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).
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.
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.