EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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63 EW CORNEA October 2014 software of the femtosecond laser to create the lamellar cut; a specially designed keyhole-shaped mask was inserted in the internal part of the glass of the applanation cone to create a pocket. "The most import- ant intraoperative pearl is to remove the edematous epithelium from the cornea, allowing the laser head to applanate on a smoother surface," he said. "Another pearl is that ideally we should create the corneal lamellar pocket at 50% of the corne- al thickness." Placing the solution inside the cornea "to dehydrate the cornea to eliminate the pain and irritation that's present is truly novel," Dr. Trattler said. Case studies At the 2014 ASCRS•ASOA Symposium & Congress, Prof. Pallikaris presented results from his initial cohort of 4 patients who underwent the procedure using the WaveLight FS-200 femtosecond laser (Alcon, Fort Worth, Texas). The first 3 patients developed bullous keratopathy after cataract surgery; the first 2 had chronic open angle glaucoma and no light perception or hand motion vision. The third patient underwent penetrating keratoplasty for bullous keratopathy, had graft failure, and a blind eye due to steroid-induced glaucoma. All 3 patients were free of symptoms at last follow-up; the first patient has remained symptom-free for 2 years. Attempts to insert silicone oil into the cornea through a manually created pocket in the fourth patient failed. Because the technique is still being perfected and is in early stag- es, postop follow-up has been pa- tient-dependent, Dr. Pallikaris said. "We aim for a decrease in the corneal edema anterior to the sili- cone oil meniscus, which should be evident in the early postoperative phase. We may also facilitate corneal epithelialization using a therapeutic contact lens from 3 to 7 days," he said. Also, the amount of silicone oil needed to produce the results is not yet standard, but "ideally we should only need a uniform 'thin' film," he said. One patient needed to have some of the oil removed once it was determined via optical coherence tomography (OCT) and slit lamp that there was an excessive amount of silicone. For surgeons interested in re- peating the procedure, Dr. Pallikaris recommended using a femtosecond laser "in every case, as the preci- sion of pocket creation is crucial as corneal nutrition may be influenced, leading to complications." Dr. Trattler believes using sili- cone oil in a femtosecond-created pocket "has the potential to restore some vision to people who might be at the very low end of visual gain and may not be candidates for DSEK surgery." Dr. Trattler questioned if the procedure may have an effect on the patient's refraction. "A lot of work is left to be done, but it seems like this is a straight-forward procedure [that can] help improve the corneal surface and maybe even change the patient's refractive error," he said. Dr. Pallikaris acknowledged more follow-up is needed and addi- tional patients should be included in any future study of the technique. "This femtosecond laser-assisted procedure resulted in the retreat of bullous keratopathy symptoms, and was safe, effective, and repeatable," he said. "These are encouraging first clinical results." EW References 1. Levenson DS, Stocker FW, Georgiade NG. Intracorneal silicone fluid Arch Ophthalmol. 1965;73(1):90–93. 2. Pallikaris IG, Kymionis GD, Plaka AD, et al. Intracorneal Insertion of Biocompatible Material for Treatment of Bullous Keratopathy. Paper presented at the 2014 ASCRS•ASOA Symposium & Congress. Boston: April 25–29, 2014. 3. Kymionis GD, Diakonis VF, Kankariya VP, et al. Femtosecond laser-assisted intracorneal biopolymer insertion for the symptomatic treatment of bullous keratopathy. Cornea. 2014 May;33(5):540–543. 4. Gurelik G, Safak N, Koksal M, Bilgihan K, Hasanreisoglu B. Acute corneal decompensa- tion after silicone oil removal. Int Ophthalmol. 1999;23(3):131–135. Editors' note: Drs. Pallikaris and Trattler have no financial interests related to their comments. Contact information Pallikaris: pallikar@med.uoc.gr Trattler: wtrattler@gmail.com SOFT SHIELD ® COLLAGEN CORNEAL SHIELD OASIS ® IRIS EXPANDER MICROSURGICAL SCALPELS ® Premier Edge ® MICROSURGICAL SCALPELS CUSTOMIZE A SURGICAL KIT oasismedical.com/customsurgicalkits Choose from a wide variety of surgical instruments to design your custom surgical kit. 800-528-9786 (USA Toll Free) oasis@oasismedical.com www.oasismedical.com Find out how can help your practice. Intacs name and logo are registered trademarks of Addition Technology, Inc. Feather name and logo are registered trademarks of FEATHER Safety Razor Co., Ltd. OASIS, SOFT SHIELD, and PREMIER EDGE names and logos are registered trademarks of OASIS Medical, Inc. 514 S. Vermont Ave, Glendora, CA 91741. LIT-MultiEW_AD.Rev1_9.2014 Your Solutions Brought To Life. Visit Us at AAO Booth #4003