EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/387844
135 October 2014 EW MEETING REPORTER 'What Really Works in Corneal Refractive Surgery?' The "What Really Works in Corneal Refractive Surgery?" symposium explored a number of approaches for various corneal procedures. LASIK and PRK long-term results were discussed, as was astigmatism cor- rection, myopia, and correcting for presbyopia. The session was chaired by Daniel Epstein, MD, PhD, Zurich, Switzerland, and Julian Stevens, MD, London, U.K. Astigmatism correction with corneal incisions Thomas Kohnen, MD, PhD, Frankfurt, Germany, opened the session, discussing options for astigmatism correction with corne- al incisions. These options include astigmatic keratotomy (AK), limbal relaxing incisions (LRIs), and in the future, laser keratotomy (LK). "I think in the future, we will have femtosecond laser opportunities," he said. Instrumentation for these incisions includes using a knife and measurement device, which indicate how long and where the incision should be placed. The opportunity to do online measurements is an important addition, Dr. Kohnen said, but no- mograms still need to be improved, as these are important in planning, and surgeons must be sure to mon- itor their results. Location is also very important, Dr. Kohnen said. To achieve successful results, you need to know where to operate. Consid- ering corneal measurement is key when determining how and where to make an incision. "I think that the total corneal refractive power becomes very important," he said. Both the anterior and posterior cornea need to be examined to make sure the measurement is correct. Dr. Kohnen said that in terms of astigmatism correction with corneal incisions, we still have to work on standardization, nomograms, long- term results, and clinical outcomes. Intrastromal approach to myopia correction Jesper Hjortdal, MD, Aarhus, Denmark, discussed ReLEX SMILE (Carl Zeiss Meditec, Jena, Germany) in his talk on the intrastromal approach to myopia correction at the corneal refractive surgery symposium. SMILE consists of using a femtosecond laser to cut out a lenticule that is then manually dissected and removed. SMILE cuts fewer anterior nerves compared to LASIK because a flap is not made, D . Hjortdal said. Potential advantages of SMILE include corneal sensitivity better than with LASIK and theoretically better biomechanics. In terms of tear secretion and quality, there seems to be no difference between LASIK and SMILE. However, SMILE provides better optics. "It seems that SMILE induces less higher order aberrations and no spherical aberrations compared to LASIK," he said. The potential advantages of ReLEx SMILE concerning less dry eye problems and the concept of a biomechanically stronger cornea need to be confirmed in vivo, D . Hjortdal said. "ReLEx SMILE is efficient, pr - cise, accurate, and safe for treatment of moderate and high myopia, and for myopic astigmatism," he said. "Most surgeons prefer to do the enhancement by excimer laser ab- lation—either on the surface, in the stromal bed after creation of a flap, or opening the cap." Finding the right angle can be challenging ! Finding the correct orientation of a Toric IOL implant is not an easy task ! The OCULUS Pentacam ® can help: 9 Topography of anterior and posterior corneal surface 9 Total corneal refractive power 9 Evaluation of corneal optical densitometry 9 Support for selection, orientation and calculation of Toric IOLs Visit the OCULUS Booth #820 at the AAO 2014 in Chicago www.oculususa.com Email: ads@oculususa.com • Tel: 888-519-5375 Sign up for the Pentacam ® educational events at www.pentacamseminar.com continued on page 136