客製化微創小切口白內障追蹤定位手術---
Customized Phacoemulsification for post-RK with VERION™ Image Guided System and AutoSert IOL Injector
大約52歲的許 許 蕭
經過蕭 醫師仔細的問診及評估過後，因為許 先生以前就有近視約450度，因為不喜歡戴眼鏡的關係，在二十多年前就接受過近視矯正手術，二十多年前的近視矯正手術不同於現在的近視雷射，此種手術無法精準矯正度數，是醫師依照個人經驗使用鑽石刀將角膜做放射狀的切開手術(Radial Keratotomy)，使前、後角膜皆變平以達到降低近視度數的目的，但術後視力大多不穩定，且隨著年齡增長、老花眼度數增加而視力會顯得更加模糊並影響日常生活。
我們也幫許 先生做了相關檢查，視神經視網膜斷層掃描(OCT)及眼底散瞳檢查，蕭 醫師評估過後認為許 先生沒有其他視網膜或視神經的病變，只是單純的老花眼越來越嚴重，也有點輕微水晶體混濁的問題。於是預計在白內障老花眼手術後應有不錯的手術效果。
約二周後我們幫許 先生安排做右眼白內障老花眼手術，手術後許 先生說看東西變比較亮，視覺品質也跟著提高，蕭 醫師請許 先生測試近距離閱讀書本，許 先生因為可以很輕易的閱讀出書本上的文字感到很開心，手術後不管是看遠或是看近都覺得很清晰！他非常謝謝蕭 醫師幫他做了雙眼的老花眼手術，因為現在上班時，閱讀信件上的地址變的非常得輕鬆，不像之前閱讀起來非常吃力！
參考資料：
Dr. Masket firmly believes the post-RK eye "is such a moving target, a multifocal lens should not be considered—it will fail unless we achieve absolute or near emmetropia." He noted that the refraction can change from morning until evening and there may be progressive hyperopic shift over time.
Barbara Bowers, MD, in private practice, Innovative Ophthalmology, Paducah, Ky., disagrees—she'll bring these patients in at several different times throughout a day "and if the vision is fluctuating a little bit, I'll consider a multifocal. If they're fluctuating drastically between the morning and afternoon readings, I'll tell them point-blank a multifocal lens will make them miserable." Dr. Masket uses four or five devices to find the flattest Ks, and those are the readings he'll use for IOL calculation.
Astigmatism is an essential component to evaluate in these eyes, said Barry Schechter, MD, in practice, Florida Eye Microsurgical Institute, Boynton Beach, Fla. "We've had some very nice results with toric IOLs in RK patients who have varying amounts of regular astigmatism," he said. "You want to look for wound gaping. If the wounds have healed nice and tight, you're more likely to get a very stable postop refraction after time, but if you see some gaping, you've got the potential for refractive surprises."
If there's "very irregular astigmatism," Dr. Schechter advises against a toric—"you just have to go with a plain monofocal aspheric lens. I've been surprised with the results obtained and with the range of vision possible due to the spherical equivalent."
Dr. Masket avoids toric lenses in some post-RK patients "for fear they may someday need a corneal transplant" and because it's rare to have regular astigmatism in these eyes.
In general, he advises adding "about a half diopter" of measured IOL power for a patient with four incisions, between 1-1.5 D for those with eight incisions, and 2 D for those with 12 or more incisions. While intraoperative aberrometry may be very useful in eyes having prior laser vision correction, it is less accurate in the post-RK eye, as corneal curvature changes during cataract surgery in these eyes, he added.
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