|
Trained in a cornea fellowship at
Asociación para Evitar la
Ceguera en México, IAP Hospital. I had the
opportunity to be exposed to and challenged by a large number and wide variety
of extreme corneal conditions coming from throughout Mexico and all of Latin
America. Even then I was very frustrated by the limited number of options to
treat conditions which threatened to deteriorate and destroy tissue vital to
sight, especially keratoconus.
An interest in refractive took me to work with Arturo Chyet
where I was exposed to the forefront of technology and thinking in refractive
surgery, including laser technologies only now considered breakthrough and to ICR’s many years prior to even their initial European commercialization in 1997.
Frankly, I became interested in pursuing ICR’s as an option for weakened corneas
when confronted by unexplainable ectasias from some of my own Lasik patients.
I wanted to find a way to help the relative few that I had, especially since the
town of Agua Prieta isn’t all that big and some of these people were individuals
who I or members of my family would see every day. I’m sorry just wasn’t good
enough. Having followed the literature from Dr. Colin, and others fairly closely, I decided to try Intacs first in some ectasia and severe keratoconus
cases. To my satisfaction the patients improved significantly in all of my
initial cases. But even then I felt there might be a way to improve on the
outcomes a bit more.
This is when confronted with post procedure monocular dyplopia in my first
patient using the horizontal ICR placement with two different sized ICR’s
described by Colin I theorized that if I repositioned the inserts to lay within
the flat meridian (highest elevation) we would gain more overall refractive effect without negative
implications. In my first patient who was then 3 months from the initial surgery
I was able to perform a careful in vivo repositioning of the inserts to align
them as described in the steep axis technique. Results were
immediate. The patients astigmatism improved substantially and complaints of dyplopia disappeared. I completed similar repositioning on the remainder of my
initial five patients with similar results. |
Ask Mark |
