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One should always use the Orbscan system (Fig. 16) to evaluate potential Lasik candidates preoperatively to rule out primary posterior corneal elevations. 15: Showing general quad map of an eye with primary posterior corneal elevation. Notice the red areas seen in the top right picture showing the primary posterior corneal elevation MINI ATLAS SERIES: CORNEAL TOPOGRAPHY (28) CHAPTER 1: ORBSCAN on. Four maps include: (a) anterior corneal elevation: NB = ± 25 µ of best-fit sphere, (b) posterior corneal elvevation : NB = ± 25 µ of best fit sphere, (c) keratometric mean curvature: NB = 40 to 48 D, (d) corneal thickness (pachymetry): NB = 500 to 600 µ.

13 on the upper right is the pre-op topographic picture and the one on the lower right is the post-Lasik picture. The main picture on the left shows the difference between the pre- and post-Lasik topographic patterns. One can detect from this any decentered ablations or any other complication of Lasik surgery. Corneal topography is extremely important in cataract surgery. The smaller the size of the incision lesser the astigmatism and earlier stability of the astigmatism will occur. One can reduce the astigmatism or increase the astigmatism of a patient after cataract surgery.

16 only the abnormal areas are shown in red for ease in detection. 16. 17: Showing three-dimensional normal band scale map. In the top right note the red areas which shows the elevation on the posterior cornea. The anterior cornea is normal CHAPTER 1: ORBSCAN (31) MINI ATLAS SERIES: CORNEAL TOPOGRAPHY avoid post-Lasik keratectasia. The rate of progression of posterior corneal elevation to frank keratoconus is unknown. It is also difficult to specify that exact amount of posterior corneal elevation beyond which it may be unsafe to carry out Lasik.

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Basic Ophthalmology for Med. Students, Pri Care Resids


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