Treating Patients with Radial Kewratotomy.pptx

People who have had radial keratotomy in the past notice that they may have to get back to wearing glasses. Routine techniques do not work in such patients in this presentation which was initially delivered to eye surgeons from across the world we discuss options with focus on presbyopic implants to restore better vision without glasses.

1. Presbyopic Implants in Post-Radial-Keratotomy Eyes Rajesh Khanna , MD Voluntary Clinical Instructor UCLA Director, Khanna Vision Institute Chinar Singh, BS

2. Financial Disclosure No author has a financial or proprietary interest in the material or methods mentioned.

3. What was known ● Post Radial Keratotomy (RK ) eyes, require extra calculations to determine the power of Intraocular lens.. ● Presbyopic Implants may be desirable in select patients wanting freedom from visual aids . ● No Published report on Presbyopic Implants in Post radial keratotomy eyes

4. Enhancing Lifestyle We have to understand unique demands 1 Glasses 2 RK Freedom 3 Bifocals

5. Zones of Vision Near Middle Far

6. Design & Methods Retrospective, non randomized, non comparative Study 21 eyes of 11 patients Post RK and had Presbyopic Implants – Crystalens , Restor . Followed up for at least six months

7. Restor Multifocal Implant

8. Crystalens Accomodative Implant

9. Post op regimen Antibiotics for a week S teroidal and N on - steroidal antiinflammatory (NSAID) drops tapered over 6 weeks. Postoperative examinations were done at 1 day, 1 week, 1 month, 2 months, 3 months and 6 months. At postoperative visits, UDVA , CDVA, Manifest refraction, Corneal topography and K eratometry readings were recorded. An independent observer collected the data.

10. Attempted Vs Achieved

11. Stability of Spherical Equivalent

12. Predictibility

13. Vision Improvement

14. Safety of Procedure

15. Change in CDVA

16. Refractive Astigmatism

17. Results Significatnt improvement in UCDVA P<0.02 All eyes 20/30 or better Spherical equivalent - 66% within +/- 1.5 D Within one standard Deviation Refractive Astigmatism within 0.5 D 35 % 1.0 D 65 %

18. ● WHAT THIS PAPER ADDS: ●   Presbyopic Implants can be implanted safely in post RK patients. Diurnal fluctuations are acceptable to patients. ●   Presbyopic Implants may be an alternative to Lasik in post RK patients above fifty.

19. Improving Predictibility Intraoperative Autorefraction or aberrometry Better prediction of Effective Lens Position Toric Presbyopic Implants Stabilize fluctuations

20. Caution Patient needs to be highly motivated Warn about fluctuations – Diurnal and Longterm May need glasses for driving May have glare

21. Conclusion Presbyopic Implants after Radial Keratotomy Safe and effective Can improve lifestyle