Eyeworld

EW REFRACTIVE SURGERY 64 June 2016 each of these patients was treated, femtosecond power was increased and more spots placed to make it easier to lift the flap, Dr. Rush re- ported. In all cases the femtosecond flap was successfully created. "We didn't have any cases of vertical gas breakthrough or epithelial ingrowth. Our refractive outcomes were similar to what you would expect to see in a virgin eye." Clinical possibilities Dr. Rush is hopeful about what this means clinically. "Just by modu- lating the settings, we can come up with a good approach to offer patients the great outcomes of LASIK rather than resorting to another re- fractive technique like PRK or doing another surgery altogether like a refractive lensectomy," he said. For those looking to create femtosecond flaps for such patients, Dr. Rush advised making these as deep as possible. "That adds more structural integrity to the flap, and it makes it less likely to open up in an RK incision," he said. In addition, the power setting is key because you don't want any tissue bridges remaining when you lift the flap. If there are any issues with the flap, Dr. Rush stressed the need for caution. "If ever an RK incision is open or you get vertical gas break- through, we don't recommend pro- ceeding with the treatment because we think it's a big risk for developing epithelial ingrowth," he said. If the flap doesn't seem to cut right, he urged practitioners to refrain from trying to lift this. Overall, Dr. Rush hopes that practitioners come away from the study with the understanding that there is no need to forego fem- tosecond LASIK in such patients and instead offer them premature lens exchange with riskier, inva- sive surgery. "With this study, we have shown that we can offer them something less invasive, give them good outcomes, and avoid having to do cataract surgery prematurely," he concluded. EW Reference Rush SW, et al. Femtosecond laser flap creation for laser in situ keratomileusis in the setting of previous radial keratotomy. Asia Pac J Ophthalmol. 2015;4:283–5. Editors' note: Dr. Rush has no financial interests related to his comments. Contact information Rush: Sloan.rush@paneye.com Rush said. "This is an ideal setting to have when you have a previous RK eye, so you don't have to worry about spreading open the incision." He finds that it then lifts more like a manual microkeratome flap would, with no resistance. Included in the retrospective consecutive chart review study were 16 eyes of 8 subjects with hyperopia after RK who had undergone femto- second laser-assisted LASIK. When Femtosecond continued from page 63 " Now a lot of us have hung the microkeratome on the shelf, and we feel a lot more comfortable using the femtosecond laser. " –Sloan Rush, MD

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