The quality of vision in the postoperative period: a fundamental goal for the eye surgeon and one that, as Dr Antonio Randazzo tells us in our interview, in the case of cataract surgery has a good chance of being fully achieved, thanks in part to the most advanced technologies and the EDOF IOL, which ensure optimal vision at all distances.
Can you tell us how you came to Ophthalmology and describe your current professional profile?
I received a dose of professional passion from my father, Dr Salvatore Randazzo, so we can say that I am a 'son of art'.
After an institutional course at the University of Catania, I then turned to French healthcare for my training, first as FFI (Faisant Fonction d'interne) e Assistant des Hôpitauxand subsequently upon completion of the training I was hired as a structured doctor, Praticien Hospitalier.
For about 2 years, I had the honour of leading the vitreo-retinal surgery service at Le Mans Hospital (CH Le Mans).
After returning home, I started several surgical collaborations in various facilities in the area.
Can you tell us about an unusual or particularly complex clinical case that you managed to handle and solve?
We are dealing with a 65-year-old patient, hypermetropic +2.75 D and astigmatic 1.50 D in OD and +3.5 D with -1.75D in OS (dominated eye) with bilateral cataract.
The patient expresses the wish to have an IOL implanted that can, as far as possible, eliminate visual defects.
In the course of the preparation we realise that we have all the congruous parameters for the implantation of a Fusion system (Mini WELL in OD and Mini WELL Proxa in OS with -0.25 myopes).
Unfortunately, performing dynamic pupillometry we realise that the K-angle is high in OD (Ph. 1).
In agreement with the patient and having fully explained all the details of the procedure, it is decided to proceed with the procedure by performing a surgical modification of the K-angle at the same time as the IOL implantation.
This modification consists of performing 3 small iris sphincterotomies after IOL implantation (Ph. 2).
In the post-operative one can clearly see that the pupil is well centred at the corneal vertex (Ph. 3) such that the IOL can perfectly fulfil its focal extension function (EDOF).
The end result, once the other eye had also been operated on, was greatly appreciated by the patient who no longer wears glasses except for an occasional pre-fitted sf +1 temple lens for DIY.
A few tips for young colleagues starting out in Ophthalmology.Â
The training of a refractive surgeon must be based on an excellent mastery of phacoemulsification and accompanied by a theoretical foundation of all anterior segment semeiotics.
Today, any refractive surgeon should have the latest technology to perform such procedures in a standardised manner, such as using new generation biometers or electronic IOL alignment systems.
But all this alone is not enough because in order to choose the best refractive solution for the individual patient, there is also a need to first understand the patient's psychology and expectations and then clearly explain the advantages and limitations of the procedure.
In the preoperative discussion, one must avoid miracle scenarios, but at the same time reassure the patient with one's seriousness and experience in the field.
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