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February 2015
EW MEETING REPORTER
he now thinks that it should be
introduced after residents have per-
formed about 50 manual procedures.
He thinks that FLACS will be part
of the future of refractive cataract
surgery and should be taught in
training programs.
Editors' note: Dr. McCulley has
financial interests with Alcon.
How to handle mid stromal
corneal opacities
Christopher Rapuano, MD,
Philadelphia, spoke about hemi-
automated anterior lamellar kerato-
plasty, which is a procedure that can
be used particularly for mid stromal
corneal opacities.
Anterior lamellar keratoplas-
ty (ALK) with a microkeratome or
a femtosecond laser uses a depth
plate, Dr. Rapuano said, but the in-
herent procedural problem with this
is that if the recipient cornea is not
of uniform thickness, the residual
posterior cornea will also not be
of uniform thickness if a uniform
thickness anterior lamellar cap is
removed.
The ideal solution for mid
stromal pathology includes smooth
donor and recipient beds, no donor
cornea/recipient bed thickness
mismatch, no donor cornea/recipi-
ent size mismatch, minimal risk of
perforation/conversion to penetrat-
ing keratoplasty (PK), and is not
too time consuming. This is where
hemi-automated anterior lamellar
keratoplasty (HALK) comes in. The
donor anterior corneal button is
fashioned with a microkeratome and
trephined. The surgeon can select a
specific microkeratome depth plate
and the exact graft diameter. Despite
some potential advantages of using
HALK, there are also some disad-
vantages. The blade dissection of
the recipient does not always create
a smooth stromal bed of uniform
thickness, and even if uniform, the
thickness of the donor cornea does
not always equal the thickness of
what was removed.
Dr. Rapuano concluded by
highlighting which keratoplasty
procedures are ideal in certain
situations. Microkeratome-assisted
ALK and excimer laser PTK work
well for superficial corneal patholo-
gy, he said. DALK works well in
deep pathology. HALK is a good
option for mid depth stromal
pathology, especially with areas of
varied corneal thickness, he said. EW
Editors' note: Dr. Rapuano has no
related financial interests.
View it now: Hawaiian Eye 2015 ... EWrePlay.org
Sonia Yoo, MD, discusses complex scenarios involving femtosecond laser-assisted
cataract surgery.
