Eyeworld

Patients have more options than ever C orneal transplantation for keratoconus may soon be a thing of the past, ac- cording to a study from the cornea clinical com- mittee of the American Society of Cataract & Refractive Surgery to be published in a forthcoming issue of the Journal of Cataract and Refractive Surgery. Authors Jose Guell, M.D., Ph.D., associate professor of oph- thalmology, Autonomous University of Barcelona, Spain, and Sheraz Daya, M.D., medical director, Cen- ter for Sight, London, present read- ers with a comprehensive overview of the current surgical management strategies available for progressive, non-inflammatory corneal thinning. Ectasia comes in many forms, the most common being kerato- conus. Likewise, treatment options for ectasia and keratoconus are nu- merous. Where do we stand at the moment? What evidence is there to suggest these alternative therapies provide a benefit to patients? Those are the questions Drs. Guell and Daya attempt to answer in their paper, Surgical Management of Ecta- sia. "In Europe, we have access to a lot more therapeutic methodologies than U.S. surgeons," said Dr. Daya. "With all of these different method- ologies, the paradigm of how to treat keratoconus is changing. A lot of these therapies are investiga- tional. For instance, doing photorefractive keratectomy and crosslinking the cornea at the same time is investigational but seems to have some validity. There are so many different methodologies avail- able, where do they all fit in?" The authors acknowledged that patient management strategies vary widely from country to country and often depend on the surgeon's expe- rience and skill level, as well as avail- able technology and severity of the patient's condition. "For example, crosslinking is not yet accepted in the U.S.," Dr. Guell said. "It's still under FDA ap- proval. But intracorneal rings can be used in the U.S. and in Europe." Traditionally, management has been glasses followed by contact lenses, and that method represents the treatment of choice in 90% of patients. If contacts failed, then often surgeons would go straight to a corneal transplant. "That's changed now with all of these different methodologies," Dr. Daya said. "We can delay transplan- tation, rehabilitate vision using other methods, and may eliminate transplantations altogether. If we do a transplant we can do one that is less risky and almost eliminate the chance of corneal blindness." Drs. Daya and Guell list a num- ber of alternative management op- tions such as collagen crosslinking EW REFRACTIVE SURGERY February 2011 55 by Faith A. Hayden EyeWorld Staff Writer The surgical management of ectasia 4StewartCourt,DenvilleNJ07834•USA ☎ 973-989-1600•800-225-1195•Fax973-989-8175 globe@katena.com•www.katena.com Designed by Dominick Benedetto, MD of Bayonne, NJ K3-2528 Designed by Perry Binder, MD of San Diego, CA K3-2526 Hersh IntraLase Spatula Designed by Peter Hersh, MD of Teaneck, NJ Thisnewdouble-endedinstrumentfeaturesa6mm longspatulaononeendanda10mmlong spat- ula on the opposite end. Each spatula has a roundedanteriorsurfaceandaflatposterior sur- face with a 2mm beveled tip. The tip is used to break through the edge of the flap, allowing the spatula to easily enter the intrastromal space for planar stripping of the interface. ® Designed by Richard Thorlakson, MD of Phoenix, AZ K3-2536 Thorlakson Z-LASIK Flap Lifter TM Thisnewdouble-endedinstrumentwasdesignedto both identify the edge and easily dissect a LASIK flap created with a femtosecond laser. It features a modified Sinskey Hook on one end which aids in finding an entrance site for the spatula to start the separation. Ontheoppositeend,the12.25mmlong spatula is used to undermine the flap while the two 2.25mmnotchesatthetiphelptodissectanyadhe- sions that may be encountered. Top View Specially designed to undermine and elevate a corneal flap, this 12mm long spatula has a unique 1mm tip which is used to enter the interface. The semi-sharp edges and flat posterior surface of the spatula are utilized in the interface to break through any small adhesions that might remain. Top View Benedetto IntraLase Spatula Designedtoliftacornealflapcreatedwitha fem- tosecond laser, this instrument features a 10mm long, bi-convex spatula with semi-sharp beveled notches near the tip. This design keeps the tip in theintrastromalplaneandminimizes vectorforces as the spatula sweeps under the flap. Should an adhesion be encountered, the notches are used to cut through and complete the dissection. Top View ® Femtosecond LASIK Instruments Binder IntraLase Flap Elevator ® Z-LASIK is a trademark of Ziemer Ophthalmic Systems AG TM IntraLase is a registered trademark of Abbott Medical Optics ® Femtosecond LASIK Instruments K3-2522 continued on page 56 May 2011

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