By Christopher J. Rapuano MD
This up to date quantity covers a couple of issues, from the technology of refractive surgical procedure to accommodative and nonaccommodative therapy of presbyopia, from sufferer review to overseas views. It examines particular tactics in refractive surgical procedure, in addition to refractive surgical procedure in ocular and systemic illness. significant revision 2011-2012.
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Extra resources for 2011-2012 Basic and Clinical Science Course, Section 13: Refractive Surgery (Basic & Clinical Science Course)
Multizone keratectomies. A , Depth of ablation required to correct 12 0 of myopia in a single pass . B, Figure demonstrates how use of multiple zones reduces the ablation depth required . (Illus tration by Cyndie C. H. ) Figure 1-20 CHAPTER 1: The Science of Refractive Surgery. 25 and requi re a small number of pulses to ablate the cornea. Scanning-slit lasers use excimer technology to generate a narrower slit beam that is scanned over the surface of the tissue to alter the photoablation profile, thus improving the smoothness of the ablated cornea and allowing for larger-diameter ablation zones.
The correction of higher-order aberrations requires non-radially symmetric patterns of ablation (which are often much smaller in magnitude than ablations needed to correct defocus and astigmatism ). The difference between the desired and the actual wavefront is used to generate a 3-dimensional map of the plan ned ablation. Accurate registration is required to ensure that the ab lation treatment actually delivered to the cornea matches the intended pattern. Such registration is achieved by us ing marks at the limbus prior to obtaining the \vavefront patterns or by iris registration, which matches reference points in the natural iris pattern to compensate for cyclotorsion and pupil centroid shift.
The use of corticosteroids and some diseases, such as diabetes, increase the risk of cataract development, which could compromise the long-term postoperative visual outcome. Certain medications- for example, isotretinoin (eg, Sotret, Claravis) and amiodarone (eg, Cordarone, Pacerone)-have been traditionally thought to increase the risk of poor results with photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) due to a potentially increased risk of poor corneal healing; however, there is no evidence for this in the peer-reviewed literature.
2011-2012 Basic and Clinical Science Course, Section 13: Refractive Surgery (Basic & Clinical Science Course) by Christopher J. Rapuano MD