NOV 2013

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

Issue link: https://digital.eyeworld.org/i/220233

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Page 31 of 122

February 2011 November 2013 EW REFRACTIVE SURGERY 29 Focusing continued from page 27 retreatment could be reduced by creating a side cut. Included in group 1 were 24 eyes of patients coming in for retreatments. In group 2 were 103 eyes of 80 patients who underwent traditional LASIK flap lifts. When investigators reviewed the charts of these patients they found that those who had their original LASIK done in the relatively distant past had a higher risk of epithelial ingrowth than those who had undergone the procedure more recently. Also, how the original flap was cut appeared to make a difference. "We saw that patients who had their original LASIK done with a microkeratome had a higher risk of epithelial ingrowth when retreated than patients who were done with a femtosecond laser," Dr. Yoo said. When results were stratified according to how the original flap was cut, the difference was evident. Those who had their original surgery done with a microkeratome followed later by a flap lift were at much higher risk than microkeratome flap patients who later had a side cut, Dr. Yoo observed. The study determined that those retreated with a side cut had an epithelial ingrowth rate of just 21% versus 83% for microkeratome cases where the flaps were lifted. Dr. Yoo believes it is the architecture of the side cut that makes it so successful at keeping ingrowth at bay. "I think it creates a very sharp and clean edge and compared to a microkeratome edge of a LASIK flap tends to be more vertical," she explained. "That sort of morphology of having a more vertical side cut may be helpful in preventing epithelial ingrowth." Still, side cuts can result in other complications. In another study that Dr. Yoo took part in, published in the August issue of the Journal of Refractive Surgery, investigators reported on complications in creation of side cuts after primary LASIK. Included here were two patients who experienced issues resulting from a piece of stromal tissue displaced during side cut creation, Dr. Yoo noted. "These were cases where the new side cut intersected the old (flap) edge," she said, adding that there was a sliver of tissue that was lost or displaced, resulting in irregular astigmatism. Investigators determined that this came down to proper patient selection. "You need to choose the patients that are best suited for this technique—those who have large, well-centered flaps who now require a myopic enhancement," Dr. Yoo said. "That would ensure that you have at least ½ mm (margin) on all sides." Overall, Dr. Yoo urges practitioners to confine the use of side cuts for retreatments to patients who have myopia or myopic astigmatism. "If a hyperopic treatment is necessary then you're not going to have enough room to do this," she warned. Also, since study results indicated that the time since the initial LASIK was a factor in epithelial ingrowth, she recommended that this be taken into account. "Another reasonable approach would be to consider a surface ablation for patients who are greater than three years out from their original LASIK because even with the new side cut technique there were still some cases that developed epithelial ingrowth," she said. EW THINK EFFICIENCY "Thanks to LENSAR, I am able to perform cataract surgery 3 minutes faster than I was prior to implementing the laser. And with my wonderful staff, my turnover times are also faster, so I am experiencing greater effciencies than ever before." Editors' note: Dr. Yoo has financial interests with Alcon (Fort Worth, Texas), Abbott Medical Optics (Santa Ana, Calif.), and Carl Zeiss Meditec (Jena, Germany). Contact information Yoo: 305-326-6322, syoo@med.miami.edu 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 – William Soscia, MD Scan to learn about LENSAR at AAO 2013

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