Eyeworld

EW SECONDARY FEATURE 96 March 2016 Save up to 64% compared to other iris expansion products! "For the cost, ease of use and effectiveness, the Xpand NT is absolutely the best pupillary expander available." - Charles H. Williamson, M.D., Baton Rouge, LA "The Xpand NT is an excellent, cost effective alternative for pupil expansion." - Richard J. Ruckman, M.D., Lufkin, TX "I have found the Xpand NT pupil expander to be the most effective device that allows me to perform femto second laser capsulotomy and lens fragmentation in patients with small pupils." - Y. Ralph Chu, M.D., Bloomington, MN "Xpand Your View" Visit us at ASCRS 2016 in Booth 744 DIAMATRIX Quality • Value • Innovation R 210 Nursery Road, The Woodlands, TX 77380 (T) 800.867.8081 (F) 281.292.5481 (W) www.diamatrix.com (E) info@diamatrix.com Doc 20160215 TM Conflict of Interest Statement: None of the physicians listed above have any financial interest in Diamatrix Ltd or its affiliated companies nor were they compensated for their statements. v Small MICS incision v Eight point iris fixation v Advanced titanium alloy v Quick, easy and secure iris engagement v Creates a nearly circular, 6.7mm diameter pupil v Available in both single-use and multi-use formats v Simple and intuitive insertion, placement and removal v Designed for minimal iris trauma during placement and removal release the lenticule edge," he said. "Without this technique, some surgeons have had to unnecessarily switch the patient to PRK. It is also important to use a lenticule dissec- tor instrument specifically designed for SMILE to minimize the trauma to the stroma from the lenticule extraction. We now consider this part of the routine procedure, not a complication." LASIK flap and retreats from there, Dr. Reinstein said. PRK is also a retreatment option. David Donate, MD, Lyon, France, developed a new retreatment method called sub-cap-lenticule-ex- traction (Sub-Cap-LE), which he described as a modified SMILE pro- cedure at the same depth as the first without the upper cut. "Then the inferior face of the previous interface becomes the superior face of the new lenticule," he said. "The point is to avoid a millefeuille—or layered effect—by performing another regular SMILE, which is difficult to place above or below the first SMILE." This technique, which Dr. Donate presented at the 2015 International Society of Refractive Surgery annual meeting in Las Vegas, maintains the benefits of the original SMILE procedure, but he said it is the trickiest retreatment option, especially if the lenticule is thin. The case report describing Sub- Cap-LE published in the Journal of Refractive Surgery in October 2015 noted that "more cases are needed to develop a consistent surgical protocol." Dr. Donate said another com- plication of SMILE is a tear of the incision to the cornea. He advised surgeons to be focused during the procedure to avoid this situation altogether. Overall, Dr. Donate said if the surgeon is comfortable with docking the patient and the laser, SMILE is not difficult, provided "all the steps of the procedure are well respected." EW References 1. El-Naggar MT. Bilateral ectasia after femtosecond laser-assisted small-incision lenticule extraction. J Cataract Refract Surg. 2015;41(4):884–888. 2. Donate D, et al. Preliminary evidence of successful enhancement after a primary SMILE procedure with the sub-cap-lenti- cule-extraction technique. J Refract Surg. 2015;31(10):708–10. Editors' note: Dr. Reinstein has finan- cial interests with Carl Zeiss Meditec. Dr. Donate has no financial interests related to his comments. Contact information Donate: david.donate@yahoo.fr Reinstein: dzr@londonvisionclinic.com Skills continued from page 95 Retreatments As with any corneal refractive sur- gery procedure, some refractive error can remain because of the "natural variation between individuals in the corneal response with respect to healing and biomechanics," Dr. Reinstein said. His preference for retreatment is to perform a thin-flap LASIK, which he said will always be possible by using a cap thickness of 135 µm. "Doing a LASIK over a SMILE has the benefit of reducing the risk of epithelial ingrowth compared to doing a flap-lift LASIK retreatment," he said. But if the cap used was thinner, surgeons could use a "circle" method where a femtosec- ond laser converts the cap into a

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