Glomerular Filtration rate and its determinants.pptx
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Rio 2016 management of cataract in ectatic cornea - Dr.Ahmed Almasry
1. No Financial interest
Ahmed El-Massry M.D.
Professor of Ophthalmology
Alexandria University
Egypt
Surgical
Management of Cataract in Ectatic Cornea
ESOIRS 2016
7. In young patients : Till 35 years of age:
• With Mild treated Keratoconus and stable K readings:
1- Pentacam is mandatory.
2- Optical and Ultrasonic Biometry are essential
3- Third generation Formulae for IOL calculation:
- Haigis L
- Shammas
-Holladay 2
4- All results should be within two diopters of Haigis L
formula
8. Young patient with Cataract, Mild
Unstable KC
• Stability is a must
- Signs of Progression of KC:
1. Thinning of the cornea
more than ten microns per year.
2. Increase of the curvature
of the cornea more than one diopter per year.
3 . Increase the difference
between the superior and inferior meridia more
than one and half Diopters.
9. How to stabilize the irregular cornea
before cataract surgery
• Young patient before 30 years of age with
unstable cornea :
1- Stabilize the cornea by Corneal
Collagen Cross linking (CXL).
2- Pin hole test is essential :
If the vision improves: do CXL , CXL & ICRS –
• Wait three months and do cataract surgery
10.
11. Middle aged cataract patient with
Stable Mild, Moderate KC
1- Pentacam is mandatory
2- Optical Biometry is reliable
3- Compare K readings in pentacam and Lenstar
or IOL Master.
4- Third generation Formulae like Haigis L .
5- Toric IOLs don’t have good results in irregular
Cornea.
12. Middle aged Cataract patient
“ 40-55years” with KC
• If the Ks are 52.00D- 55.00D :
Cornea l irregularity should be treated first:
-ICRS and wait for three months then :
- Pentacam
-Optical Biometry:
Haigis L Masket Shammas
13. Middle aged Cataract patient with
advanced KC
• Triple procedure:
DALK, Phaco and IOL
• Hydrops:
PKP and Catarcat extraction and IOL
14. Old age above 60 years and KC:
• Mild Keratoconus ; Kc1, with steep cornea mostly
Stable depend on the readings of Pentacam
• Moderate with Kc2, Kc3 : Make the surgery on
steps:
first : remove the cataract then assess the need
of the IOL especially when the powers of IOLs are
out of range…(-17.00 D , - 15.00 D IOL)
15. Old age with advanced KC
• Signs of advancement:
- Pachymetry less than 400 microns in the
center .
- K-max more than 60 D
- Endothelial folds
- History of Hydrops.
- Opaque apex.
• Standard PKP and Cataract and IOL
21. Post RK, lasik and cross in the same case
• Biometry problems.
• Surgical difficulties as the cornea is not so stiff.
• Opened RK incisions.
• Wait long time after surgery for visual rehabilitation.
23. Post PKP
• Wait one year after PKP.
• Full explanation of rejection chance.
• Soft shell technique for endothelial protection.
• Small air bubble indicator for endothelial coating.
Day 1 postop
25. Take Home Message
• Complete explanation to the patient.
• All preoperative investigations
(Pentacam, Manual Ks , specular
microscopy,……..)
• All plans and tools to protect the cornea.
• Correlate the age with the stability and stage
• Enough time for the compromised cornea to
heal.