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 Post subject: Retreatments
PostPosted: Sat Jul 29, 2006 2:04 pm 
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Review of Ophthalmology

How to Manage Custom Enhancements

Performing custom enhancements on refractive patients involves more than just entering the data and ablating, say experts.

Walter Bethke, Managing Editor

Excerpt:

?A surgeon from out-of-state called me about a patient who had 2 D of myopia left after his primary surgery, so the surgeon decided to just go back and do a custom retreatment,? Dr. Krueger says. ?The results were bad. When I asked him to check the ablation printout for how deep the ablation was, it read 100 ?m. The surgeon happened to do a surface ablation, thinking he might conserve some tissue, but the 100-?m ablation made the patient +5?a huge overcorrection.?

Read the entire article at:
http://www.revophth.com/index.asp?page=1_973.htm

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PostPosted: Sat Sep 29, 2007 7:46 pm 
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http://www.aao.org/aao/publications/eye ... eature.cfm

Quote:
One More Surprise

Ronald R. Krueger, MD, medical director of refractive surgery at the Cleveland Clinic, raised another refractive surprise that particularly concerns him: custom re-treatment of a symptomatic aberrated eye. This is for patients who have undergone a previous conventional treatment and are looking for a ?custom upgrade,? not to be confused with an enhancement. For example, consider a patient who has surgery for a ?10 D with a conventional treatment. He achieves 20/20, but the quality of the vision appears more like 20/30 because of the resultant aberrations. This can occur simply because making the cornea flatter in the center in a high myope can create spherical aberration. Also, with traditional techniques, inadequate tracking and registration can lead to subclinical decentration and ablation nonuniformity, inducing coma and other higher-order aberrations.

Having a bad eye day?

This patient seeks a custom re-treatment to improve his vision. Yet instead of achieving a good end result after the custom re-treatment either with PRK or under the flap, he is in even worse shape with a +2 D or even up to a +5 D overcorrection. ?The problem is that the patient?s eye has so many aberrations that the depth of tissue removal to correct all these far exceeds what would be expected for the small residual refractive error. As a result, the surgeon gets a refractive surprise, and ends up overcorrecting the patient,? Dr. Krueger said. He attributes this to the fact that when wavefront-driven custom ablation officially made its FDA-approved debut on October 25, 2002, it was approved for primary treatment. When custom ablation is used for re-treatment, it can behave differently due to the excessively high aberrations and thinner cornea, which can result in massive overcorrections. The surgeon needs to compensate for this.

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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