Eyeworld

121 EW CORNEA March 2018 and with it, change the corneal pa- rameters like curvature and translu- cency. So it was an important prior- ity to carefully remove it. Following cyst removal, the visualization was naturally not optimal, with epithe- lium-off and substantial amounts of scarring." It is vital to conduct thorough epithelial cell removal, as leaving epithelium behind could engender recurrences. Using a LASIK spatu- la, Dr. Kanellopoulos irrigated the traumatic pocket to dissect and detach the ingrown epithelial tissue, removing as much as possible. Retro-illumination revealed that the corneal transparency was improved, however, epithelium was still pres- ent on the underside of the upper portion of the cornea, within the pocket. Because this area was diffi- cult to reach, Dr. Kanellopoulos cre- ated a flap by cutting away a portion of the side of the pocket, allowing him easier access to the epithelium present under the flap/pocket. Sealing the wound The final surgical step involved seal- ing the flap incision to avoid any recurrence of epithelial ingrowth. Dr. Kanellopoulos decided that su- turing the wound was not the most prudent choice in this case, as much of the trauma and the incision site were along the visual axis. "Suturing in this case was a difficult option, as we were working centrally on the visual axis and sutures could potentially be the cause of visual distortions, which we wanted to avoid," he said. "If the epithelium does not regrow along the new incision, I would not expect signif- icant scarring, but I would expect some growth as we finished with gaping stromal layers, which we attempted to minimize. Again, there were few options here. We thought that instead of suturing we would consider another, somewhat simpler alternative. We used the ReSure Sealant [Ocular Therapeutix, Bed- ford, Massachusetts], which has the advantage of reliably sealing off the wound from further ingrowth until the injured stromal layers become cohesive and provides high flexibil- ity compared to other adhesives I have used in the anterior chamber." The choice of adhesive was important to the final surgical outcome. In addition to forming a mechanical barrier and prevent- ing epithelial cells from growing underneath the flap and along the interface, the ReSure Sealant is comfortable for the patient, biocom- patible, and protects the eye from external contaminants by covering the ocular surface like a large, glued- on contact lens. Dr. Kanellopoulos' positive experiences with the ReSure Sealant were demonstrated in past studies. 1,2 The first day operative results were good. OCT imaging revealed epithelial intrastromal cyst reso- lution, and recurrence of epithe- lial cell ingrowth was successfully thwarted by a thorough elimination of ingrown cells and the use of the bandage adhesive, allowing good outcomes for a difficult case. EW References 1. Kanellopoulos AJ. Novel hydrogel tissue adhesive minimizes surgically induced astigmatic change. Ocular Surgery News. Nov. 10, 2012. 2. Kanellopoulos AJ, et al. Ocular tissue adhesive application in DSAEK: a comparative study. JOJ Ophthal. Nov. 14, 2015. Editors' note: Dr. Kanellopoulos has no financial interests related to his comments. Contact information Kanellopoulos: ajkmd@mac.com Ultra clean air where you need it In the SurgiCube®, sterile air passes no contamination sources. It's blown directly over the operating area and instruments. • A smart alternative to the OR • Sterile laminar downfl ow • Cost effi cient • Patient Friendly • Location independent Protect your Sterile Zone from Airborne Contamination The Innovative Operio Mobile clean air zone unit ensures that both the surgical site and the instrumentation near the wound site remain sterile during the entire surgical procedure. • Circulates ambient air through HEPA fi ltration • Cleans air from dangerous bacteria-carrying particles • Guaranteed <5 CFU/mᵌ inside the clean air zone • Can be used for a multitude of procedures • Easy to use and transport For more information, please call or visit: toulmeditech.com Toul Meditech AB Tunbytorpsgatan 31, SE 721 37 Västerås, Sweden Phone + 46 21 13 50 00, info@toulmeditech.com Think outside the box into the Cube! Overall size: 24"L x 18"W x 51-67"H, 92 lbs For more information, please call or visit: surgicube.com SurgiCube International BV Seggelant-Noord 4, 3237 MG Vierpolders, The Netherlands T +31 181 76 06 00, info@surgicube.com A smart alternative to the OR Sterile laminar downfl ow Cost effi cient Patient Friendly Location independent • Cleans air from dangerous bacteria-carrying particles • Guaranteed <5 CFU/mᵌ inside the clean air zone • Can be used for a multitude of procedures • Easy to use and transport For more information, please call or visit: For more information, please call or visit:

• Blank Page
• Blank Page (1)