1. Bioptic Surgery Kangnam Eyence Eye Clinic Woon Bong Jwa

2. Biopitcs Phakic IOL + LASIK, LASEK - Zaldivar (1999) Excellent option for - >-19D SE - significant astigmatism More reliable refractive results Decrease the risk of halos

3. Management of Astigmatism during & after ICL operation Incisional Astigmatic Procedure LASIK or LASEK Toric ICL

4. Incisional Astigmatic Procedure The change of incisional direction, size according to astigmatism during ICL op. Relaxing Incision after ICL op.

5. CCI on the direction of WTR astigmatism by preop. MR, Topo. Incisional size (by Astigmatism) – 3mm : < 1D – 3.5mm : < 1.5D – 4mm : < 2D – 4.5mm : >2D Incisional Astigmatic Procedure

6. 2005. 1 ~ 2005. 2 ICL op. patients 50 eyes, female : male = 23 : 6 (p) Preop. SE : -10.69±3.37D (-4.5 ~ -20.38D) Preop. Astigmatism : -1.62 ±1.21D (-0.5 ~ -6.25D) Incisional Astigmatic Procedure

7. Topical anesthesia Superior CCI ( 3mm ~ 4.5mm) ICL insertion to A/C Rotation of ICL ICL haptic insertion Confirm of ICL centration Irrigation & wound adhesion Incisional Astigmatic Procedure

9. Results of Incisional Astigmatic Procedure during ICL operation

10. The changes of spherical equivalent after ICL operation

11. The changes of astigmatism after incisional astigmatic procedure

12. The changes of vision after incisional astigmatic procedure

13. The changes of astigmatic amount after incisional astigmatic procedure

14. Complications during & after incisional astigmatic procedure Scant iris hemorrhage Corneal wound leak & dehiscence Infection – no Crystalline lens touch - no

15. Easy & safe procedure Fast recovery of naked vision Increased patient ’ s satisfaction No intra & post op. complications Stable refractive results Effective to 2.0D below astigmatism Conclusions of incisional astigmatic procedure during ICL operation

16. Bioptics by LASEK 2003. 10 ~ 2004. 11 Bioptics patients 43 eyes, female : male = 14 : 4 (p) Pre ICL SE : -9.49±2.12D (-5.25~-11.25) Pre ICL Astigmatism : -2.27±1.12D (-1.00~-4.00) Post ICL SE : +0.33±0.39D Post ICL Astigmatism : -2.36±0.71D Interval to LASEK after ICL operation : 4.65±2.63m

17. Horizontal axis marking 20% alcohol soaking : 15 sec. Excimer laser ablation (Visx star S4) Cold saline irrigation T-lens & 5% NaCl qid LASEK procedure (Bioptics)

18. Results of LASEK after ICL operation

19. The changes of vision after LASEK operation (Bioptics)

20. The changes of astigmatism after LASEK operation (Bioptics)

21. Striate keratopathy – next F/U day Delayed wound healing - no Corneal opacity - no Steroid induced ocular HT - no Complications of LASEK after ICL operation (Bioptics)

22. Conclusions of LASEK after ICL operation (Bioptics) Accurate correction results Increased patient ’ s satisfaction No intra & post op. complications Stable refractive results Effective to all ranged astigmatism