Eyeworld

103 EW INTERNATIONAL October 2017 References 1. Waring GO, et al. Results of the prospective evaluation of radial keratotomy (PERK) study 10 years after surgery. Arch Ophthalmol. 1994;112:1298–308. 2. Miyashiro MJ, et al. Lasso procedure to revise overcorrection with radial keratotomy. Am J Ophthalmol. 1998;126:825–7. 3. Damiano RE, et al. Purse-string sutures for hyperopia following radial keratotomy. J Refract Surg. 1998;14:408–13. 4. Nose W, et al. Corneal suture for the correc- tion of hyperopia following radial keratotomy. J Refract Surg. 2007;23:523–7. Editors' note: Dr. Francesconi has no financial interests related to her comments. Contact information Francesconi: cmfrancesconib@gmail.com said. "This technique is a viable way to remodel the cornea. The study concluded that corneal sutures could be used to correct RK-induced hyperopia and improve corneal asphericity in an attempt to stabilize these corneas. It was effective even for high degrees of hyperopia and in cases with irregular astigmatism and open incisions." Progressive corneal flattening Progressive hyperopia was shown to occur in the Prospective Evaluation of Radial Keratotomy (PERK) study that followed 427 patients (793 eyes) for 10 years after RK. 1 The method involved eight centripetal incisions to reduce myopia of –2.00 D to –8.75 D. Of the 374 patients (675 eyes) who were examined after 10 years, 38% had a refractive error of within 0.50 D and 60% within 1.00 D. The study revealed that between 6 months and 10 years after RK, 43% of the eyes changed in the hyper- opic direction by 1.00 D or more. The average rate of change was +0.21 D per year between 6 months and 2 years, and +0.06 D per year between 2 and 10 years after surgery. A shift in the hyperopic direction was seen to continue during the entire 10 years after surgery. In addition to progressive corne- al flattening over time, post-RK pa- tients who develop presbyopia will often require remeasuring of their corneal curvature and modifica- tion using a contact lens. Many RK patients need additional incisional surgeries like astigmatic keratotomy (AK), where incisions are placed at the steepest points of the cornea to relax and transform the cornea to a more spherical shape. "Dr. Nose remodeled corneas with open incisions using a differ- ent modified technique. Instead of suturing inside the incisions, he sutured parallel to the incision, creating a square suture that kept the incision from opening at the sides," Dr. Francesconi said. "Using square sutures on either side of the incision was also advantageous for fitting contact lenses, since there were no open incisions. Surgery may not achieve spectacle-free vision, but at least the remodeling allowed the patients to use contacts and thereby greatly improve their visual acuity." Dr. Nose's modified suturing technique offers a solution for eyes with very few alternatives, other than full thickness keratoplasty, which comes with its own set of complications. Visual rehabilitation through contact lens use is a signifi- cant advantage. EW © Copyright 2017 Lions VisionGift and Stephens Instruments ( 800 ) 354-7848 stephensinst.com halo@stephensinst.com Distributed exclusively through THE NEW STANDARD IN GLAUCOMA IMPLANT PATCH GRAFTS EASY-PEEL PACKAGING Patented easy-peel packaging allows for quick introduction of sterile tissues to the surgical field, saving valuable OR time. 99.9% CLARITY Unlike traditional patches, Halo tissue grafts are clear and will remain clear, resulting in simplified post-op assessment and improved patient cosmesis. STABLE STORAGE Halo tissues can remain at room temperature and never need reconstitution, so you'll always be ready for emergencies as well as scheduled procedures. Developed at Lions VisionGift's renowned Vision Research Laboratory, Halo sterile tissues provide distinct procedural and cosmetic benefits. NOW AVAILABLE Cornea, Sclera & Pericardium halograft.org For more information visit us at AAO booth #3540

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