assignment 1 Qs

Question 1

Considering the site of tissue ablation in each type of refractive surgery, which procedure would you recommend for a myopic patient with EBMD/ABMD who wants refractive surgery?

Answer 1

PRK, since the epithelium and Bowman’s layer will be removed in the process of the procedure.

Question 2

What is the best refractive surgery procedure for a 23 year old male patient with a refractive error of: -4.00-2.00x090 OD, OS?

Answer 2

LASIK

Question 3

What is the best way to remove a bandage contact lens without causing an epithelial abrasion in a post-PRK patient?

Answer 3

The best way is to pull the lens down off the cornea to make sure it’s mobile then once its past the limbus then you pinch it off

Question 4

What is the best refractive surgery for a pt that has corneal pachymetry readings less than 490 microns?

Answer 4

PRK

Question 5

According to Dr. Findley, what measurements are needed on corneal topography for a patient to qualify for corneal refractive surgery?

Answer 5

Posterior float <40 microns; Difference of astigmatism between eyes <1.00 D; <1.50 D of irregular astigmatism in the central 3mm; <2.00 D of irregular astigmatism in central 5mm; Periphery >20 microns thicker than center.

Question 6

55 year old Caucasian female presents to your office wanting to have the cataract within her right eye removed. The patient has been wearing toric SCLs for 10 years. Before cataract surgery can be performed, how long before surgery should the patient stop wearing her CLs?

Answer 6

Before cataract surgery, toric soft lenses should be removed for at least 2 weeks. Spherical soft lenses should be removed for at least 1 week, and RGPs for at least 4 weeks.

Question 7

You have a 4 day post-op LASIK patient in your exam chair. There were no complications during surgery. SLE shows central corneal opacification with no inflammation. Manifest refraction shows a large hyperopic shift. What is your best course of treatment for this patient?

Answer 7

This is Central Toxic Keratopathy. There is no treatment, only time will heal it (in 6-9 months).

Question 8

Which is considered the most important variable in IOL calculations, the axial length measurement or the anterior cornea measurement?

Answer 8

Anterior cornea because it is the most important surface, affecting both spherical power and astigmatism.

Question 9

According to Dr. McWherter, how can a subconjunctival hemorrhage created during cataract surgery reduce the risk of endophthalmitis?

Answer 9

It allows WBCs to reach the incision site more easily

Question 10

What type of patient qualifies for cataract surgery by most insruance standards

Answer 10

Someone who complains about problems with decrease VA with glare

Question 11

Who is a good candidate for mono vision with cataract surgery

Answer 11

Patient who did well with mono vision when younger and has cataracts and ptosis as the only exam abnormalities

Question 12

What patient is at highest risk for IOP spike after cataract surgery

Answer 12

Pigment dispersion and pseudoexfoliation patietns on 2 meds

Question 13

Who is a potential multifocal IOL candidate

Answer 13

Self proclaimed perfectionist patient who believes he can live with the halos shown on the online multifocal simulator

Question 14

Which of the following treatments has the lowest endophthalmitis rates after cataract surgery and is not disapproved by the FDA?

Answer 14

TriMoxi in the anterior vitreous during surgery with vancomycin in the AC

Question 15

TriMoxi should be avoided in which of the following patietns

Answer 15

Patietns with levaquin allergy

Question 16

Which of the following is true about laser cataract sx

Answer 16

The femtosecond laser creates a true circular capsulorhexis

Question 17

What is the risk invovled with iris manipulation during cataract surgery

Answer 17

Increases post op inflammation

Question 18

Your patient is wanting a multifocal IOL but in glare testing they see halos. They claim they would be okay seeing like that for the rest of their life. Would this be a contraindication to perform the cataract surgery with that specific IOL? Why?

Answer 18

This would not be a contraindication (in this case). The patient acknowledges the glare and is okay with living with it. If the glare were too much for the patient to deal with, another lens should be chosen prior to surgery

Question 19

When performing a slit lamp exam on a patient for their 1 week post LASIK visit you notice full thickness undulating stromal folds. How would the surgeon correct these folds in order to prevent them from being permanent

Answer 19

This finding is called macrostriae. Since the patient has been 24 hours post op, the proper way to treat this is by removing the epithelium. If macrostriae were seen within 24 hours following surgery, the LASIK flap could be lifted and smoothed down

Question 20

Regarding phakic IOLs, what is the vault and what is its purpose

Answer 20

It is to create space between the posterior surface of the IOL and the crystalline lens to allow adequate aqueous flow

Question 21

According to Dr. Findlay, if you have a PRK patient that’s develops stromal haze, when would you expect the haze to fade away

Answer 21

You should expect stromal haze to fade in about 6-12 months

Question 22

Name something that is usually not a mid to late complication of LASIK

Answer 22

Infectious keratitis. Onset is within the first 24 hours

Question 23

What two conditions can mimic diffuse lamellar keratitis

Answer 23

Infectious keratitis and pressure induced stroma;l keratitis or PISK

Question 24

When doing a pre op evaluation of the cornea for a patient who is wanting to have PRK, you notice a scar. The scar appears to be superficial to the flap interface. Is PRK still a good surgery option or should your patient pursue other surgical options?

Answer 24

PRK is still an option for this patient because it may remove the scar since it is superficial

Question 25

What are 4 relative contraindications of multifocal IOLs

Answer 25

Latent phorias Threat of disease that may affecte central vision Dry eye Perfectionist patietns

Question 26

When examining the conjunctiva before and after refractive surgery, why would you use lissamine green?

Answer 26

To monitor if dry eye has worsened following the refractive surgery

Question 27

You notice mictrostriae on your post LASIK patient. What must be done to help this patient? Does anything have to be done at all

Answer 27

This Econ’s from inital flap malpositiojn or slippage so you must repair it quickly before it becomes permanent. Lift and refloat the flap and stroke it down. If greater than 24 hours hours the epithelium must be removed

Question 28

What is the difference between keratoconus and form fruste keratoconnus

Answer 28

Keratoconnus is inferior corneal thinning of both eyes and form fruste keratoconnus is inferior thinning of one eye, but not the other. This is due to eye rubbing of only one eye. The treatment for keratoconnus can involve scleral CL or corneal collagen cross linking, whereas form fruste keratoconnus is not progressive, so there is no treatment necessary for it

Question 29

Post LASIK you see epithelial ingrowths moving toward center of the cornea with a decreased VA due to irregualr astigmatism. Would you treat, if so, how?

Answer 29

Yes, you would want to treat this patient due to the complain of decreased VA. The treatment would be to lift the flap back up, scrape the epithelium from the stromal bed, respoition the flap and then apply a bandage CL on the eye

Question 30

What is proper procedure if a buttonhole develops in the flap intraoperatively during LASIK

Answer 30

stop the procedure and replace the flap, then let the flap heal for 3-6 months and then do PRK

Question 31

What are 6 potential complications of refractive lens exchange?

Answer 31

Wound leak, IOP spike, endophthalmitis, TASS, CME, and RD

Question 32

When performing KRS on a mixed astigmat with a Rx of +1.00 -2.00 x 180 OU, how must you treat the patien

Answer 32

For a mixed astigmatism treat one meridian as simple hyperopic astigmatic and the other as simple myopic astigmatism. In this instance if would be Plano -1.00 x 180 and Plano +1.00 x 090

Question 33

A post cataract patient with a small axial length presents with high IPO and shallow AC depth both centrally and peripherally. What is the likely diagnosis and how can it be treated

Answer 33

``` Aqueous misdirection Three treatment options 1. Cycloplege (the patient typically would be for the cataract surgery itself) 2. YAG laser to anterior hyaloid 3. Pars plana vitrectomy ```

Question 34

SMILE, a refractive surgery that uses femtosecond laser to make an intrastromal laser cut has A similar outcome to LASIK. What is one benefit of SMILE compared to LASIK and why

Answer 34

Less risk of fry eye symptoms, in incision takes place withi nthe cornea without the need for a larger corneal flap resulting in less damage to corneal nerves

Question 35

Regarding a patient with Fuch’s who shows prominent bullae, what surgical procedure should be performed ASAP

Answer 35

Descemets Membrane Endotherlial Keratoplasy (DMEK)

Question 36

What is the difference between a posterior polar cataract and PSC

Answer 36

Posterior polar cataract has sharply demarcated borders

Question 37

Why should you never polish a posterior polar cataract

Answer 37

The capsule can rupture

Question 38

What corneal procedure has the highest rejection rate in the first 2 years: PL, DALK, DSAEK, or DMEK?

Answer 38

PK has the highest rejection rate in the first 2 years with 18% DALK 4% DSAEK 5-12% DMEK 1%

Question 39

In terms of corneal transplant methods, which method does not lead to corneal astigmatism

Answer 39

DMEK | Descemets membrane endothelial keratoplasy

Question 40

What are the two post op stages in penetrating ketratoplasty (PK)? What are the risks with each stage?

Answer 40

Epithelialization is the first stage and takes 1-2 weeks to occur. Patients run the risk of rejection and endophthalmitis Stromal healing is the second stage and takes 1 year. Patients do run the risk of infection from loose suture and rejection

Question 41

Which corneal transplant procedure is MOST useful for case of granular dystrophy that compromises a patients VA

Answer 41

Given the granular dystrophy is a stromal dystrophy, a PK would be indicated

Question 42

When you have a patient with a flat anterior chamber and high IOP what are two dx that should be suspected

Answer 42

Angle closure and malignant glaucoma (aqueous misdirection)

Question 43

What is the official treatment for malignant glaucoma

Answer 43

Pars plana vitrectomy

Question 44

What 3 tests are required at the initial post op visit within the first 3 days after cataract surgery

Answer 44

VA IOP Slit lamp

Question 45

DALK and OK have simialr stages and treatment. However, what are some of the slight differences with DALK?

Answer 45

DALK has: - less risk of rejection - can taper steroids earlier and remove sutures earlier - less blunt trauma risk

Question 46

What is the typical schedule of antibiotic, steroid, and NSAID drops following cataract surgery

Answer 46

ABX: q1h first day, TID x 3 more days Steroid: QID tapered 1 gt per week NSAID: dose depends on type

Question 47

A 45 year old male comes in in wtih confluent corneal guttata, what are possible treatment options

Answer 47

DMEK, if they choose to defer surgery, monitor every 6 months or sooner if symptoms worsen

Question 48

A patient reports for a post opt surgery with an epithelial defect. The surgical note states that TriMoxi was used during the procedure. In addition to BCL, what type of medication do you need to Rx

Answer 48

An abx

Question 49

You have a patient that comes in after cataract surgery. On examination you find their pressures to be 60mmHg OU. you recheck pressures after a couple minutes and once again find it to be 62mmHg OU. Would you want to burp the wound> why

Answer 49

Yes. You would want to burp the wound and recheck pressures after 30m. If pressures are still high, burp again and repeat every 30m until pressure stops rebounding

Question 50

When would you want to burp for post op cataract surgery

Answer 50

Depending on what the pressure is before you begin burping, you will need to continue doing so until you reach a desired IOP

Question 51

What does the burping technique consist of

Answer 51

Numbing, betadine, abx drops, lid speculum, then calmly press the sclera adjacent to the wound to release pressure, then give IOP drops

Question 52

With PK/DALK, what can be used to erase high astigmatism once healed and is referred to as the silver bullet

Answer 52

Toric IOL once healed is your silver bullet

Question 53

How often do you burp a patients eye with IOP of 60mmHg

Answer 53

As often as needed every 30-40m until IOP is consistently within normal limits

Question 54

Which topical IOP drop should be avoided in patietns with corneal edema

Answer 54

Cosopt

Question 55

What is a concern of prolonged inflammation after cataract surgery

Answer 55

CME

Question 56

What is a sign of endophthalmitis

Answer 56

Vitreous cells

Question 57

What is true of the femtosecond laser during cataract surgery

Answer 57

It creates a true circular capsulorhexis

Question 58

What are some potential causes of rebound inflammation

Answer 58

- greater inflammatory potential/history of uveitis - iris manipulation during surgery - retained hidden lens fragment (check angle and sulcus with gonio)

Question 59

What is true about a white cataract

Answer 59

They are often pressurized and need to be decompressed to prevent the “Argentinian flag sign”

Question 60

An exposed blue suture or haptic (eroded through conjunctiva) is

Answer 60

Simialr to an exposed glaucoma tube; needs abx and return to surgical practice

Question 61

Which patietns should be told they are at higher risk of complications during cataract surgery, higher risk of needing a second surgery, and should be referred to a more experienced surgeon

Answer 61

Posterior polar cataracts Phacodonesis White cataracts

Question 62

What is the best treatment for an eye that had high IOP and very shallow peripheral and central AC after cataract surgery, with no choridal hemorrhage?

Answer 62

IOP drops and cyclo LPI Something about posterior hyaloid membrane

Question 63

Signs of endophthalmitis include

Answer 63

Injection Vitreous cells Hypopyon Not SPK

Question 64

You see an hypopyon on POD 1, what is the most likely dx

Answer 64

TASS

Question 65

Which surgery has the fastest recovery

Answer 65

DMEK

Question 66

What is the correct order of surgeries in increasing order concerning the amount of host tissue removed

Answer 66

DSAEK=DMEK

Question 67

What is the best treatment for Fuchs

Answer 67

DMEK

Question 68

What can cause of edema in a transplant

Answer 68

- endothelial injection (acute immune attack) - bare stroma exposed to Aq humor - bare stroma exposed to isotonic tears - chronic graft failure (endo attrition)

Question 69

How do you tell the difference between a hypopyon and a pseudohypopyon

Answer 69

The hypopyon is flat and the pseudohypopyon is layered. The hypopyon is infection or inflammation and the pseudohypopyon is not inflamed

Question 70

A 60 year old AA male presents to your office for his post op cataract evaluation. You checked the patients IOP and you noticed an IOP spike. What should you do next and what could have caused that

Answer 70

You should perform gonio to examine the TM and see if it was unhealthy, which would habe caused the patient to have had a natural propensity for a IOP spike

Question 71

Refractive surprise tends to occur due to which factors and how would you explain this occurrence to the patient

Answer 71

The eye shifts during healing which may be due to unique biology of the individuals eye such as posterior corneal astigmatism. The dr should never blame the surgeon but explain that every eye and person is difference and sometimes it just happens

Question 72

What is the risk for posterior capsule opening

Answer 72

Vitreous traction Posterior cataract fragment Limited capsule support IOP spike

Question 73

What is the treatment of choice when a Fuchs patient presents with fibrosis and counting fingers VA

Answer 73

penetrating keratoplasty

Question 74

Regarding aqueous misdirection (malignant glaucoma), what are the 4 most common differentials

Answer 74

Wound leaks Choroidal effusion Angle closure Choridal hemorrhage

Question 75

What is the silver bullet to erase high astigmatism in PK/DALK

Answer 75

Toric IOL once its healed

Question 76

What is the difference between PRK and LASIK

Answer 76

In LASIK, a thin flap is created in the Cornea by a microkeratome or femtosecond laser. The flap is lifted to expose the underlying corneal tissue and is then replaced after the cornea is reshaped by an excimer laser. In PRK, the epithelium is removed and completely disregarded before the underlying corneal tissue is reshaped with an excimer laser. This is the main difference.

Question 77

What is an advantage of DMEK as compared to PK?

Answer 77

Descemets membrane stays intact with DMEK as opposed to PK where you have bare stroma. This also allows for less edema in DMEK.

Question 78

What type of corneal transplant provides the BCVA and lowest percent of tissue rejection?

Answer 78

DMEK

Question 79

Why does PK have such a high rate of rejection at 18%?

Answer 79

Because it replaces the endothelium and not just the stroma. Foreign endo is most likely to cause rejection.

Question 80

What is the #1 lost ophthalmic lawsuit?

Answer 80

The most commonly lost ophthalmic lawsuit is due to unmonitored steroid-induced glaucoma damage. As a side note, in the ophthalmology world, doctors win 90% of the cases brought against them.

Question 81

What are the two post op stages of a penetrating keratoplasty? And how long do each of the stages last?

Answer 81

Epithelialization and stromal healing. Epithelialization takes 1 day to 2 weeks and stromal healing takes 1 year (because sutures take a long time).

Question 82

Why is it bad to have loose sutures?

Answer 82

Increased risk of an infection!

Question 83

What is the most important step to remember BEFORE removing sutures on the eye?

Answer 83

Apply antibiotics and wait

Question 84

What are indications for a Deep Anterior Lamellar Keratoplasty (DALK)?

Answer 84

Stromal Disease with a healthy endothelium!

Question 85

Why do we want to keep the BSCL and antibiotic on the cornea for 1-3 months after the epithelium has healed?

Answer 85

We should treat PK patients as though they are neurotrophic then send back to the surgeon if an epi defect develops.

Question 86

You are about to do a corneal transplant on your patient with Fuch’s Dystrophy. You decide you want to do a DSAEK transplant. How would you explain to your patient the difference in DSAEK vs. DMEK (regarding the corneal components).

Answer 86

Both procedures include the same corneal layers except DSAEK does NOT include the stroma!

Question 87

How is DALK different than PK?

Answer 87

The healing process is different. The stitches can be removed in 8 months and there is less risk with blunt trauma with DALK.

Question 88

What is the most likely the cause of new corneal edema that resolves with steroids after a transplant as opposed to not resolving with steroids?

Answer 88

Edema that resolved with steroids was rejection. If it failed to resolve, it it may be endothelial attrition.

Question 89

What finding in a Fuch’s patient indicates the need for surgery as soon as possible?

Answer 89

Bullae

Question 90

What layers of the cornea are removed and replaced with a deep anterior lamellar keratoplasty?

Answer 90

Epithelium, Bowman’s, and stroma.

Question 91

After a Penetrating Keratoplasty, when should the patient wear goggles?

Answer 91

When participating in sporting events and when sleeping.

Question 92

How long does a patient have to lay for after a DSAEK?

Answer 92

24 hours

Question 93

What procedure has the same indication as DSAEK? And of the two, which is more difficult with ACIOL, PPV, tubes, large iris defects, etc?

Answer 93

DMEK has the same indications but is more difficult compared to DSAEK.

Question 94

At what time of day is the edema initially worse in Fuchs?

Answer 94

AM

Question 95

What is the difference between PRK and LASIK

Answer 95

In LASIK, a thin flap is created int he cornea by a micorkeratome or femtosecond laser. The flap is lifted to expose the underlying corneal tissue and is then replaced after the cornea is reshaped by an excimer laser. In PRK, the epjtelrium is removed and completely disregarded before the underlying corneal tissue is reshaped with an excimer laser

Question 96

If a patient has FUchs and presetns with guttata but not bullae, should they be referred to surgery, and if not, when should their follow up be?

Answer 96

Surgery not needed. Instead, the follow up should be in 6 months or sooner if symptoms worsen. If guttata are confluent, push for elective DMEK if they qualify

Question 97

How long does it take for the corneal stroma to heal after a penetrating keratoplasty

Answer 97

1 year

Question 98

What does DMEK stand for

Answer 98

Descemets membrane endothelial keratoplasty

Question 99

Morning blur in fuchs patient is likely indication of what

Answer 99

Bullae | Patient should be referred to surgery soon because morning blur is a sign that next stage in the fuchs patient is bullae

Question 100

What is an early sign of bullae in a fuchs patient

Answer 100

Morning blur

Question 101

What are some lifelong observations following PK that rewuire calling the surgeon ASAP

Answer 101

Redness, pain, blur (symptoms of loose suture, infection, or rejection)

Question 102

Name three conditions that can be associated with corneal ectasia

Answer 102

Down syndrome Floppy eyelid syndrome Connective tissue diseases

Question 103

What determines the severity of keratoconnus

Answer 103

Dr. Tenkmans preference is how severe the visual rehabilitation is

Question 104

What methods can we se or recommend in order to prevent keratoconnus progression in our patients

Answer 104

Patients should be advised to avoid rubbing their eyes. We can treat any ocular allergies the patient may have bad use corneal crosslinking in order to make it easier for the patience to stop rubbing their eyes

Question 105

What do you perform corsslinking on the worst eye first

Answer 105

You want to make sure the <1% risk of scarring doesn’t occur. If it does, it will most likely occur in the worst eye first

Question 106

What is conjunctivochalsis

Answer 106

Excess folds in the conjunctiva

Question 107

What is considered sub clinical DME progression

Answer 107

DME as a center point thickness (CPT) between 225 and 299um on a time domain OCT. progression is an increase in CFT of at least 50um and CPT of at least 300um

Question 108

What are the 3 most common macualr problems

Answer 108

1. AMD 2. RVO 3. DME

Question 109

What structure of the retina can be used to determine if drusen is large enough to start a patient on AREDS 2 to decrease the risk of progression of dry AMD

Answer 109

Retinal venules can be used to determine if drusen size is large enough to have success with AREDS 2 to slow poregssion of dry AMD

Question 110

Which type of patient benefits the most from AREDs vitamins

Answer 110

Patients with poor nutrition benefit the most from AREDS vitamins. Patients who already get the vitamins they need from their diet of leafy greens and vegetables won’t get much more of a benefit because ARMD cannot be managed only by increased amounts of vitamins once the necessary intake is met.

Question 111

A 68 year old female presents to your clinic experiencing central vision loss. She also is a current every day smoker. You dilate the patient and discover what appears to be dry AMD. What is one of the first things you would inform the patient to do

Answer 111

Stop smoking— smoking can dramatically increase your risk of AMD getting worse and progressing to Wet AMD

Question 112

What is most indicative of AMD treatment failure

Answer 112

The present of fluid on OCT

Question 113

When was the first AntiVEGF treatment FDA approved

Answer 113

2011

Question 114

How does AntiVEGF injections work to limit new BV

Answer 114

It binds to and stabilized the leaky retinal vessels increasing their structural integrity which allows them to not leak any of their contents into the retina

Question 115

What are some systemic concerns with lucentis treatment and what type of patietns are at most risk of blindness?

Answer 115

With any anti-VEGF treatment there is an increase risk systemically of hemorrhages, cerebrovascular events, myocardial infarctions, and hypertension. Diabetic patients are at an increased risk of blindness secondary to their already compromised vasculature. These patients already have increased risk of heart attack, stroke, etc.

Question 116

Which AntiVEGF drug has the best safety profile and why

Answer 116

Lucentis because it has the shortest half life

Question 117

Which of the AntiVEGF injections commonly used in Wet AMD has the highest efficacy?

Answer 117

Eyelea

Question 118

What os Ozurdex? What does it release? And what is it used to treat?

Answer 118

It is an intravitreal steroid. It has a much larger needled and injects a small pellet that allows the slow release of dexamethasone steroid over the course of a few months. It is used to treat diabetic macular edema.

Question 119

What is the standard of care for treatment of CRVO and what are the risks involved?

Answer 119

Anti-VEGF. CRVO patients normally are at risk of 90 day glaucoma but with anti-VEGF treatment the patient is at risk for neovasular glaucoma for a longer period of time, sometimes up to a year.

Question 120

How soon should you refer a patient who presents with a macular hole?

Answer 120

Surgery within 1 month

Question 121

How soon should you refer a patient who presetns with an ERM

Answer 121

Within 1-2 months

Question 122

How soon should you refer a patient that has a mac on RD

Answer 122

Same day, within 12-24 hours

Question 123

How soo should you refer a patient for surgery that has a mac off RD

Answer 123

Next day, within 1-7 days of onset. Not as urgent because VA will be the same regardless of same day vs 1 week later

Question 124

If a patient has recently eaten (within the last hour) what is the risk/complication that could happen during retinal surgery?

Answer 124

Patients have a possibility of asphyxiating on the food they have recently eaten due to complications/reaction to anesthesia used in retinal surgery

Question 125

When advising a patient who will be having retinal surgery requiring a gas bubble, how long should you let them know that it will be in their eye and how it iwill affect their vision

Answer 125

Let the patient know the gas bubble will be in their eye for about 3 weeks. Their vision will be blurry for the first week and a half which is normal

Question 126

A patient reports to your clinic for a follow up after a RD surgery. The patient was placed on accurate and is confused as to why they are taking the medication. What do you tell them?

Answer 126

According to Dr. Kitchens, this acne medication as well as other mediations such as methotrexate aid in halting a form of scar tissue formation called proliferative vitreoretinipathy (PVR)

Question 127

Which AntiVEGF has the highest chance of baseline VA after one year of injections

Answer 127

Lucentis + deferred laser

Question 128

What is the point of doing both a scleral buckle and vitrectomy instead of scleral buckle alone or vitrectomy alone?

Answer 128

scleral buckle and vitrectomy together have a 95% success rate at attaching the retina from the first surgery while each alone is about 85% success. And that is because the scleral buckle goes around the entire eye and reduces the risk of having additional tears while the vitrectomy decreases the chance of having a re-detachment. It is preferred to do a scleral buckle in younger myopic patients, and vitrectomy on patients with multifocal IOL because we would not want to induce myopia from using a scleral buckle unless necessary.

Question 129

What are possible risks of RD surgery

Answer 129

ERM Diplopia Ptosis Axial length change