2008-2009 Basic and Clinical Science Course: Section 13: by Christopher J. Rapuano, MD

By Christopher J. Rapuano, MD

This part underwent significant revision for the 2008-2009 edition.Reviews the underlying thoughts in refractive surgical procedure, together with its clinical foundation, the position of the FDA, and sufferer review. particular strategies are mentioned intimately, and using refractive surgical procedure to regard presbyopia is tested. a brand new bankruptcy discusses overseas views.

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Extra resources for 2008-2009 Basic and Clinical Science Course: Section 13: Refractive Surgery

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Haze formation does not seem to occur in the central flap interface following LASIK, which may be related either to lack of significant epithelial injury and consequent subcellular signaling or to maintenance of some intact surface neurons. LASIK shows very little long-term evidence of healing between the disrupted lamellae and only typical stromal healing at the peripheral wound. The lamellae are initially held in position by negative stromal pressure generated by the endothelial cells aided by an intact epithelial surface.

This information is useful in refractive surgery, both in aiding the calculation of custom ablations to enhance vision or correct optical problems and in explaining patients' visual symptoms. Wavefront Analysis and Irregular Astigmatism As discussed, irregular astigmatism is usually caused by irregularities of corneal shape resulting from such factors as keratoconus, refractive surgery, PKP, and scars following traumatic injury. Visually significant irregular astigmatism is a relatively uncommon problem typically associated with corneal grafts or scars and requiring a gas-permeable contact lens for visual rehabilitation.

The remaining keratocytes respond by generating new glycosaminoglycans and collagen, to a degree dependent on the duration of the epithelial defect and the depth of the stromal injury. Corneal haze is localized in the subepithelial anterior stroma and may last for several years after 28 . Refractive Surgery surface ablation. Clinically significant haze, however, is present only in a small percentage of eyes. The tendency toward haze formation is greater with deeper ablations, surface irregularity, and prolonged absence of the epithelium.

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