Case Study 3

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The Bader Procedure for the Treatment of Keratoconus
Dr. Samir A. Quawasmi
July 25, 2008
Case Study 1

Patient History:

Date of initial contact with patient was 10/31/2007.

Patient is a 36 year-old male accountant with moderate keratoconus in the right eye and advanced keratoconus in the left eye. Patient complains of difficulty seeing distant objects. Has worn glasses and contact lenses for 5 years. Preference is for contacts. Near objects become doubled (shadowed) in the left eye much worse than in the right eye.
V.A./RT : CF and V.A./LT : CF
Improved with pinhole to V.A./RT: 0.8 and V.A./LT: 0.3
Indications for Keratoconus in LT were stromal thinning, Munson and Vogt stress signs. Full confrontation study indicated no loss of visual field. Central and color vision OK.
Indications for Keratoconus in RT were stromal thinning, stress signs. Rest of eye exam normal.
Collected Ultrasound Pentacam data on both eyes and Bader Procedure was recommended as course of treatment.

11/5/2007
Bader Procedure performed.
Patient received RT eye circular keratotomy 7mm from pupilary axis at a depth of 4.00mm and arcuate keratotomy 5.5mm from the pupilary center with arc length of 60º@20 at a depth of 4mm.
Patient received LT eye circular keratotomy 7mm from pupilary axis at a depth of 4.00mm and arcuate keratotomy 5.5mm from the pupilary axis with arc length of 60º@160 at a depth of 4mm.
Vision post-op RT 0.8 LT 0.3

11/13/2007
Patient reports driving ability improved and very satisfied with procedure. V.B.E. 0.8
Advised continued use of collagen.

12/4/2007
Patient reports continued improvement in vision. V.B.E. 0.9
Advised continued use of collagen.

2/4/2008
Patient reports ability to carry on life normally. Patient reports that there are instances of burning sensation in the eyes and, at times, fogginess of vision (due to the edema and the process of healing). Still, very pleased with results. Advised continued use of collagen.
V.RT 0.9 LT 0.6 , V.B.E. 1.25
Refractive reading RT (-8.0,-7.75@15) (this is mirror effect). Confirmed readings with duochrom -2.50,-2.00@15.
Refractive reading LT (-9.00,-7.00@173) (this is mirror effect) Confirmed readings with duochrom -4.50,-3.00@175.
Given G. Isoptocarpine to stabilize pressure in the eye and to provide clarity during instances of fogginess.

5/3/2008
V. RT 0.8 V.LT 0.8 Refractive reading RT (-5.00,-2.00@1) Refractive reading LT (-4.00,-4.00@178)
Given Glasses. Collagen and G. Pilocarpine. No squeezing or squinting reported.