Indications

Surgical correction of hyperopia (1–3 D).

Surgical management of presbyopia via monovision/multifocal approach.

Selected cases of postsurgical hyperopia and astigmatism. Non-FDA approved “off-label” application.

Preoperative Procedure

1. Discontinue soft contact lens wear at least 1 week and rigid contact lens wear 2 weeks preoperatively. Confirm stability and regularity of corneal topography.

2. Patient should not wear eye makeup on day of procedure.

3. Treat preexisting dry eye and blepharitis. Consider non-preserved lubricants, lid hygiene, punctual plugs, topical cyclosporine, and oral doxycycline for blepharitis.

4. Determine treatment plan. Consult recent nomograms for application pattern and expected effect. In general, concentric rings of 8 spots are placed at optical zones of 7 or 8 mm, or both.

5. Perform preoperative keratometry.

Instrumentation

1. Integrated conductive keratoplasty (CK) lid speculum.

2. Cellulose sponges.

3. CK corneal marking template.

4. CK console.

5. Sinskey hook.

6. Gentian violet marking pen or pad.

Operative Procedure

1. Mark center of entrance pupil either at slit lamp or under coaxial microscope. Mark axis of astigmatism if astigmatism to be treated.

a. Sinskey hook.

b. Gentian violet.

2. Prep operative eye.