Pembicara

Invited Speaker PIT 2016-2019

Invited Speaker Young Ophthalmologist Program 2016-2019

Invited speaker Zeiss Trifocal IOL, Jepara 2017

Invited speaker 4th Biennial Meeting Inascrs 2017

Invited speaker PAO Annual Meeting, Manila 2018

Invited Speaker JECIM, Jakarta 2018

Pendidikan

Profesi Dokter FK.UGM 2007

Profesi Dokter Spesialis Mata FK.UGM 2014

Master Ilmu Kedokteran Klinik FK.UGM 2014

Instruktur Phacoemulsifikasi 2014 UGM 2014

Member of Korean College of Cosmetic Surgery 2014

Member of Asia Cornea Society 2015

Member of INAVRS 2016

Member of INASCRS 2016

Member of APACRS 2016

Member of ESCRS 2017

R.Prabowo

(Bobby)

Pembicara

Advisory board of Alcon trifocal IOL 2018

Invited Speaker Foresight, Seoul 2018

Invited speaker of Tecnis Symfony IOL, Surabaya 2018

Invited speaker of Centurion User Meeting, Bandung 2019

Invited speaker of KMU Edu, Gresik 2019

Invited speaker 5th Biennial Meeting Inascrs, Jakarta 2019

Pembicara

Invited speaker Premium IOL meeting, Jogja 2019

Invited speaker of Medical and Surgical Refraction

Seminar, Semarang

2020

Invited speaker JECIM, Jakarta 2020

Invited speaker Basic Evolution Innovative IOL

Technology, JECIM, Jakarta

2020

Invited speaker Premium IOL meeting, Bandung 2020

“Dr.YAP”RUMAH SAKIT MATA

YOGYAKARTA

Jl. Cik Ditiro No. 5 Yogyakartawww.yap.or.id

Manajemen Kelainan

Refraksi dengan

Phakic IOL dan

Toric IOL

LOVE THE ENDOTHELIUM

KELAINAN REFRAKSI

Myopia

Hypermetropia

Astigmatism

Presbyopia

METODE KOREKSI

KELAINAN REFRAKSI

Laser in situ keratomileusis (LASIK)

Photorefractive Keratotomy (PRK)

Refractive Lenticule Extraction, Small Incision Lenticule Extraction

(ReLEx SMILE)

Phakic IOL (pIOL)

Refractive Lens Exchange (RLE)

Barsam A, Allan BDS. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database of

Systematic Reviews 2014, Issue 6. Art. No.: CD007679. DOI: 10.1002/14651858.CD007679.pub4.

Nanavaty MA, Daya SM. Refractive lens exchange versus phakic intraocular lenses. Curr Opin Ophthalmol 2012, 23:54 – 61

PHAKIC IOL

PHAKIC IOL

Lensa tambahan yang diimplantasi di kamera oculi anterior atau

posterior untuk koreksi kelainan refraksi dengan preservasi lensa

mata serta kemampuan akomodasinya

Seringkali digunakan sebagai metode koreksi kelainan refraksi

pada pasien dengan moderate to high refractive error

KEUNTUNGAN PHAKIC IOL

Menjaga arsitektur kornea

Menjaga fungsi lensa mata (kemampuan akomodasi)

Menjaga tear film

Hasil refraksi dapat diprediksi

Reversibel

KRITERIA INKLUSIUsia > 21 tahun

Refraksi stabil (perubahan visus <0.5D) minimal 1 tahun terakhir

Tidak dapat dikoreksi dengan prosedur laser

Toleransi buruk terhadap kacamata maupun lensa kontak

Irido-corneal angle ≥ 30o

Anterior chamber depth (ACD) ≥ 2.5-3.0 mm tergantung jenis pIOL

cECC >2.300 sel/mm2 (>2.500 sel/mm2 jika usia >21 tahun, >2.000 jika usia >40 tahun)

Tidak ada kelainan fungsi iris maupun pupil

Ukuran pupil mesopic <5-6 mm

Guell JL et al. Phakic intraocular lenses. Part 1: Historical overview, current models, selection criteria, and surgical techniques. J Cataract Refract Surg 2010;

36:1976–1993

KRITERIA EKSKLUSI

Adanya penyakit pada segmen anterior

Uveitis rekuren atau kronis

Adanya katarak yang signifikan secara klinis

Riwayat operasi kornea atau intraokular

TIO >21mmHg atau glaukoma

Adanya degenerasi makular atau kelainan makula

Abnormalitas retina

Adanya penyakit sistemik (kelainan autoimun, DM, atopi)

Guell JL et al. Phakic intraocular lenses. Part 1: Historical overview, current models, selection criteria, and surgical techniques. J Cataract Refract Surg 2010;

36:1976–1993

INDIKASI & KONTRAINDIKASI

INDIKASI

Kelainan refraksi tinggi (myopia ≥ -

5D, hyperopia ≥ +4D)

Kornea tipis

Corneal tomography abnormal

Dry eye

Kontraindikasi pada korneorefractive

surgery

KONTRAINDIKASI

Usia >45 tahun

ECC < 2500 sel/mm2

ACD <3.0 mm

ACA <30o

TIO > 20 mmHg

Kelainan intraokular

Sinjab MM. Five Steps to Start Your Refractive Surgery: A Case-Based Systematic Approach. Jaypee Brothers Medical Publishers: 2014.

PEMERIKSAAN PRE-OP

Pemeriksaan visus

uncorrected & corrected

Pemeriksaan slit-lamp

Tonometri

Motilitas okular

Ukuran, bentuk, dan lokasi

pupil

Specular biomicroscopy

Corneal tomography

Biometri

White-to-white measurement

Pemeriksaan fundus

Penghitungan pIOL power

Guell JL et al. Phakic intraocular lenses. Part 1: Historical overview, current models, selection criteria, and surgical techniques. J Cataract Refract Surg 2010;

36:1976–1993

JENIS PHAKIC IOL1. Anterior Chamber Intraocular Lenses

(ACIOL)

• Angle-supported ACIOL

• Iris-fixated ACIOL

2. Posterior Chamber Intraocular Lenses

(PCIOL)

• Sulcus-supported PCIOL

ANGLE-SUPPORTED ACIOL

IRIS-FIXATED ACIOL

IRIS-CLAW IOL ANTERIOR

1. Buat irisan 5.5 mm sklerokorneal/kornea

2. Buat dua parasentese 45o dari insisi utama

3. Masukkan iris claw di anterior chamber

4. Injeksi 2% HPMC

5. Pegang optic lensa dengan lensa forcep

6. Kaitkan iris perifer ke haptic dengan sinsky

hook/chopper/jarum udara

7. Lakukan pada haptic berikutnya

IRIS-CLAW IOL ANTERIOR

SULCUS-SUPPORTED PCIOL

KOMPLIKASI

Angle-supported resiko dekompensasi endotel

Iris-fixated teknik implantasi cukup rumit

Posterior chamber meningkatkan resiko katarak

TORIC IOL

METODE KOREKSI

ASTIGMATISMA

Limbal relaxing incisions/arcuate keratotomy

Laser in situ keratomileusis (LASIK)

Photorefractive Keratotomy (PRK)

Pemasangan toric IOL

TORIC IOL

Toric IOL adalah lensa intraokular yang bertujuan mengkoreksi

astigmatisma yang dapat terjadi post operasi katarak

Pada 1/3 pasien katarak, sudah terdapat astigmatisma 1 D atau

lebih

22% memiliki astigmatisma >1.5 D

Yamauchi et al. Comparison of visual performance of toric vs non-toric intraocular lenses with same material. Clinical Ophthalmology 2018:12 2237–2243

Yamauchi et al. Comparison of visual performance of toric vs non-toric intraocular lenses with same material. Clinical Ophthalmology 2018:12 2237–2243

Visser N et al. Toric intraocular lenses: Historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. J

Cataract Refract Surg 2013; 39:624–637

INDIKASI

INDIKASI

Sesuai indikasi tindakan ekstraksi

katarak

Astigmatisma pre-op ≥ 1-1.5 D

KONTRAINDIKASI

Astigmatisma irregular akibat ulkus

kornea atau ectasia

Instabilitas zonular

Dehisensi kapsul posterior

Dilatasi pupil buruk

Riwayat operasi mata (prosedur

vitreoretina)

PEMERIKSAAN PRE-OP

Pemeriksaan pre-op katarak

Keratometry penting untuk menentukan IOL power dan axis

Penghitungan toric IOL power

JENIS TORIC IOL

Monofocal toric IOL

Multifocal toric IOL

Toric phakic IOL

PERSIAPAN PRE-OP

Salah satu persiapan pre-op terpenting adalah marking kornea

PROSEDUR

TORIC MONOFOCAL IOL

PROSEDUR

TORIC MULTIFOCAL IOL

TOP 4 ERROR

PEMASANGAN TORIC IOL

1. Kesalahan pengukuran pre-op

2. Kesalahan marking kornea

3. Kesalahan peletakan IOL

4. Tidak memperhitungkan surgically induced astigmatism

membutuhkan kemahiran dan ketelitian operator

Roach L. Toric IOLs: Four Options for Addressing Residual Astigmatism.

REFERENSI

Barsam A, Allan BDS. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD007679. DOI: 10.1002/14651858.CD007679.pub4.

Nanavaty MA, Daya SM. Refractive lens exchange versus phakic intraocular lenses. Curr Opin Ophthalmol 2012, 23:54 – 61

Guell JL et al. Phakic intraocular lenses. Part 1: Historical overview, current models, selection criteria, and surgical techniques. J Cataract Refract Surg2010; 36:1976–1993

Kohnen et al. Phakic intraocular lenses. Part 2: Results and complications. J Cataract Refract Surg 2010; 36:2168–2194

Sinjab MM. Five Steps to Start Your Refractive Surgery: A Case-Based Systematic Approach. Jaypee Brothers Medical Publishers: 2014.

Pineda II R, Chauhan T. Phakic Intraocular Lenses and their Special Indications. J Ophthalmic Vis Res 2016; 11 (4): 422–428.

Yamauchi et al. Comparison of visual performance of toric vs non-toric intraocular lenses with same material. Clinical Ophthalmology 2018:12 2237–2243

Roach L. Toric IOLs: Four Options for Addressing Residual Astigmatism.

Visser N et al. Toric intraocular lenses: Historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. J Cataract Refract Surg 2013; 39:624–637

“Dr Yap” eye hospital Cold Phacoemulsification Cataract Surgery

2014

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