SEP 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 51 of 98

September 2013 Refractive challengesFebruary 2011 and innovations so as to avoid potential further complications with attempted corneal refractive surgery," he said. Reaction to surgery choice and the free cap Dr. Salz said that he believes the choice to do a LASIK procedure in this case was the correct option. He said he would have chosen LASIK surgery over other lens-based surgeries or refractive lens exchanges. He said other options that involve taking out the lens could increase the risk of a detached retina postoperatively, and there is not that same increased risk with LASIK. Dr. Salz said he believes the use of the mechanical microkeratome is the major factor contributing to the free cap complication in this procedure. He said in thousands of cases that he has done over the past eight years with the femtosecond, he has never had a free cap. It is possible for a free cap to occur with a femtosecond laser, though Dr. Salz said this is rare. Dr. Salz also emphasized the importance of presenting all possible options to the patient prior to surgery, ensuring a choice is being made based on informed consent. It is important to make sure the patient knows about both the microkeratome and femtosecond laser options, as well as the other procedures. "Free caps are a recognized complication with the microkeratome," Dr. Probst said. "They are generally associated with extremely flat corneal curvature (<40) or poor suction." However, he said that this type of complication is basically eliminated when using a femtosecond laser. "In this case, the outcome has been excellent as many cases of free flaps can result in induced astigmatism and epithelial ingrowth," Dr. Probst said. He would counsel the patient and explain that this complication is uncommon, yet it is a recognized complication of LASIK. "I would emphasize that she had achieved an excellent resolution of the complication with preservation of her best corrected vision," he said. Dr. Probst would also explain the many options the patient has moving forward, including PRK, LASIK again, or clear lens extraction (CLE). Dealing with the patient's refractive goals With this kind of complication, it's extremely important to take another look at the patient's refractive goals and determine how to proceed. "I don't think it's wise to take patients who are successful at monovision and try to talk them into more extensive and more risky lensbased surgery," Dr. Salz said. For a EW FEATURE 49 patient who has already done well with monovision, he does not think it is wise to do a high risk, expensive procedure. continued on page 50 Only One System Delivers the Shield of PROTECTION. DuoVisc® Viscoelastic System offers both the endothelial protection of chondroitin sulfate in VISCOAT® OVD with the proven mechanical protection and space maintenance found in PROVISC® OVD.1 1. DuoVisc® OVD Product Insert. © 2013 Novartis 1/13 VIS13003JAD One System. No Compromises.

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