OCT 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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October 2012 ability in performance, which is an ineradicable attribute of manual incision construction, will lead to greater reproducibility and less variation in results," Dr. Packer said. Placement of LRI incisions should also be more predictable with femto technology, Dr. Packer added. "The potential for laser LRIs includes the ability to place the photodisrup- tive cutting effect at precisely the right orientation and to make cuts of the correct length and depth to create the desired refractive effect." LenSx experience The diamond LRI blade is going the way of the old RK blades as they are replaced with something better. Gary Foster, M.D., Eye Center of Northern Colorado, Fort Collins, prefers to use the LenSx laser to address astigmatism in as many patients as possible. "I prefer to use it on all my cataract patients with astigmatism, whether they choose a multifocal IOL, a toric, or standard monofocal with an LRI with a standard mono- focal," said Dr. Foster, who has used the LenSx model for over a year in commercial use. "I have a strong preference for the femtosecond laser over diamond bladed LRIs because it reduces so many of the possible variables that lead to inconsistent outcomes," he said. He usually employs the laser for astigmatism within the 1 D range— for patients with higher astigma- tism, he will combine the LenSx with a toric IOL. When using the toric to correct higher degrees of astigmatism, he'll still create some of the femtosecond arcuate incisions available but not open them, just as other surgeons have described for other laser models. "I use the slit lamp later to titrate the results. At the slit lamp, I use a Sinskey hook and open up incisions a bit to get more refractive effect and fine-tune the patients' results," he said. Dr. Foster believes use of this technology will improve as surgeons become more accurate with their alignment and marking to reduce parallax. He also thinks that the nomograms under evolution for use with the laser will help surgeons who are new to the technology. Some nomograms formed from collective wisdom are available on internet discussion lists, Dr. Foster said. EW Editors' note: The physicians have financial interests with the laser manufacturers that they discuss in this article. Contact information Culbertson: 305-326-6364, wculbertson@med.miami.edu Foster: 970-221-2222, gjlfos@aol.com Packer: 541-687-2110, mpacker@finemd.com Talamo: 781-890-4979, jht1@comcast.net Custom surgical treatment for keratoconus is "useful" A group of Italian researchers have found pachymetry-guided custom excimer laser-assisted lameller keratoplasty an effective alternative to penetrating keratoplasty in cases of moderate to advanced keratoconus. Lead author Leopoldo Spadea, M.D., Eye Clinic, University of L'Aquila, Italy, evaluated 35 eyes that had 24-month follow-up after treatment with the technique. Donor lamella was prepared with the excimer laser and subsequently sutured to the host cornea using 16 single 10-0 nylon sutures. At final follow-up, uncorrected distance vision was better than 20/60 in 45.7%, and corrected distance vision was better than 20/40 in 88.6%; the mean refractive astigmatism was –2.11 D. "In the present study, the custom technique provided a satisfactory increase in corneal thickness in all patients, restoring structural and optical integrity to the tissue," the authors wrote in the September issue of the Journal of Cataract & Refractive Surgery. The authors added the long-term safety of the technique needs assessment with a larger group of patients.

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