Two day program on

Keratorefractive surgery course

12^th and 13^th, March-2009

 

Host: Ophthalmology department with the cooperation of Mashhad University of Medical Sciences Ophthalmology Research Center and ongoing training center

Location: Khatam Al Anbiya Ophthalmology Hospital – Shahid Gharani Blvd. - Mashhad

Scientific Secretary: Dr. Mohammadreza Sedaghat

Executive Secretary: Dr. Ali Dehghani

 

Thursday 3/12/2009

 

Friday 3/13/2009

 

 

 

 

Thursday 3/12/2009

 

 

Friday 3/13/2009

 

Date	Time	Title
3/13/2009	8:15-8:30	Reciation of the Holy Quran
	8:30-10:30	Conventional versus customized ablation Panel members: Dr. Validad – Dr. Javad Hashemian – Dr. Ghoreyshi – Dr. Hosseini Tehrani – Dr. Jabarvand – Dr. Salavati
	10:30-11:00	Break
	11:00-13:00	Postop  complications of keratorefractive surgery panel Panel members: Dr. Zarei – Dr. Sedaghat – Dr. Hashemi – Dr. Jabarvand – Dr. Movahedan

 

Questions discussed in each panel

 

Patient  selection  for keratorefractive surgery panel

 

 

1-    What is your opinion on selecting patients for keratorefractive surgery considering their age and stability of refraction?

2-    According to refraction type, how many diopters of refractive eye can you fix using keratorefractive surgery?

1. Simple myopia
2. Simple hyperopia
3. Simple myopic astigmatism: for example Plano – 2 X 180
4. Simple hyperopic astigmatism: for example Plano +2X180
5. Compound myopic astigmatism: for example -2 -3 X 180
6. Compound hyperopic astigmatism: for example +2 +3 X 180
7. Mixed astigmatism

• +4-2X180
• +3-3X180
• -3+4X180

3-    Would you recommend keratorefractive surgery during breastfeeding and pregnancy?

4-    What are your thoughts on keratorefractive surgery in the case of diseases and consumption of the following drugs?

1. Rheumatoid arthritis and other controlled rheumatismal diseases
2. Mild to moderate and controlled dry eye
3. Different stages of diabetes and hypertension
4. Blepharitis and MGD and history of stye and heart chalazion
5. Previous chalazion in patient’s eyelid
6. Accutane consumption due to acne

5-    What are your measures and criteria for correcting refractive eye and and what type of refraction do you recommend?

1. Subjective refraction
2. Cycloplegic refraction

6-    What drug would you prescribe for cycloplegic refraction and how must one us this drug?

 

 

Corneal imaging panel

 

1. Which pre-keratorefractive surgery diagnostic corneal imaging procedure would you recommend?
   1. Ultrasonic pachymetry
   2. Placido-based topography
   3. Elevation topography (which of the following would you choose? Orbscan; Pentacam; Gallile)
   4. ORA (corneal rigidity)
   5. Aberrometery
   6. Which of the following methods would you choose for measuring cornea thickness?
      1. Ultrasonic pachymetry – orbscan – pentacam – Gallile
      2. Thinnest point of cornea – central corneal thickness
      3. What indicators do you usually use in placido-based topography?
         1. Topographic pattern
         2. Corneal statistics indices such as IS value
         3. Which elevation based topography do you prefer?
            1. Orbscan
            2. Pentacam
            3. Gallile
            4. What factor do you keep in mind regarding orbscan quad map?
            5. What factors do you keep in mind regarding pentacam and what are your recommended print outs?
            6. Which pre-surgery indicators have helped you regarding aberrometery?
            7. What is the role of ORA and its helper indicators in keratorefractive surgery?

 

Surface ablation versus lasik & postop management

 

1-    Which keratorefractive surgery would you recommend for patients?

1. Surface ablation
2. Lamellar surgery
3. Both techniques

2-    In the case of surface ablation:

1. Which of the following would you use and why: PRK, Lasik, Epilasik?
2. Which of the following procedures would you use for epithelium removal:

• Mechanical
• Alcohol (with what device and how long?)

1. What king of range myopathy and hyperopia of do you use for patients with surface ablation?
2. In the case of applying mitomycin:

• Which patients require mitomycin?
• How long must mitomycin be used based on refraction rate?
• Considering your experience with mitomycin, what side effects have you observed?

1. In the case of bandage contact lenses:

• What type of lens would you recommend and for how long?
• Does the period for using contact lenses differ in myopia and hyperopia patients?

3-    In the case of lamellar keratorefractive surgery:

1. Which of the following techniques would you use and why?

• Conventional lasik with mechanical kratom
• Femtolasik

1. What is range myopia and hyperopia of patients who have undergone lasik surgery?

4-    What optical zone do you prefer in myopia and hyperopia and astigmatism patients?

5-    What is the maximum ablation depth that you recommend for keratorefractive surgery?

6-    Regarding postop management of patients with surface ablation:

1. What type and duration of chemotherapy would you recommend for patients?
2. What methods do you use for pain alleviation?
3. Do you agree with these patients consuming vitamin c?
4. What is your recommended duration for using UV absorber sunglasses for these patients?
5. How and how long should follow ups be performed for these patients?

7-    In case of postop management of lasik patients:

1. What type and duration of chemotherapy do you recommend?
2. How and how long should follow ups be performed for these patients?

Conventional versus customized corneal ablation panel

1-    What is your routine method for keratorefraction from the following tehcniques? And why?

1. Conventional ablation
2. Customized ablation

2-    Which patients are in your opinion candidates for customized ablation surgery?

3-    What type of customized ablation would you recommend for different patients?

1. Optimized ablation
2. Wavefrom guided ablation
3. Topographic guided ablation

4-    What are the differences between machines and devices used for keratorefractive surgery?

1. Device speed (50-100-400-500-1000 HZ)
2. Eye tracking
3. Torsion detection

5- What measures should be taken before performing customized ablation surgery?

 

Postop  complications of keratorefractive surgery panel

 

1-    If you were faced with post-surface ablation surgery delays in epithelium recovery, what measures would you apply?

2-    If faced with post-surface ablation surgery overcorrection or under correction, what measures would you take?

3-    What approach do you take for post-lasik surgery under correction and over correction?

4-    What would you recommend for striae formation after lasik surgery?

5-    What is the prevalent duration of epithelial in growth regarding lasik surgery and what methods of coping would you recommend?

6-    What is you recommended approach in the case of corneal ulcers:

1. In patients undergone lasik surgery
2. In patients with PRK

7-    In the case of post-PRK surgery early corneal haze formation:

1. What approach would you take?
2. How would you grade corneal hazing?
3. From which grade higher is considered clinically significant?
4. What is your recommended treatment method for these patients?

• Wait and watch
• Corneal scrapping and MMC
• PTK and MMC

8-    Regarding post lasik ectasia:

1. What are your indicators for diagnosis?
2. How is regression distinguished?
3. What is you recommended treatment in different stages of ectasia?
4. What role do anti IOP drugs play in these diseases?
5. What is the role of ORA in diagnosis ectasia prone patients?
6. How do you diagnose form frist keratoconus before surgery?
7. What is in your opinion the minimal residual stromal bed in lasik surgery?
8. What is the place of corneal cross-linking in treating these types of patients?

9-    Regarding PRK:

1. What proceedings would you recommend for reducing late corneal haze?
2. What is your limit on reducing corneal haze?
3. What are your recommendations for treating these patients?

• Wait and watch
• Corneal scrapping and MMC
• PTK and MMC