Eyeworld

95 EW SECONDARY FEATURE March 2016 film appears and the patient is able to see the fixation target very clearly, Dr. Reinstein said. As the patient looks at this target, corneal suction fixes the eye into place, which Dr. Proper centration of the cali- brated curved contact glass of the femtosecond laser and the cornea is important as well. When these two come into contact, a meniscus tear Reinstein said "essentially autocen- trates the visual axis and hence the corneal vertex to the vertex of the contact glass, which is centered to the laser system, and the center of the lenticule to be created." The surgeon then confirms centration, comparing it to the posi- tions of the corneal reflex and pupil center to a Placido eye image. If cen- tration is unsatisfactory, the surgeon can release suction and repeat the procedure. To avoid "mud crack-type microfolds in the cap" after the lenticule is extracted, Dr. Reinstein said he uses a dry micro-spear to "redistribute any redundant portions of the cap evenly to the periphery, performed with fluorescein staining at a slit lamp in the OR immediately after the procedure." Managing complications The most common intraoperative complication in SMILE is loss of suc- tion during femtosecond ablation. Exactly when this occurs determines how it is managed. "If suction loss occurs during the lower interface, it is a simple case of reprogramming the case with a thinner cap, and SMILE can be per- formed as normal without any risk of crossing the original interface," Dr. Reinstein said. "If the suction loss occurs during the creation of the tunnel (i.e., after the lenticule has been created completely), then suction can be reapplied and the femtosecond ablation for the tunnel only can be safely performed. "If the suction loss occurs during the upper lenticule interface creation, the surgeon needs to care- fully consider whether the procedure can be finished by repeating the upper interface creation, or whether the patient needs to be switched to SMILE at a more superficial cap depth, LASIK, or PRK," Dr. Reinstein explained. He added that it's important to know how to identify the upper interface if the lower interface is accidentally dissected first. "This can be simply achieved by inserting the Sinskey tip sideways into the incision, rotating the tip upward to engage the lenticule edge, and moving in a nasal direction to Made by the respected eye-care specialists at THE POWER TO CALM THE ITCH For allergic conjunctivitis 1 BEPREVE ® — FIRST-LINE, YEAR-ROUND, WITH BROAD-SPECTRUM ALLERGEN COVERAGE INDICATION AND USAGE BEPREVE ® (bepotastine besilate ophthalmic solution) 1.5% is a histamine H 1 receptor antagonist indicated for the treatment of itching associated with allergic conjunctivitis. IMPORTANT SAFETY INFORMATION · BEPREVE ® is contraindicated in patients with a history of hypersensitivity reactions to bepotastine or any of the other ingredients. · BEPREVE ® is for topical ophthalmic use only. To minimize risk of contamination, do not touch the dropper tip to the eyelids or to any surface. Keep the bottle closed when not in use. · BEPREVE ® should not be used to treat contact lens-related irritation. Remove contact lens prior to instillation of BEPREVE ® . Lenses may be reinserted 10 minutes after BEPREVE ® administration. · The most common adverse reaction occurring in approximately 25% of patients was a mild taste following instillation. Other adverse reactions occurring in 2%-5% of patients were eye irritation, headache, and nasopharyngitis. Please see the accompanying full Prescribing Information for BEPREVE ® on the following page. Reference: 1. BEPREVE [package insert]. Tampa, FL: Bausch & Lomb Incorporated; 2012. For product-related questions and concerns, call 1-800-323-0000 or visit www.bausch.com. BEPREVE is a trademark of Bausch & Lomb Incorporated or its af liates. © Bausch & Lomb Incorporated. BEP.0014.USA.16 laser settings for the individual laser (energy, spot size, spot spacing) and by minimizing the trauma to the stromal interface." continued on page 96

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