tomo 18 g

Sarthak Kothari

Shantilal Shanghvi Cornea Institute,

Cataract & Refractive Services

KAR Campus, LVPEI

uiz

• 25 years old / Male
• Came for LVC opinion

1

UCVA

Sphere

Cylinder

BCVA

Right eye

20/40

-1.0

-1.0 @ 180

20/20

Left eye

20/60p

-1.5

-1.0 @ 170

20/20

• 20 years , female

• h/o PCOD

• Came for refractive surgery opinion for govt. job

2

Cyclo RR

Sphere

Cylinder

BCVA

Right eye

-3.0

-0.50 @20

20/20

Left eye

-3.25

-0.25 @ 150

20/20

PGP

Sphere

Cylinder

BCVA

Right eye

-2.25

0.00

20/25P

Left eye

-2.5

0.00

20/25P

• History :

o Refraction stability
o CL usage, type and last use
o Contact sports
o LVC for job purpose
o Pregnancy / Thyroid /PCOD
o Keloidal tendency
o Family h/o KCN

Key Points

• 21 years old / Female
• Glasses changed 1 year back – not aware of error
• Came for LVC opinion

3

Cyclo

Sphere

Cylinder

BCVA

Right eye

-3.0

-1.5 @ 180

20/20p

Left eye

-3.5

-1.25 @ 175

20/20

PGP

Sphere

Cylinder

BCVA

Right eye

-2.0

-1.0 @ 180

20/30p

Left eye

-2.25

-1.0 @ 180

20/25p

Keloidal Tendency

• Unstable refraction
• Dermal keloidal tendency

Key Points

• 22 years old / Male
• Referred for KC, advised CXL e/w

4

UCVA

Ref Error

BCVA

Right eye

20/250

-0.75 DS -3.0 DC @ 10

20/25

Left eye

20/320

-0.5 DS -4.0 DC @ 165

20/30

• 22 years old /Male
• Referred for KC

5

UCVA

Ref Error

BCVA

Right eye

20/250

0 DS -3.0 DC @ 20

20/20p

Left eye

20/320

0 DS -3.25 DC @ 150

20/20p

• KC vs steep regular cornea
• Steep K and LVC
• Ptosis

Key Points

• 27 years old / Female

• Wanted Laser vision correction

6

Sphere

Cyl

BCVA

Right eye

-6.75

-0.25 @180

20/20P

Left eye

-6.50

-0.5 @ 180

20/20P

• False Positive BAED maps
• WTW

• LVC: K readings, Pachy, Residual, PTA

Key Points

• 24 years , Male

• Glasses – stable since 4 years

• Came for refractive surgery opinion

7

Cyclo /
PMT
Sphere

Cylinder

BCVA

Right eye

-7.0

-3 @ 180

20/30

Left eye

-7.0

-3.25 @ 175

20/30p

PGP

Sphere

Cylinder

BCVA

Right eye

-8.0

-2.0 @ 180

20/30p

Left eye

-8.0

-2.5 @ 175

20/30p

• PRK under-correction vs Phakic IOL

Key Points

Cyclo RR

Sphere

Cylinder

BCVA

CL BCV

Right eye

-20.0

-1.0 @180

20/40p

20/25p

Left eye

-22.0

-0.5 @ 15

20/60p

20/40p

• 29 years , Female

• Soft CL user; last use = 2 days ago

• LE 200 XT

8

• Phakic IOL Criteria
• ICL vs IPCL
• Toric vs non-toric

Key Points

Toric ICL
Smart Toric

IPCL

• Collamer material
• Sizes: 12.1, 12.6 ,13.2, 13.7 mm
• Powers: -3 to -18 DS

+1 to +6 DC
+3 to +10 DS

• Hybrid hydrophilic acrylic
• Sizes: 11.0 to 14.0 (0.25mm steps)
• Powers: -1 to -30 DS

+1 to +10 DC
+1 to +15 DS

Selection Criteria for implanting PIOLs

Age >21 years

Stable refraction

Ametropia not
appropriate for
cornea based

refractive surgery

Anterior chamber

depth (Int.)
>=2.8mm

Minimum

endothelial cell
density > 2200

cells/mm2

Pupil normal
shape and size

Open angles

(angle

width>=300)

No ocular
pathology

• 20 years , Male

• Diagnosed as BE advanced KCN (RE>LE) and advised corneal transplant Sx

• DOV RE>LE

• Came for second opinion regarding keratoconus surgery

9

Sphere

Cylinder

BCVA

Right eye

-

-

CF

Left eye

-5.0

-2.0 @ 180

20/250

• Hypo CXL: AS-OCT minimum pachy > 330um

• Primary visit CXL:

✔ Age <16 years

✔ Borderline pachy, poor vision

✔ One eyed

Key Points

✔ Mental retardation

✔ Other eye hydrops

✔ Unable to follow-up

Eye

Sphere

Cylinder

BCVA

Right eye

-2.0

-3.0 @10

20/100

Left eye

-1.25

0.00

20/20

• 30 years , Female

• RE DOV noticed since 2-3 years

10

• PPCD : U/L, steep K, amblyopia, endothelial pattern

Key Points

Thank You

• 25 years old / Female

• Wanted Laser vision correction

11

Sphere

Cyl

BCVA

Right eye

-3.25

-0.75 @ 5

20/20

Left eye

-3.25

-1.0 @ 170

20/20

• Flat K and LVC

Key Points