EyeWorld Asia-Pacific September 2012 Issue

37 EWAP rEfrActivE September 2012 Surgery, Naval Medical Center, San Diego, Calif., USA; and professor of ophthalmology, University of California, San Francisco, Calif., USA. “Because we do not know if CXL combined with primary LASIK will prevent ectasia, there is no way to assess the risk/benefit ratio,” Dr. Schallhorn said. “No one has established evidence-based indications for the combination.” Dr. Schallhorn said he has yet to see clinical studies that combine primary LASIK with CXL. “The issue is ectasia prevention, and ectasia can manifest years after LASIK,” Dr. Schallhorn said. “Any studies would require long-term follow-up and need to be combined with a control population who underwent LASIK without CXL. This would be a difficult and expensive study to conduct.” Dr. Schallhorn doesn’t believe it’s a good idea to use CXL in primary LASIK procedures, especially if the patient is an otherwise excellent candidate for LASIK. “In fact, promoting CXL with primary LASIK for all patients could do the community and the market great harm because essentially the message would be that LASIK without CXL is unsafe, which of course is not true.” Challenges would be additional surgical time and exposure to additional products (risk of infections), possible endothelial cell damage, and possible side effects of keratocyte death, Dr. Stulting said. If the procedure isn’t performed correctly, Dr. Tomita noted, complications could include severe DLK or increasing striae. “When performed as instructed, the post-operative outcomes at 1 week are the same as the outcomes of regular LASIK performed without crosslinking,” Dr. Tomita said. Dr. Tomita argued that using CXL as a preventative measure for eyes at risk of ectasia is better than post-op treatment because “treating iatrogenic ectasia is difficult once [it has] developed.” Dr. Reinstein echoed Dr. Schallhorn’s sentiment about safety benefits needing to be proven over a long time period. Meanwhile, LASIK remains a safe procedure, and if performed properly, ectasia development may not be as big a risk as some think. “In any case, there is no need for crosslinking in LASIK if current safety criteria with respect to corneal thickness and residual stromal thickness are observed,” he said. “There have been over 20 million procedures performed to date, and the long-term safety with respect to ectasia is excellent, particularly with the use of thin flaps created by femtosecond lasers. It is hard to justify crosslinking in routine cases at this point.” EWAP Editors’ note: Dr. Schallhorn has financial interests with Abbott Medical Optics (Santa Ana, Calif., USA). Dr. Tomita has financial interests with Avedro. Drs. Reinstein and Stulting have no financial interests related to this article. contact information reinstein: +44 020 7224 1005, dzr@londonvisionclinic.com Schallhorn: 619-920-9031, scschallhorn@yahoo.com Stulting: 770-255-3330, dstulting@woolfsoneye.com tomita: +81-3-5221-2207, tomita@shinagawa.com « The One Use-Plus SBK microkeratome is: •simple, easy to use and safe •comparable to FemtoSBK (accuracy and predictability) •without intraop and postop femtolasers complications •and at a significant less cost. » LASIK Surgery MORIA S.A. 15, rue Georges Besse 92160 Antony FRANCE Phone: +33 (0) 1 46 74 46 74 - Fax: +33 (0) 1 46 74 46 70 moria@moria-int.com - www.moria-surgical.com • Thin, 100-micron, planar flaps • Accuracy and predictability equivalent to Femto-SBK • Smoother stromal bed • No femto-complications • … At a fraction of the cost Think Thin SBK without compromise Ahmed El-Massry, MD (Alexandria, Egypt) El-Massry A. Comparative study between One Use- Plus SBK and FemtoLASIK flaps. Keynote lecture, 68 th annual congress of the AIOC, Jan 21-24, 2010; Kolkata, India. Dr. El-Massry has no financial interest and is not a paid consultant for Moria. Download long-version testimonials on: www.moria-surgical.com Roundtable with 7 international SBK experts, #66076B Compendium of clinical and laboratory cases, #66083EN SBK newsletters now on line Keratome One Use- Plus SBK (Moria) IntraLase ® 60kHz (Abbott Medical Optics) VisuMax ® 500kHz (Carl Zeiss Meditec) Nb of eyes First 132 Last 112 Last 112 Flap thickness 106 ± 10.9 110.0 ± 12.0 105.0 ± 8.0 OBL 0% always always VGB 0% occasionally occasionally Pupil tracking easy difficult difficult Visual recovery fast slower slower Flap re-lift easy for years difficult difficult