OCT 2013

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

Issue link: https://digital.eyeworld.org/i/194331

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October 2013 have become quite popular," she said. Dr. van Meter uses Fugo blades (Medisurg, Norristown, Pa.), and recommends surgeons get a "deep dissection, as leaving extra stroma in the bed will decrease the patient's vision down the road." Keys to acceptance Currently, no prospective, randomized studies exist to elucidate which technique is better, Dr. van Meter said. "It's good to know how to perform DALK, but endothelial keratoplasty provides a faster visual recovery," he said, but thinks the advantages of preserving endothelial cells and graft integrity while reducing the risk of rejection may help DALK increase its acceptance. For the time being, though, "the advantages do not outweigh the disadvantages." Dr. Beltz said case selection may be the single most important factor "for reliable use of the microkeratome. For the beginning surgeon, I would advise selecting cases with central corneal thickness of 380 microns or more," she said, and uses the CB microkeratome system (ALTK, Moria), which employs a gas turbine-driven microkeratome to perform both the recipient as well as the donor lamellar cut with the use of an artificial chamber. She recommends using the "zero" suction ring to reliably create a host cut of 9.0 mm diameter. Dr. Lee only converts to full thickness surgery if he sees a macroperforation during the stromal portion of the removal. He prepares his own tissue and waits until he knows he has a successful big bubble before prepping the donor tissue. "I typically use an 8.5 mm trephination and punch it right at the beginning of the case, only to peel away Descemet's membrane and endothelium after recipient stromal removal has been successful," he said. The advent of the femtosecond laser means "the trephination is going to be perfect," he said, which may increase the likelihood of surgical acceptance. EW Editors' note: Drs. Beltz, Lee, and Van Meter have no financial interests related to this article. Prof. Busin has financial interests with Moria. Contact information Beltz: jacquelinebeltz@mac.com Busin: mbusin@yahoo.com THINK EFFICIENCY "As a new user, I can say that the LENSAR Laser System was easy to add to my existing surgical routine. In fact, from day one, I was able to integrate the femto laser without increasing total procedure time." EW CORNEA 57 Lee: wblee@icloud.com Van Meter: wsvanmeter@aol.com At LENSAR™, we're always thinking ahead. That's why we designed the LENSAR Laser System with your effciency in mind. Automated procedure planning based on customizable surgeon preferences, pre-programmable laser-to-patient positioning, and an easy-to-use joystick for docking control reduce suction time and improve effciency. Combined with thoughtful ergonomics, you can seamlessly integrate the LENSAR Laser System into your existing surgical regimen without increasing overall procedure time. The LENSAR Laser System. Designed for effciency, designed for you. Learn more at LENSAR.com – Steven Shanbom, MD Scan to learn about LENSAR at AAO 2013

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