Getting the Markings Right

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Presentation transcript:

Getting the Markings Right Joja Surgicals Pvt. Ltd. www.jojasurgical.com jojasurgical@gmail.com

This presentation is issued in scientific interest to promote better marking techniques for Toric IOL implantation, LRIs and refractive surgeries The tool and software described in this presentation are patented / copyrighted

This is not an advertisement

Why is Marking Important? For every degree of rotation 3.3% of the effect is lost With 30 degree rotation all effect of the Toric lens is lost Beyond that you start adding to the astigmatism

Why is Marking Important? Higher the Toric correction greater the chances of errors e.g. For a 5 degree misalignment In a 6 D Toric – error is 1 D In a 1.5 D Toric – error is 0.25 D

So let’s get the marking spot on ! Two issues in marking Making sure our 0 – 180 meridian is ‘true’ horizontal Making sure that the marks bisect the cornea through the optical centre

Current Markers Hand held markers With spirit level to ensure horizontality

Current Markers Do not ensure that the marks pass through the centre of the cornea

Are you bisecting the cornea?

Current Markers You also need a second intra-op mark if the placement axis is not 0 – 180

Current Markers Come in only one size But the corneas are not of the same size or shape!

Issues Still does not solve the problem of bisecting the cornea through the optical centre

A New Approach A slit lamp based system Uses gravity to define horizontal Uses Purkinje images to ensure centring on the cornea

3 Simple Steps Set the slit lamp beam to the desired placement axis Align the beam to pass through the corneal centre (described later) Mark the cornea

Step 1 – Setting the Angle The slit beam can be set to the axis of placement No need for reference marking Clamp device to chin rest of slit lamp

Setting the Angle

Step 2 Unclamp the calibrator device Place the patient’s head normally on the slit lamp

Centring on the Cornea Patient looks at the light with the other eye closed Move the slit beam across the cornea until you get a bright Purkinje image

Centring on the Cornea Images bordered in red show the correct positioning of the slit beam

Centring on the Cornea

How do we know it is accurate?

Planiware can be downloaded from www.suryodaya.in/planiware This is a IOL planimetry software designed for measuring Centration of IOL, rhexis, pupil Measurement of rhexis / pupil areas and diameters Angular measurements of Toric IOLs Planiware can be downloaded from www.suryodaya.in/planiware

Verifying your markings

Happy marking!