Tuy nhiên, những rủi ro liên quan đến một khâu IOL (xem chương 8) thường chỉ làm cho các tùy chọn ưa thích ở những bệnh nhân trẻ, trong đó bảo quản lâu dài của số lượng tế bào nội mô có ưu tiên. Implant quyền lực trong ba thủ tục không chính xác liên quan đến tính toán | CATARACT SURGERY IN COMPLEX EYES IOL into the sulcus endothelial loss is initially similar to that with posterior chamber lens implantation101 and should subsequently be lower than that with an anterior chamber IOL. However the risks associated with a sutured IOL see Chapter 8 usually only make this the preferred option in young patients in whom long term preservation of the endothelial cell count takes priority. Implant power in triple procedures The inaccuracy associated with lens implant power calculation during a triple procedure reflects the unpredictability of keratometry following corneal grafting. The options to minimise this source of error are discussed in Chapter 6. The variation in refractive outcome has led to the suggestion that non-simultaneous penetrating keratoplasty cataract extraction and lens implantation or two-stage surgery should be 103 As mentioned above cataract surgery as a second procedure inevitably causes some endothelial damage and may cause graft rejection. A two-stage operation also has the disadvantage that keratometry does not stabilise until graft sutures are removed up to two years after surgery which delays visual rehabilitation. In addition many graft patients have to wear a contact lens to correct residual astigmatism irrespective of spherical error. As a result two-stage surgery may only be advisable when early cataract is present and its visual significance is Postoperative management In patients with dry eyes or cicatrising conjunctival disease intensive preservative free topical lubricants should be used in conjunction with the usual topical antibiotics and steroids also preservative free if available . Close and regular follow up is essential in these patients who have a high rate of serious complications. Persistent epithelial defects should be treated with a soft bandage contact lens or tarsorrhaphy. In cases refractory to this treatment amniotic membrane transplantation may be required and .
