Refractive Surgery

Question 1

Different forms of refractive surgery

Answer 1

• laser vision correction
• implantable collateral lens
• refractive lens exchange

Question 2

What to mention when discussing refractive procedures

Answer 2

• visual outcomes
• risks
• regression
• further surgery
• consent

Question 3

Different forms of laser surgery

Answer 3

• LASIK
• LASEK

Question 4

LASIK procedure

Answer 4

1. The cornea is anaesthetised and lid speculum inserted
2. A suction ring is applied to limbus to create an immobile cornea
3. The flap is created by IntraLase laser
4. The flap is lifted to expose the stromal bed, the hinge most often being placed at 12 o’clock
5. The eye tracker is engaged and the excimer laser is applied
6. The flap is washed with balance salt solution, replaced, and the edges are smoothed down

Question 5

Benefits of intralase flap creation

Answer 5

• uniform flap thickness
• laser more accurate

Question 6

LASEK procedure

Answer 6

• cornea is anaesthetised and a lid speculum inserted
• 18% ethanol is applied to cornea in a corneal ring for around 30 seconds to loosen the epithelium
• the edge of the loosened epithelium is lifted with surgical instrument

Question 7

Different types of Implantable collateral lenses

Answer 7

• monovision
• distance
• multi focal
• monofocal

Question 8

Post operative managment for LVC

Answer 8

• rest for 24 hours
• eye shield sleeping for 1 week
• don’t drive until advised by optom
• take pain killers
• clean hands before using eye drops
• do not rub eyes

Question 9

Discharge medications

Answer 9

• Antibiotic -
• antiinflammatory
• lubricant

Question 10

Refractive surgery complications (no answer)

Question 11

What is diffuse lamellar keratitis

Answer 11

• diffuse sterile inflammation
• occurs within 24-48 hours
• LASIK px only

Question 12

DLK management

Answer 12

• stage 1/2 increase steroid to hourly and review 24-48hrs
• stage 3/4 surgical management

Question 13

LASIK flap complications

Answer 13

• striae
• dislodged flap

Question 14

LASEK complications

Answer 14

• slow epithelial healing
• corneal haze

Question 15

Cause of dry eye in refractive surgery

Answer 15

• suction effects on goblet cells
• alteration in corneal curvature

Question 16

Corneal ectasia signs/symptoms

Answer 16

• reduced vision
• induced cyl
• glare and haloes
• cone shape cornea

Question 17

Ectasia management

Answer 17

• urgent referral
• cross linking

Question 18

H&S for Refractive surgery

Answer 18

• motivations
• hobbies
• occupation
• GH
• meds
• ocular health
• family history spectacles
• contact lenses

Question 19

Pre-Op discussion with px

Answer 19

• visual outcomes at near and distance
• risk of infection/inflammation/poorer outcomes
• regression
• further surgery (LVC enhancement/cataracts/laser)
• consent

Question 20

Post operative discussion

Answer 20

• post op medications
• advise on signs and symptoms of complications
• eye cleaning
• rest for 24 hours
• wear the eye shield whilst sleeping for 1 week
• don’t drive until advised by optom
• take pain killers if necessary
• clean hands before handling eye drops
• don’t rub eyes
• no make up for 1 week
• avoid getting soap in eyes
• not excessive excessive for 1 week
• no swimming 2 weeks
• no contact sports for 4 weeks

Question 21

What happens a a post-op appointment

Answer 21

• how is vision and comfort
• eye drop regime
• general discussions of outcome
• record vision
• IOP

Question 22

Endophthalmitis risk with cataract surgery

Answer 22

• 0.1%
• potentially sight threatening

Question 23

CMO symptoms and timeframe

Answer 23

Reduced vision
2-8 weeks post surgery

Question 24

Treatment of CMO

Answer 24

• predforte
• acetazolamide

Question 25

RLE complications

Answer 25

- increased IOPS - retinal detachment - IOL displacement - posterior capsular opacification