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Joja Surgicals Pvt. Ltd.
www.jojasurgical.com
[email protected]
Why is Marking Important?
For every degree of rotation 3.3% of
the effect is lost
With 30 degree rotation all effect of
the Toric lens is lost
Beyond that you start adding to the
astigmatism
Why is Marking Important?
Higher the Toric correction greater
the chances of errors
e.g. For a 5 degree misalignment
In a 6 D Toric – error is 1 D
In a 1.5 D Toric – error is 0.25 D
So let’s get the marking spot on !
Two issues in marking
Making sure our 0 – 180 meridian is
‘true’ horizontal
Making sure that the marks bisect the
cornea through the optical centre
Current Markers
Hand held markers
With spirit level to ensure horizontality
Current Markers
Do not ensure that the marks pass
through the centre of the cornea
Are you bisecting the cornea?
Current Markers
You also need a second intra-op mark if
the placement axis is not 0 – 180
Current Markers
Come in only one size
But the corneas are not of the same
size or shape!
Issues
Still does not solve the problem of
bisecting the cornea through the
optical centre
A New Approach
A slit lamp based system
Uses gravity to define horizontal
Uses Purkinje images to ensure
centring on the cornea
3 Simple Steps
1.
2.
3.
Set the slit lamp beam to the
desired placement axis
Align the beam to pass through the
corneal centre (described later)
Mark the cornea
Step 1 – Setting the Angle
The slit beam can be set to the axis
of placement
No need for reference marking
Clamp device to chin
rest of slit lamp
Setting the Angle
Step 2
Unclamp the calibrator device
Place the patient’s head normally on
the slit lamp
Centring on the Cornea
Patient looks at the light with the
other eye closed
Move the slit beam across the
cornea until you get a bright
Purkinje image
Centring on the Cornea
Images bordered in red show the
correct positioning of the slit beam
How do we know it is accurate?
Planiware 2.0
This is a IOL planimetry software
designed for measuring
Centration of IOL, rhexis, pupil
Measurement of rhexis / pupil areas
and diameters
Angular measurements of Toric IOLs
Planiware can be downloaded from
www.suryodaya.in/planiware
Verifying your markings