Left eye
Nose

Arc 1 Axis

Arc 2 Axis

Incision 1

Arc 1 Length

Arc 2 Length

Incision 2

Nose

Patient information

Date of birth

Date
Month
Year
Patient ID
Notes
Eye
PRE-OP BCVA
PRE-OP UCVA

Refraction

Sphere
Cylinder
Axis

Parameters

Tunnel

Inner diameter
Outer diameter
Depth
Width

Segment

Width
Thickness
Length

Outer cut

Diameter
Depth

Inner cut

Diameter
Depth
Surgeon

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CUSTOMIZATIONS

Nose
Nose
INTRAOPERATIVE PLAN

DATE OF BIRTH

00 / 00 / 0000

PATIENT ID

EYE

LEFT

Surgeon name

Channel

WIDTH

Inner diameter

Outer diameter

Depth

Incision 1 axis

Incision 2 axis

Implant 1

Central axis

Cw limit

ccw limit

Implant 2

Central axis

Cw limit

ccw limit

Notes: