By Christopher J. Rapuano MD
This up-to-date quantity covers a few themes, from the technological know-how of refractive surgical procedure to accommodative and nonaccommodative remedy of presbyopia, from sufferer overview to overseas views. It examines particular approaches in refractive surgical procedure, in addition to refractive surgical procedure in ocular and systemic sickness. significant revision 2011-2012.
Read or Download 2011-2012 Basic and Clinical Science Course, Section 13: Refractive Surgery (Basic & Clinical Science Course) PDF
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Extra info for 2011-2012 Basic and Clinical Science Course, Section 13: Refractive Surgery (Basic & Clinical Science Course)
Intraocular lenses (TOLs) (see Chapter 8) . Careful undilated and dilated evaluation of the crystalline lens for clarity is essential, especially in patients older than 50 years. Surgeons should be wary of progressive myopia due to nuclear sclerosis. Patients with mild lens changes that are visually insignificant should be informed of these findings and advised that the changes may become more significant in the future, independent of refractive surgery. They should also be told that [OL power calculations are not as accurate when performed after keratorefractive surgery.
An immunocompromised state-for example from cancer or HIV/ AIDS-may increase the risk of infection after refractive surgery (see Chapter 10). Medications that affect healing or the ability to fight infection, such as systemic corticosteroids or chemotherapeutic agents, should be speCifically noted. 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.
However, it is not clear that pupil size can be used to predict which patients are more likely to have such symptoms. It is possible that the size of the effective optical zone, which is related to the ablation profile and the level of refractive error, is more important in mini mizing visual side effects than the low-light pupil d iameter. Edwards JD. Burka JM, Bower KS, Stutzman RD, Sediq DA , Rabin Je. 15% on night-vision difficulty and contrast testing after refractive surgery. J Cataract Refract Surg.