RIL CALCULATOR

RIL-PRE OPERATIVE CASE RECORD FORM

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SURGEON NAME

SURGEON CONTACT NUMBER

PATIENT NAME

AGE

HOSPITAL NAME & PLACE

SURGEON MAIL ID

GENDER

Male Female

DATE

a.	Minimum endothelial cell density - cells/mm2	Age Group	Yes or No
	2800	21 to 25	Yes No
	2650	26 to 30	Yes No

Minimum endothelial cell density - cells/mm2	Age Group	Yes or No
2400	31 to 35	Yes No
2200	36 to 45	Yes No
2000	46 and Above	Yes No

b. ACD more than 2.8mm

Yes No

c. Spherical Power Remains same in Past One Year

Yes No

If anything NO from above Questions Not advice for recommendation of RIL

NAME OF THE BIOMETRY

PARAMETERS		RIGHT EYE	LEFT EYE
VISUAL ACUITY (Uncorrected)
VISUAL ACUITY(Best Corrected)
Subjective Refraction
	Spherical
	Cylinder
WHITE TO WHITE in mm (DIGITAL CALIPER )
CENTRAL CORNEAL THICKNESS in microns (CCT)

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