1. JAIRO E. HOYOS, MD MELANIA CIGALES, MD Instituto Oftalmológico Hoyos Barcelona - SPAIN

2. J Hoyos

3.  THE TOPOGRAPHY OVER-ESTIMATES CORNEAL POWER AFTER CORNEAL CORNEAL POWER AFTER CORNEAL REFRACTIVE SURGERY REFRACTIVE SURGERY  THE TOPOGRAPHY OVER-ESTIMATES CORNEAL POWER AFTER CORNEAL CORNEAL POWER AFTER CORNEAL REFRACTIVE SURGERY REFRACTIVE SURGERY UNDERCORRECTION IOL CALCULATION RESULT = HYPEROPIA J Hoyos

4. METHODS TO CALCULATE CORNEAL POWER POST-REFRACTIVE SURGERY 1- HOLLADAY REFRACTIVE HISTORY 2- HARD CONTACT LENS 3- CORNEAL TOPOGRAPHY 4- KERATOMETRY J Hoyos

5. KMSG HOT LINE kmsg@intercom.es J Hoyos

6. KMSG HOT LINE TO CALCULATE CORNEAL CURVATURE “HOLLADAY REFRACTIVE HISTORY METHOD” PRE-OP KERATOMETRY OBTAINED CORRECTION (Corneal Plane) CORNEAL POWER POST-R.S. J Hoyos

7. KMSG HOT LINE  SRK-T (>26 mm )  Holladay (24.5 – 26 mm)  Hoffer Q (>22 mm) J Hoyos

8.  POST-LASIK CENTRAL CORNEA IS THINNER = BIOMETRY ERROR: INDENTATION USING BIOMETRY ERROR: INDENTATION USING APPLANATION [IMMERSION BEST] APPLANATION [IMMERSION BEST]KMSG HOT LINE IS IMPORTANT TO HAVE THE PREOPERATIVE AXIAL LENGTH J Hoyos  AXIAL LENGTH CAN INCREASE DUE TO A GLOBE INGROWTH. TO A GLOBE INGROWTH.

9. PRE-LASIK: (40 years) Refraction: -16 - 4 x 170º Sim K: (46.3 x 42.4) Axial length : 31.9 mm 3 YEARS POST-LASIK: CATARACTS POST-LASIK : Refraction: -0.50 Sim K (32.7 x 32.3) J Hoyos

10. In the corneal plane: -14.75 2- Post-LASIK REFRACTION : -0.50 2- Post-LASIK REFRACTION : -0.50 3- CORNEAL PLANE CORRECTION : 3- CORNEAL PLANE CORRECTION : 1- Pre-LASIK REFRACTION : -16 - 4 x 170 Spherical equivalent : -18 = -14.25 -14.75 (-0.5) (-0.5) - “CLINICAL HISTORY METHOD” J Hoyos

11. 5- Post-LASIK CORNEAL POWER : = 30.10 3- CORNEAL PLANE CORRECTION : -14.25 4- Pre-LASIK KERATOMETRY : 42.4 x 46.3 Mean Keratometry: 44.35 - 44.35 14.25 J Hoyos “CLINICAL HISTORY METHOD”

12. TCC: Sim K = 32.5 Central K= 30.6 CALCULATED = 30.1POST-LASIK J Hoyos

13. PRE-LASIK: Refraction: -16 - 4 x 170º Axial length: 31.9 mm POST-LASIK (3 years): Cataract Axial length: 31.06 mm AXIAL LENGTH = 31.9 mm J Hoyos

14.  CORNEAL POWER = 30.1 D  AXIAL LENGTH = 31.9 mm  FORMULA CALCULATION = SRK/T RESULT ACRYSOF (MA60BM) A const 118.80: +16.5 Predict refraction -0.74 Final refraction 0.00 J Hoyos

15. -2 -1 -1 -2.5 -0.5 -0.5Post-OP-3.5 -2.75 -2 -2.75 -9 -9 -8.25 -21.25 -18Pre-OP-21 -18.5 -18 -16.5 CATARACTS Post-KM in situ Post-LASIK 7 Cases 1 Case

16. CORNEALPOWER J Hoyos 31.3 31.9 31.5 30.4 30.3 36.5 29.8 36.5 Central-K 32.27 ± 2.69 32.27 ± 2.69K-Calculated 32.21 ± 3.07 32.21 ± 3.07Sim-K 35.41 ± 2.00 30.25 32.63 30.37 30 30.1 37 30.35 37 35.9 35 37.05 33.85 32.5 37.85 33.6 37.6 Refractive History TCCTCC

17. RESULTS J Hoyos SRK/T Obtainedrefraction -0.31 ± 1.03 -0.31 ± 1.03 Desired Desiredrefraction -0.75 ± 0.38 -0.75 ± 0.38 IOL POWER IOL POWER 16.87 ± 1.45 +16.5 +15.0 +16.5 +16.5 +17.5 +18.5 +15 +17 +19 0 0 -2 0 +1.5 0 -0.75 -1.25 -1 -1 -0.55 -0.62 0

18. 3-POSSIBILITY OF INDENTATION BIOMETRIC ERROR BIOMETRIC ERROR 2-FORMULA CALCULATION : SRK/T 1-CORNEAL CURVATURE CALCULATION Clinical History Method (If Unknown, use flattest K) J Hoyos

19. Refraction: OD_____________________ OS _____________________ Keratometry: OD__________________ OS __________________ Axial Length: OD__________________ OS___________________ PRE-REFRACTIVE SURGERY DATES Patient___________________________ Surgery______________Date_________ J Hoyos