pattern of 181
complications of 135
contraindications for 126
intraoperative complications in 147
laser parameters of 127t
modified techniques for 131
retreatment after 179, 180t
surgical technique of 131t
techniques for 131t
Small palpebral fissure 95
SMILE See Small incision lenticule extraction
Snail track degeneration 54
Snell’s law 22f
Snellen’s visual acuity 145
Sodium citrate drops 105
Space-occupying corneal inlays 203
design 203
principle 203
Specular microscopy 156
Spherical aberration 44, 111, 112, 196
Spherical equivalent 90, 117, 132, 223
Spherocylindrical correction, amount of 232
Spherocylindrical error 119
Staar foam tip 158
Staphylococcal species 146
Staphylococci 82
Staphylococcus 100, 168
aureus 82
epidermidis 168
Starbursts 46
Steep keratometry 95
Steeper keratometric axis 231
Steeper preoperative keratometry 173
Sterile corneal infiltrates 82
Steroids, discontinuation of 165
Streptococcal species 146
Streptococcus 100, 168
species 82
Streptomyces caespitosus 75
Stroma 132
anterior one-third of 11
changes 13
dystrophies 61
fibrosis 201
healing 15
hypercellularity 15
keratitis 100
keratocytes 11, 13
nerve bundles 14
pocket 6, 87
tissue 4, 5
Stromal ablation, deeper 11
Stromal keratitis, pressure-induced 100, 104f
Stromal placement, depth of 231
Stromal tunnel/pockets, creation of 232
Sub-basal nerve plexus 143
Sub-cap lenticule extraction 182, 182f
Subepithelial nerve fiber 125
Submacular hemorrhage 168
Suboptimal visual gain 144
Suction loss 96, 135
incidence 135
intraoperative 136f
management of 137fc
management 135
pathophysiology 135
predisposing factors 135
prevention 97, 135
risk factors 96, 97
treatment 97
Supracor 196
Surface ablation 71, 175, 177
complications of 78
indications of 71f
procedures 78
techniques 71
with LASIK, comparison of 76
Surface asymmetry index 23
Surface regularity index 23
Surgical technique 129, 226, 231
Synthetic polymethylmethacrylate 229
Systemic disorders 58
Systemic medications 59
T
Tangential map 18
TBI See Tomographic biomechanical index
Tear 238
film 81
osmolarity 61
Terrien’s marginal degeneration 230
Theoretical eye models 111
Therapeutic keratoplasty 102
Thermal keratoplasty 4
Tissue elastic properties 40
TLSS See Transient light sensitivity syndrome
TMR See Topography-modified refraction
Tomographic biomechanical index 61
Topical anesthetics 78
Topical brimonidine tartrate 81
Topical corticosteroids 146
Topical steroids 143, 222
Topography systems 31
Topography systems, elevation-based 23
Topography-guided ablation 5, 116, 117, 117fc, 118, 119
platforms 114
profile 116f
Topography-modified refraction 117
Topometric display 26
Toric intraocular lens 226
Torsional alignment 115
Trabecular meshwork 97
Trabeculectomy 165
Tractional tears, risk factors for 54
Transient light sensitivity syndrome 89
Traumatic choroidal ruptures 54
Trigeminal nerve 11
True corneal ectasia 27f
True optical aberration 42
Tscherning aberrometers 45, 115
U
UCVA See Uncorrected visual acuity
UDVA See Uncorrected distance visual acuity
Unclean contact lens 137
Uncorrected distance visual acuity 216–218, 223
Uncorrected visual acuity 61, 65, 76, 117, 118, 174, 175, 196, 210, 211, 218
Uveitis 33
Uveitis-glaucoma-hyphema syndrome 151, 163
V
VA See Visual acuity
Vannas scissors 73
Vertical asymmetry, index of 26
Vertical gas breakthrough 97
prevention 97
treatment 97
Videokeratograph 18
Vinciguerra
butterfly technique 73
screening report 37f
Virgin eyes 5
treatment of 117
Vision 211
and ocular motility assessment 60
non-improvement of 145
optimal quality of 207
quality of 76, 92
threatening complications 66, 67
Visual acuity 65, 68, 102, 112, 175
and quality 201, 211
Visual disturbances 102
Visual gain 232
Visual outcomes 90, 113
efficacy of 4
Visual quality 76, 111
Visual recovery 92
delayed 67, 135
Visual symptoms 145
Visually disturbing optical phenomena 167
VisuMax femtosecond laser 129
system 128t
components of 127t
VisuMax laser 140, 182f
platform 126f
system 130
Vitamin C 105
Vitreoretinal pathologic conditions 56
Vitreous detachments, posterior 52
W
Wavescan system 115
White ring sign 139
White without pressure 53
Wound healing
fibroblasts 14
severe 15
WWOP See White without pressure
X
Xenon dimer gas 90
Z
Zernike coefficient 45
Zernike polynomials 44, 45f, 45t, 50, 115
descriptions 50
Zonular traction tufts 53
×
Chapter Notes

Save Clear

CURRENT CONCEPTS IN REFRACTIVE SURGERY
CURRENT CONCEPTS IN REFRACTIVE SURGERY: Comprehensive Guide for Decision Making & Surgical Techniques
Editors Jeewan S Titiyal MD Professor and Head Cornea, Cataract and Refractive Surgery Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India Manpreet Kaur MD Assistant Professor Cornea, Cataract and Refractive Surgery Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India Sridevi Nair MD Research Officer Cornea, Cataract and Refractive Surgery Services Dr Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India Foreword Walter Sekundo
Jaypee Brothers Medical Publishers (P) Ltd
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23-B
Ansari Road, Daryaganj
New Delhi 110 002, India
Landline: +91-11-23272143, +91-11-23272703
+91-11-23282021, +91-11-23245672
Email: jaypee@jaypeebrothers.com
Corporate Office
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas Office
JP Medical Ltd.
83, Victoria Street, London
SW1H 0HW (UK)
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
Email: info@jpmedpub.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2022, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
Current Concepts in Refractive Surgery: Comprehensive Guide for Decision Making & Surgical Techniques
First Edition: 2022
9789354652134
Printed at:
My parents, my dear wife Basanti Titiyal
My children, Dr Hemant Titiyal and Dr Renuka Titiyal
Jeewan S Titiyal
My Alma mater and mentors, for being the guiding light
My family, for their unwavering support, love and time
Manpreet Kaur
My teachers, for motivating me to excel
My parents and husband, for believing in my abilities
Sridevi Nair
Our patients, who constantly inspire us to perform better
Jeewan S Titiyal
Manpreet Kaur
Sridevi Nair
Contributors Foreword
The field of refractive surgery has witnessed quantum leaps over the past decades in terms of cutting-edge technologies, novel surgical techniques and more precise visual outcomes. At present, refractive surgeons have a wide armamentarium of refractive surgical procedures at their disposal that may be customized based on the patient profile.
This excellent book provides a comprehensive synopsis of modern-day refractive surgery in an easy to read format along with abundant excellent illustration and photographs. Hence, for trainees this work will provide the theoretical knowledge required for a successful fellowship. For established surgeon it will serve as a useful reference handbook. The book has been divided into sections to enable an easy flow of understanding, with the initial section tracing the evolution of refractive surgery over the years. The preoperative assessment is detailed in the subsequent section with well-written chapters elucidating the finer nuances of corneal topographical assessment, aberrometry and biomechanics. Of note, the chapter on patient selection and decision-making encompasses the most useful aspects of refractive screening and patient counseling, with flowcharts and algorithms to enable selection of appropriate refractive technique in different scenarios.
Each of the present refractive surgical techniques is covered in detail, with techniques, outcomes and management of complications. Surface ablation, laser-assisted in situ keratomileusis and refractive lenticule extraction constitute the cornerstones of corneal refractive procedures and are comprehensively highlighted in this book. Customized ablation may be the future of refractive surgery and the book provides an insight into different algorithms, case selection and outcomes with various ablation profiles. Phakic intraocular lenses are a viable alternative to patients not suitable for corneal-based procedures and are covered in detail in the subsequent section paying attention to pitfalls and complications prevention. Surgical management of presbyopia is still challenging for even experienced refractive surgeons, and the section on presbyopia provides an overview of where we stand today and the way forward to tackling this still-elusive problem. Thereafter, the complex issue of retreatment after corneal procedures is tackled in depth for both corneal ablative procedures and small incision lenticule extraction.
The frontiers of refractive surgeries are ever expanding, and the last section highlights the management of hyperopia, refractive surgery in thin corneas, role in pediatric cases as well as bioptics. The role of collagen cross-linking as an adjunct is discussed with different refractive procedures including ring segments.
As mentioned above, the highlight of this book is the easy readability, with the text interspersed with tables, flowcharts and high-definition photographs to enhance reader experience and understanding. And yet, it includes all the important details of the field. Even for those of us, who read and wrote numerous books and papers, to read this handbook is truly a joy.
I congratulate the authors on their endeavor and believe the readers will be enriched by the experience this book provides.
Walter Sekundo MD PhD
Professor and Chairman
Department of Ophthalmology
Philipps University of Marburg
Marburg, Germany
Preface
Refractive surgery is one of the most dynamic and exciting fields in ophthalmology, with fast-evolving surgical techniques, state-of-the art diagnostics and sophisticated laser platforms and machinery. Present day refractive procedures offer a high index of safety and efficacy, and we have come close to achieving the elusive goal of guaranteeing ‘perfect’ visual outcomes for a majority of patients.
This book is an endeavour to provide a comprehensive insight into the current concepts of various refractive surgical procedures—the techniques, outcomes, complications and their management. The salient points of each chapter are reiterated in the form of easy-to-understand flowcharts and tables, to allow the readers to grasp the significant concepts and protocols at a glance.
Today we have a plethora of refractive procedures to choose from, and selection of the appropriate refractive technique based on the patient characteristics and requirements is a skill in itself. The highlight of this book is an exhaustive section on preoperative assessment and decision-making, which is the cornerstone to optimizing outcomes and patient satisfaction for any refractive practice. Advanced diagnostic modalities to screen for risk of ectasia have enhanced the safety of refractive procedures, and the newer indices and parameters with their clinical applicability are covered in detail.
Each refractive technique is comprehensively addressed in separate sections, with an emphasis on the different laser platforms for corneal procedures, technical specifications and laser parameters and the types of intraocular implants. We are slowly but surely moving forward towards the goal of customized refractive surgery as per individual requirements, and our book highlights various customized ablation patterns as well as the role of integrated aberrometry and corneal biomechanics in optimizing outcomes.
Despite the leaps forward, some refractive frontiers are yet to be conquered including efficacious and predictable techniques for presbyopia. The current status of surgical management of presbyopia is well-elucidated in the book. In addition, the management of various challenging case-scenarios is highlighted, including hyperopia, borderline corneas, pediatric patients and irregular corneas.
The book is intended to serve as a comprehensive guide for all refractive surgeons and will be an invaluable addition to their reading list. We hope the readers enjoy perusing the book and can integrate the practical aspects to enhance their decision-making skills and clinical practice.
Jeewan S Titiyal
Manpreet Kaur
Sridevi Nair
Acknowledgments
We express our sincere gratitude to the entire staff of our Cornea and Refractive Investigative Laboratories, who were of invaluable help in the meticulous maintenance of the clinical records. We gratefully acknowledge the immense efforts of the scientists, optometrists, data entry operators and research staff in ensuring comprehensive evaluation of each and every patient despite a heavy workload. We wish to thank the staff of our refractive operation theater for providing an organized and efficient working environment.
We thank all our colleagues and residents of the Cornea and Refractive Surgery Units for their support. We also wish to thank all our contributors for their valuable efforts.
We acknowledge our patients who are an integral part of this entire venture, for placing their trust in us, and providing us with an opportunity to assist them to the best of our ability.
We sincerely appreciate the entire production team of Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India for their exemplary hard-work, support and commitment towards this project.