EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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August 2012 Refractive challenges and innovations February 2011 EW FEATURE 37 neapolis, and founder, Minnesota Eye Consultants, Minneapolis. He uses MMC for 1-2 minutes followed by a thorough rinse in his post-ker- atoplasty patients. This contrasts with only 12 seconds of MMC in most PRK patients who have not had a previous keratoplasty. Dr. Lindstrom has used LASIK before in keratoplasty patients but has found better results with his current approach. However, without MMC, he noticed the patients got a good deal of corneal haze. "The surface ablation approach seems to give a better outcome for us. You get some smoothing and higher order aberration reduction if you can get a good wavefront read- ing and manage defocus and astig- matism," he said. Dr. Lindstrom's successes in this area have included a patient who was visually disabled and contact lens intolerant; after surgery, the patient had 20/25 visual acuity, and Dr. Lindstrom had corrected 11 D of astigmatism. In addition to PRK, LASIK is another option, Dr. Berdahl said. "LASIK flaps have the benefit of less likelihood of re-epithelialization difficulties and haze formation," he said. Toric IOLs under a PK are also an option, Dr. Berdahl explained. "The downside is that if the patient needs a PK in the future, he will have lenticular astigmatism in the IOL," he said. Dr. Kanellopoulos will use an IOL if the patient has signifi- cant anisometropia. He has used the Artisan phakic IOL, the Artiflex toric phakic IOL (both from Ophtec, Groningen, the Netherlands) placed on the iris, the Visian ICL (STAAR Surgical, Monrovia, Calif.), and the Cache (Cache AcrySof, Alcon, Fort Worth, Texas). Dr. Kanellopoulos also com- monly uses astigmatic keratotomy (AK) in these patients. In its tradi- tional form, AK is limited in terms of reproducibility and long-term effi- cacy, he said. "Femtosecond laser-as- sisted astigmatic keratotomy appears to offer a significant advantage in this technique, and we have been re- cently using the LenSx femtosecond laser [Alcon] in performing fem- tosecond laser-assisted and OCT- guided astigmatic keratotomies with excellent success," Dr. Kanellopoulos said. Before the laser was available for this use, he had used a diamond Whether you're just beginning or experienced in cataract and refractive surgery, ASCRS is the professional society that's right for every stage of your career. Young Ophthalmologists & Residents When you're the newest member of the team, things can be a little overwhelming. ASCRS can help with the transition. Our monthly Journal of Cataract and Refractive Surgery, Annual Symposium, and online educational initiatives work to continuously augment your formal training. Through them you'll meet like-minded young ophthalmologists facing similar challenges and concerns, along with those who've successfully navigated the waters and can provide the guidance to answer your clinical, financial, and practice management questions. For young practitioners, ASCRS is where the anterior segment ophthalmology community comes together. ASCRS offers U.S. residents and fellows an unmatched opportunity to experience anterior segment ophthalmology beyond your training program—all at no cost! Resident and fellow membership, which includes the Annual Symposium, is free during your training. ASCRS makes it easy to gain real-world experience and education with no added cost. Join ASCRS today! The Society for Surgeons AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY 4000 Legato Road, Suite 700, Fairfax, VA 22033 • 703-591-2220 • www.ASCRS.org blade set at 110% of the depth at the 6-mm optical zone. One limitation with the femto- assisted AK approach is that the maximum cylinder that can be cor- rected is 5 or 6 D. In situations that require higher correction, he recom- mended using AK along with PRK or LASIK. Dr. Kanellopoulos prefers to perform the AK within the graft, including an optical zone of under 8 mm. Other options include perform- continued on page 38 An ASCRS Membership For every stage of your career