How technology can improve ophthalmologic surgical decisionsS

Surgical decisions must be based on objective data for the safety of the patients. It is possible to get images from most of intraocular structures, if cornea, aqueous and vitreous humor are translucid. Several exams can be used to program surgical procedures and to anticipate severe problems.
Removing an intraocular faquic lens (for correction of ametropia) before corneal decompensation can be decided based on endothelial cells counting with specular microscopy.
Prevention of a sudden angle closure crisis in a narrow iridocorneal angle (avoiding severe pain episode, loss of cornea transparency and damage of pupil diaphragm and optic nerve) is possible by measuring the angle with topography of the anterior chamber and anticipating the time of cataract surgery, to gain space in the anterior chamber.
Vitreomacular tractions and epiretinal membranes can be asymptomatic, but they can cause vision distortion if retinal external layers are damaged. Central vision can be lost if macular tractions develop a macular hole. Anticipating these problems with OCT tracking and OCTA allows the surgeon to decide the best opportunity to perform a vitrectomy and release these tractions.
Vascular diseases that can cause ischemia in the macula or in peripheral retina can be documented with 30 º and 200º angiography , it can detect neovessels with higher risk of bleeding. Hemovitreous can be prevented with vitrectomy, removal of fibrovascular tissue and laserterapy in isquemic areas. If ischemia is very severe, vitrectomy and panphotocoagulation with laser can reduce significantly the risk of neovascular glaucoma.
Asymptomatic retinal tears, with or without peripheral retina detachment, can be found in 200º retinography. Vitrectomy, with gas tamponade in case of detachment, can prevent central vision loss.
Serous macular detachment associated with optic nerve pit can be treated with a new technique. After vitrectomy a scleral plug was used to tamponade the hole in the optic nerve, without a foreign body reaction and with a good resolution of the serous detachment.
It is possible to decide the best procedure for each patient after analyzing information from different exams, with much better functional results.

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