Eyeworld

EW REFRACTIVE SURGERY 54 February 2011 by Matt Young EyeWorld Contributing Editor Femtosecond procedures may result in complications T he femtosecond laser has added a new layer of precision to LASIK flap creation, and research suggests that it is a remarkable, though not error- free, device. A new report by George D. Kymionis, M.D., Ph.D., lecturer, Institute of Vision and Optics, Faculty of Medicine, University of Crete, Heraklion, Greece, and colleagues, found that a fem- tosecond inadvertently cut an epithelium- only flap. It was then necessary to convert the procedure to a PRK. "Despite the high predictability and safety of the femtosecond laser in terms of flap thickness, complications may occur," Dr. Kymionis reported. Notably, Ioannis G. Pallikaris, M.D, Ph.D., Heraklion, who per- formed the first LASIK procedure in 1989 and developed the Epi-LASIK procedure, co- authored the study. Dr. Kymionis added that complications of the femtosecond procedure include ep- ithelial and sub-epithelial gas breakthrough, visually significant epithelial ingrowth, in- complete flaps, and subconjunctival gas bub- ble formation. Of course, he noted, microkeratomes have their own set of com- plications, which include decentered or free flaps, buttonholes, epithelial abrasions, and irregular flap edges. from the Original Topical Anesthetic Gel THICKER IS BETTER 0HQWLRQWKLVDGDW$6&56%RRWKIRUD)5((XQLWGRVHVDPSOH )RUPRUHLQIRUPDWLRQFDOORUYLVLWZZZRFXVRIWFRP 2&X62)7,QF5LFKPRQG7; THICKER THICKER IS BETTER BETTER THICKER THICKER m the F V L 9 D U W H 7 ( 7 5 2 ) V L H V D H U F Q L G Q D W U R I P R F H E D O I I R J Q L V X I R V V H P o ro f O THICKER THICKER THICKER ginal J F L W H K W V H Q D \ W L V R F V L Y U H K J L K D V R U J Q L W D U H S R H K W Q L \ F Q H L F À I H V " V H L O O H M F L W H K W V H Q D O H ri O pi o T THICKER IS IS IS BETTER BETTER c G S V H Y R U S P L \ O W Q D F À L Q J L V W D K W O H J W L Z O D H G \ K : F L Q L O F H K W U R P R R cal Anestheti pi BETTER BETTER BETTER l W Q H L W D S H K W K W e c G BETTER for need Eliminates • prior use for Ideal • STICK WITH TETRA supplemental / drops multiple for injections intravitreal to prior VISC STICK WITH TETRA STICK WITH TETRAVISC ™ anesthesia intracameral supplemental anesthesia D prior use for Ideal • formulations, two in vailable A • G D V L K W Q R L W Q H 0 I Q L H U R P U R ) W injections intravitreal to prior etraVisc TetraVisc formulations, ™ Original D K W R R % 6 5 & 6 $ O O D F Q R L W D P U R G Q R P K F L 5 F Q , 7 ) 2 6 X & 2 S etraVisc TetraVisc and Original ™ TE FOR P D V H V R G W L Q X ( ( 5 ) D U R I P R F W I R V X F R Z Z Z W L V L Y U R ; 7 H TE O S Surgeons continued from P. 53 ing the cornea to get the gas bubbles to come up to the sur- face and escape or gently wiping the cornea with a sponge. For Dr. Lane, the main advantage of wavefront-guided ablation is the added safety and accuracy of the procedure. "Any time you have a piece of equipment that will improve safety, especially when you're talking about an elective pro- cedure, it has to be strongly considered," he said. "With modern-day LASIK, you can't afford to have bad results." EW Editors' note: Drs. Lane and Davis have no financial interests re- lated to their comments. Contact information Davis: eadavis@mneye.com Lane: sslane@associatedeyecare.com Although the femtosecond laser is safe and precise, it can result in complictions, such as epithelial ingrowth, pictured here Source: Edward J. Holland, M.D.

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