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18 Corneal tomographic analysis is essential
before cataract surgery - 4 steps in
screening candidates for premium IOLs
by Prof. Naoyuki Maeda
New advancements in surgical techniques have improved the safety and efficacy of cataract
procedures to a remarkable level. As a result, indications for cataract surgery have expanded, and
cataract patients’ expectations for post-surgical results have grown.
The introduction of premium IOL or new technology IOLs such as multifocal IOL, toric IOL, and
aspherical IOLs have enabled us to modify the optical properties of the eye postoperatively in tailor-
made fashion. While the choice of an IOL, aside from its power, was not so critical from the patient’s
point of view in the days when only spherical IOLs were available, today, his or her postoperative
satisfaction will depend not only on the power but also on the optical characteristics of the IOL.
Therefore, it is important for cataract surgeons to understand the lifestyle of each patient, the ocular
pathology, and the optical quality of the eye before surgery. This article explains on the basis of case
examples how the Pentacam® can be used for assessing corneal optical quality for the selection of
premium IOLs. In the process it conveys the importance of corneal tomographic screening before
cataract surgery.
18.1 Corneal topography for selecting premium IOLs
When planning for the implantation of a new technology IOL surgeons have to select one particular
IOL from at least four kinds of IOL for the recipient patient. They must evaluate the optical quality of
the cornea during the preoperative evaluation, because suboptimal optics of the cornea or could lead
to a postoperative refractive error or spoil the outcome in other ways.
We have been proposing four steps for the interpretation of corneal tomography before performing
cataract surgery as shown in Table 10.
Table 10: 4 steps in the interpretation of corneal tomography
18 Corneal tomographic analysis is essential before
cataract surgery - 4 steps in screening candidates
for premium IOLs
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