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Re: Would you submit this 42yo woman to refractive surgery?


Dear Kerafriends,

Jim is right (as always) – I’m really not feeling safe in offering LASIK, as besides the skewed axis seen on axial curvature maps and the PTA quite near 40%, her Pentacam shows some suspect parameters, mainly: ART max < 386 and BAD-D > 1,22 – Sandra, you can find some interesting data on this field on reference (1).

I like the ICL option too! By the other hand, I’m worried about this small irido-corneal angle (32,9/32,5). How smaller would it become after an ICL implantation? These small irido-corneal angles are also an issue in case of Artisan lenses, as there’s a big chance it’s not possible to keep the 1.5mm safety distance between the lens and the endothelium.

I also like the surface ablation option! By the other hand, RELEX Smile is now available here. As this leaves (almost) intact the Epithelium, the Bowmann membrane and, also, the strongest anterior stromal portion of the cornea, it seems to me it has many interesting advantages over surface ablation – don’t you think so?.

I was wondering if anyone in this group (besides me) minds about the irido-corneal angle when planning an ICL implantation?

Thank you all again!



A By Emil Chynn

Correct me if I’m wrong, but I know of no published evidence that shows that the structural integrity of the cornea is stronger after SMILE vs ASA/LASEK/epiLASEK/PRK

In contrast, I’d think that any incisional or lamellar procedure would be inherently more destabilizing vs a surface ablation (advanced or otherwise)

Does anyone have any data about the strength of the cornea post-SMILE vs post-ASA/PRK?

Emil William Chynn, MD, FACS, MBA

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