Abstract book 6th RMS 16.indd

Methods: We report our experience of
5 patients treated with corneal wedge
excisions for high astigmatism after
Penetrating Keratoplasty (PK) Corneal
topographies of the eyes that had
undergone P.K were obtained using
OPD and Pentacam. Maps obtained
were analyzed. Wedge resection was
performed; a thin crescent of cornea from
the area at the graft-recipient interface
was excised measuring between 0.1 and
0.15mm in thickness, the length of incision
centered at the axis of the flatter meridian
of the cornea and was extended over a
range of 60-90 degrees, then the wound
was closed with interrupted 10-0 nylon
sutures. Wedge resection was followed by
fitting speciality Contact lenses to mask
the residual astigmatism
Results: Case studies showed improved
topographic appearance and a reduction of
pre operative astigmatism, the maximum
astigmatism treated was 32.6D,reduced
to 6.64D postoperatively, significant
improvement in both uncorrected and
contact lens best corrected vision was also
noted.
Conclusion: High Astigmatism is an
important complication of penetrating
keratoplasty, corneal wedge resection
treatment proved to be helpful in treating
cases of high astigmatism following
penetrating keratoplasty, and With the use
of contact lenses, the visual outcome can
be significantly improved.
358
Cataract Surgery Master Class
Christopher Liu MD (UK)
Cataract surgery is the most commonly
performed surgery and has a very high
success rate. Whilst cataract surgery is
commonplace to ophthalmic surgeons,
we should be reminded that it is a unique
experience for patients undergoing
surgery. Their expectations of the surgical
experience, the recovery period, and what
visual results can be expected may be highly
influenced by their own imagination, what
the media portray, and what they have
heard from friends and relatives who have
undergone cataract surgery.
This presentation explores how we could
optimise patient experience and outcome.
It also covers common pitfalls which can
create unhappy patients despite perfect
execution of uneventful surgery. In
simple terms, assess what the patient
requires and desires, communicate what
is and is not possible, plan the surgery in
detail beforehand, avoid complications
by knowing and not underestimating
your enemy, undersell and over perform.
Thus we should use a rigorous approach
in assessment, demonstrate we have the
best interests of our patients at heart, and
offer them bespoke surgery following risk
stratification.
Risk stratification is well known to cardiac
surgeons. Essentially, all cataracts are not
the same. For example, there are those
with small pupil, weak zonules, corneal
scarring, dense cataract, post-vitrectomy
and so on. In addition, there may also
be patient factors such as deep set eyes,
bleeding tendency, cough, inability to lie
flat, anxiety, deafness, etc. We all know
which are risky cases, but we are not so
good at estimating how these risks multiply
when they co-exist. Electronic patient
record allows easy analysis of batched
results from multiple hospitals. The series
of articles by Rob Johnston published in
Eye is a good example. Risk stratification
enables allocation of a suitably experienced
surgeon and team for the case. The correct
time can also be allocated, and surgeon
and hospital statistics can be compared
meaningfully.
The next section covers surgical devices
such as iris retraction hooks, capsular
tension rings and prosthetic iris devices to
improve surgical outcome. The indications,
techniques and rational use will be
discussed. We will also discuss methods
of delivery of cataract surgery. The
majority of cases in the United Kingdom
are done as day cases. “Cataract Surgery
by Appointment” is the ultimate day case
surgery, with patients self preparing for
surgery and turning up at the ophthalmic
theatre at a pre-appointed time. They can
be in the hospital for as little as 30 minutes
including surgery before returning home.
The rationale and safety of immediately
sequential bilateral cataract surgery will be
described.
We then illustrate pitfalls with some case
histories demonstrating the importance of
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