0905hrs: Anterior Segment Reconstruction (Simon Holland)
/Dr Holland is on faculty at UBC. Thanks his current cornea fellow, Greg, for helping prepare the talk.
Discussing timing of repair of anterior segment between timing of primary repair all the way to visual rehab.
Timing of initial repair: As soon as possible, next day? We usually don’t have to repair the same night but within 24hrs.
Pre-op slit lamp exam: don’t be fooled by self-sealing leak which could lead to future epithelial ingrowth
Corneal laceration repair aiming for 90% depth and trying to avoid visual axis. If further tissue damage by burying knots then leave exposed and put on bandage lens.
Incarcerated iris: how long to leave exposed. Probably 24hr rule, excise if >72 hrs.
Tissue glue and patch grafts discussed briefly. Cyanoacrylate glue extremely useful to have. Very little glue and even store bought from hardware store if must. Dry ocular surface; quite irritating to conjunctiva so cut off if ends up dribbling there.
Patch graft useful for larger defects. Can induce a lot of astigmatism if close to visual axis.
Leave aphakic at primary repair.
Lens diaphragmatic IOL sometimes needed; gives list of 3 suppliers. Need scleral suturing.
Secondary IOL to be discussed in next talk. AC vs PC IOLs. Outcome of AC IOLs just as encouraging as posterior sutured IOLs.
Goals/expectations vary. Want 20/Happy.
Gives some clinical examples with different IOLs.
Corneal laser correction options for the future. Gives example of patient going from 1.5D to 9D astigmatism after trauma and its repair. Another case with irregular astigmatism following rust ring and how laser ablation can help.
LASIK flap disrupture example; very challenging to reposition. Also mentions subluxed IOLs from trauma and need for retina surgeon assistance for those repairs.