EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/387844
59 EW CORNEA October 2014 astigmatism touch-ups for patients with higher levels of postop astig- matism. Using the anterior side cut setting of the IntraLase, the surgeon can place AK arcuate incisions inside of the graft host interface. Improvement in outcomes with femto PK can be attributed to precise tissue apposition, but such precision in matched tissue planes must be accompanied by a modification of suturing technique in order to allow the patient to achieve all of the ben- efits of this technolog . The classical PK suturing directive made use of deep, tight bites made to ensure ap- position of posterior corneal layers. Such tight, deep suturing with un- even tension often leads to irregular astigmatism and prolonged visual recovery. The zigzag IntraLase tem- plate permits a "tongue and groove" effect between donor and recipient. When combined with a modific - tion of suture technique, the match- ing planes may be opposed without creating unwanted excessive tissue tension. Suture passes are placed at the junction of the anterior side and lamellar ring cut and are tied with the Terry slipknot technique to allow for even tissue tension and healing vectors throughout the graft host interface. Compared to the traditional vertical PK wound profile, the IntraLase zigzag template increases the length of the wound healing interface, yielding improved wound stability and rapid healing. To maxi- mize clinical outcomes, attention to detail is paramount. In order to en- sure an accurate foundation for the interlocking zigzag effect, I typically start the suturing process with the meticulous placement of 4 cardinal 8.0 silk suture passes, which are later substituted with 10-0 nylon. Proper placement of these first 4 sutures will ensure appropriate opposition as the suturing process is completed. With this technology, we no longer need to give patients un- predictable outcomes with lengthy rehabilitation, poor quality vision, and the inability to wear corrective lenses or glasses due to irregular astigmatism. The corneal surgeon who offers this state-of-the-art technology can now allow kerato- plasty patients to achieve the kind of predictable and repeatable results that we have come to expect from the family of refractive surgical procedures. EW Editors' note: Dr. Fox is medical director of the Cornea and Refractive Surgery Practice of New York and the Clarity/TLC Center in New Jersey. He has no financial interests related to this article. Contact information Fox: foxmd@laserfox.com