Intraocular Lens Repositioning //
The vast majority of intraocular lenses (IOL) that are inserted following cataract surgery remain stable and require no subsequent manipulation. On rare occasions, a lens may shift position during normal healing, as a result of poor tissue support, or following subsequent surgery or trauma. Repositioning or occasionally exchange of the dislocated IOL is often necessary for the patient to achieve optimal vision. This involves returning to the operating room and surgically recentering the lens and then anchoring it so that the lens will not shift position again. In some cases the original lens may have to be removed completely and a second lens placed. When other problems coexist (i.e., corneal decompensation/edema, glaucoma, vitreous membranes or a retinal detachment) combined procedures may be necessary. In some case doctors with different expertise (i.e., cornea and retina) will team up in the operating room to facilitate this specialized care.
Phototherapeutic Keratectomy //
The approval of the excimer laser for phototherapeutic keratectomy has given ophthalmic surgeons a new and powerful tool in the treatment of corneal diseases. The laser has the ability to “peel” thin layers of tissue off the surface of the cornea much as one might sequentially tear off the first 10 pages of a book, one at a time. The removal of diseased tissue from the corneal surface that is distorting or obstructing vision can have a dramatic impact on vision.
The spectrum of superficial corneal disease treatable with excimer laser phototherapeutic keratectomy is broad, ranging from traumatic corneal scars to hereditary corneal dystrophies. Therapeutic hard and rigid gas permeable contact lenses are the mainstay of nonsurgical treatment for many of these conditions. Their effectiveness is variable depending on the amount of surface irregularity and the density of the corneal opacity. Patient comfort, lens stability and many other problems often limit their long term acceptance by patients. When contact lenses are unsuccessful, the surgical removal of superficial corneal scarring by surgical means (a keratectomy or corneal transplant) normally would be the next step. The results of these surgical procedures have been mixed due to subsequent scarring and surface irregularity. Phototherapeutic keratectomy provides a simpler and safer alternative to these surgical treatments for many patients.
Specific indications for treatment include:
Corneal scarring involving the anterior 20% of the cornea (100 microns)
Scarring associated with keratoconus
Central corneal scarring remaining after pterygium removal
Residual corneal scarring or surface irregularity following the removal of surface calcification
Corneal nodules - i.e. Salzmann's nodules
Corneal surface and anterior dystrophies – i.e., some forms of Granular and Lattice Dystrophy
Selected cases with recurrent erosion syndrome
Iris Reconstruction //
The function of the iris as a light limiting diaphragm has been recognized by scientists and physicians for several thousand years. Initial attempts to modify the iris and pupil size and shape were pharmacologic in character. The concept of surgically modifying or repairing the iris did not receive much attention until 1917 when Key first wrote about his efforts at repairing a torn iris by suturing the iris edge to the sclera. Intraocular, iris-to-iris repair was first described by Emmerich in 1957. Neither of these contributions attracted significant attention when initially published. In large part this was because suitable equipment to facilitate surgical reconstruction, namely the operating microscope and microsurgical instrumentation, were not readily available. Today, we give little thought to the limitations of the past and look for new or novel approaches to repair the iris or restore pupillary function. Drops, sutures, various lasers, tattoo pigments, and intraocular iris prostheses are but a few of the approaches currently utilized by the doctors of Michigan Cornea Consultants when iris defects require repair.
Surgical Forms //
Once you have had your consultation and have been deemed a candidate for one of these procedures, below are the surgical forms for you to read and complete. Please use the pre-op checklist form (see below) to ensure you have read and completed the necessary forms. For any questions, please contact Elly, the surgical coordinator at 248-350-1130, extension 304
Read, Print, Complete and Return