انجمن علمی اپتومتری ایران

خانم مژگان پاک بین(SAFE CRITERIA IN PATIENT SELECTION FOR REFRACTIVE SURGERY)

خانم مژگان پاک بین(SAFE CRITERIA IN PATIENT SELECTION FOR REFRACTIVE SURGERY)

SAFE CRITERIA IN PATIENT SELECTION FOR REFRACTIVE SURGERY

 

PhD Candidate in Ophthalmic Research. Noor Research Center for Ophthalmic Epidemiology, Tehran University of Medical Sciences, Tehran, Iran

Abstract: Laser refractive surgery is one of the most performed surgical procedures to correct refractive errors in the world. Although refractive surgery is generally safe and effective, it does carry some risks. Careful patient selection can avoid most complications and improve the patients’ postoperative visual quality. To achieve acceptable results, patients should be at least 18 years of age and have a stable refractive error for one year’s duration. Refractive error ranges are Myopia ≤ -8.00 D, astigmatism ≤ -4.00 D (the amount of astigmatism and the axis should be noticed), hyperopia ≤ + 5.00 D (latent hyperopia and age should be considered). Essentially any disease that interferes with normal epithelial and stromal healing is a contraindication. These include severe dry eyes, connective-tissue diseases, active or residual corneal disease like keratoconus, herpetic keratitis, corneal dystrophy or degeneration. Cataract, glaucoma, blepharitis and uveitis are also contraindicated. medical contraindications are diabetic mellitus, history of keloids, pregnancy, autoimmune disease. Corneal Topographic risk factors include: Simulated keratometry (SimK) > 48.00 D, simK difference between two eyes > 1.00 D, asymmetric bowtie pattern, inferior superior (I-S) value > 1.4 D, skewed radial axis (SRAX) > 20 degree, KISA index > 60 %, surface asymmetry index (SAI) > 0.5, surface regularity index (SRI) > 0.56, Q value < -0.26, anterior elevation > + 12 µm, posterior elevation > + 15 µm, corneal pachymetry < 500 µm, residual stromal bed (RSB) < 350 µm, pachymetry difference between two eyes > 30 µm. Patients need to be aware that the refractive procedure may not completely eliminate the need for nonsurgical refractive correction. Patients with unrealistic expectations, even if they meet all the criteria for the procedure, should still be advised against elective refractive surgery. Their social and career history and their reasons for surgery need to be assessed carefully

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