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Ophthalmology Emphasizing Corneal and Refractive Issues

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Lectures

Intraocular Lens Gallery

The development of today's flexible and reliable intraocular lens technology was proceeded by a steady progression of ideas, materials and implantation locations. In the course of practice, each of these specimens was explanted by Dr Buzard (usually due to bullous keratopathy) and saved for research purposes. Here you will find pictures of the original (with metal haptics) and modified Binkhorst iris supported IOL , the Choyce Mark IX and even an original Shearing IOL. As a clinical note, the iris supported lenses displayed here were often removed for iris atrophy and not for corneal edema. This suggests that at least some of these patients had a long and successful result. The anterior chamber lenses displayed here were all guilty of a stiff design and sometimes vaulting which caused bullous keratopathy. The most difficult to remove was the stableflex (note only 3 haptics since one was truncated).

Lecture: Infection and Inflammation in the Refractive Surgery Patient

Proper diagnosis of infection and/or inflammation in the cornea is difficult enough in a normal untouched cornea but becomes even more difficult when corneal refractive surgery alters the anatomy and physiology of the cornea. While the refractive surgeon may think that once healed, the cornea returns to “normal”, the presence of inflammation and/or infection is often modified by pre-existing surgery. Herpes infections will follow pre-existing incisions, infection over a corneal flap (and over clear corneal incisions) will loosen the flap even years later resulting in melting of the flap and even progression of infection along the base of the flap. Infection or marginal ulcers can compromise clear corneal incisions, causing loss of integrity of the globe. Quieting inflammation quickly is imperative and the use of low dose pulse methotrexate is described for “sands of the sahara” syndrome.

There are times when a previous refractive surgery causes problems than cannot be repaired with refractive surgery of any kind. In these cases a cornea transplant is performed, and with a previous RK the torque-anti-torque suture both closes the wound and hold the incisions together.

Case Report: Corneal Transplantation after 32 Incision RK

 

This is a case report on a patient with clear evidence of keratoconus and central corneal pachymetry of almost 600 microns. The keratoconus is seen on orbscan in one eye but even the orbscan shows a thick cornea.

Case report: “Moustache Keratoconus

 

Clear Lens Exchange A discussion of the advantages of lens exchange over LASIK particularly over age 50

Wavefront Analysis A discussion of the measurement and implementation of higher order wavefronts

Scleral Band for Incision Closure By using cautery on the ends of a blue line incision closure is created

Long Term Refractive Stability and Vision An exploration of natural aging and after various refractive surgeries

Photoelasticity of the Human Cornea By viewing the cornea under polarized light new structures are seen

Corneal Dystrophies Corneal dystrophies have been simplified by the introduction of gene science

Changing the Way We See: An Age of Miracles Advances in the ophthalmology in the last 30 years

Principles of Refractive Surgery Sutures and incisions are explored as to impact on refractive error

Cataract Surgery Following Refractive Surgery Techniques to maximize uncorrected vision

Refractive Phacoemulsification Cataract as a refractive procedure

Slit Lamp Astigmatic Surgery Correct astigmatism at the slit lamp

Lectures