Eyeworld

Reporting from the 2015 Combined Ophthalmic Symposium, August 21–23, Austin, Texas EW MEETING REPORTER 128 October 2015 Refractive enhancements: Flap lifts or PRK? Refractive surgeons need to have a strategy for managing less than perfect visual outcomes, said Surendra Basti, MD, Chicago, during the "Refractive Surgery and Presbyopia Correction" session. Retreatments are common after LASIK, and the majority of retreat- ments during the first year are done by lifting the existing flap. After the first year, however, lifting the flap becomes more controversial. While it is an option, there are risks in- volved, such as epithelial ingrowth and flap tears, Dr. Basti said. In these situations, PRK may be a better retreatment modality because of its safety profile, Dr. Basti said. PRK is especially preferable if patients have dry eye, scarring at the edge of the flap, and flaps where the bed thickness is likely to be thin. For PRK retreatments, take care to avoid placing inadvertent forc- es on the edge of the flap during epithelial debridement, avoid using an Amoils brush, and use 0.02% mi- tomycin-C for 15 seconds to prevent haze. Relifting the flap is still an option, Dr. Basti added, but keeping the surface of the flap moist is key. If you're going to relift the flap, follow the convex contour of the cornea during dissection and be meticulous with cleaning the epithelium at the edge of the bed and flap. Editors' note: Dr. Basti has no financial interests related to his comments. What's new in 2015— video symposium The final session of the meeting was moderated by Douglas D. Koch, MD, Houston, and Christina Weng, MD, Houston, and featured video presentations detailing what surgeons are doing new in their practices in 2015. Richard Tipperman, MD, Bala Cynwyd, Pa., focused his presen- tation on things that he's changed in his standard technique. The first point he highlighted was the importance of ergonomics. "I am paying much greater attention to OR ergonomics than ever before,"

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