Eyeworld

113 February 2017 EW MEETING REPORTER problem in both eyes, which Dr. Lindstrom said is a good example of when you should stop and put the flap back down. The problem, according to Eric Donnenfeld, MD, Rockville Centre, New York, isn't just that the hinge is in the visual axis. It's that you have an incomplete ablation. The tissue has been removed from the back of the flap as well as the bed. This problem can't be fixed with glasses, although a gas permeable con- tact lens may be an option. A PRK ablation could also be an option. The key is getting a good image, Dr. Donnenfeld said. "If you can't get a good image, you have a more diffi- cult problem to deal with." EW Editors' note: Dr. Yoo has financial interests with Allergan. Dr. Talley Rostov has financial interests with Allergan, Bausch + Lomb, and Shire. Drs. Lindstrom, Donnenfeld, and Ursea have no financial interests related to their comments. Omeros (Seattle), Shire, and TearLab (San Diego). Panel discussions Sonia Yoo, MD, Miami, moderated two panel discussions—one on re- fractive cataract and corneal surgery and one on corneal surgery. One case involved a 69-year-old with a Visian ICL (STAAR Surgical, Monrovia, California) who then developed a cataract. Dr. Yoo asked panelists how they would deal with this patient, who was insistent on having laser cataract surgery. Audrey Talley Rostov, MD, Se- attle, said she does mostly femto in her practice and has done a number of successful cases in patients with ICLs. In tricky cases, you want to use femto because you'll have better cell count, she said, and you can preserve the endothelium by using decreased energy. Dr. Talley Rostov added that she generally keeps her usual settings on the laser even in these cases. During the corneal surgery panel, Dr. Yoo shared cases includ- ing ones with pterygium, cataract and Fuchs,' PK and toric IOL, and post-LASIK epithelial ingrowth with corneal melting. Dr. Yoo introduced a case of a 27-year-old woman who presented with poor quality of vision. The patient told doctors that during her LASIK surgery several years prior, her flaps were incomplete. A slit lamp exam showed that the flap hinge was close to the visual axis, and the patient also had irregu- lar topographies. Roxana Ursea, MD, Tucson, Ar- izona, said she would look at depth of the hinge and see how deep it goes into the stroma. If it hasn't been a long time since the LASIK, you could possibly lift the flap to smooth out the bed, she said. Richard Lindstrom, MD, Min- neapolis, noted that this could have been prevented to begin with. If you're the primary surgeon and you get a bad flap, don't just step on the excimer laser pedal anyway, he said. This particular patient had the same Join the largest subspecialty society representing the fields of cornea and external disease. Member Benefits • Cornea: The Journal of Cornea and External Disease • Annual Meetings: Select discounted registration at membership events and educational programs • VideoEd: A weekly broadcast of clinical videos recorded live at national and international meetings • Kera-net: The online forum for the exchange of clinical and scientific information • Cornea Society News: Quarterly newsletter sent to all Society Members www.CorneaSociety.org

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