EyeWorld Asia-Pacific September 2019 Issue

tions”: Z4 –0.677 in the right eye, OS Z4 –0.532 in the left. “Ideally you would like spher- i cal aberration to be less than 0.5, so use a negative aspheric lens,” Dr. Ganesh said. After trying various different IOL formulas, to determine target correction, Dr. Ganesh finally decid- ed to go with the actual measure- ment using the total-K values from the IOLMaster (IOLMaster 700 with Total Keratometry, ZEISS) with the Barrett Universal II formula and to implant the AT LISA TRI (ZEISS) in both eyes, +19.0 D in the right eye, +18.0 D in the left. Postop, the patient achieved binocular UDVA of 6/6; uniocular UDVA of 6/9+ in the righteye, 6/9 in the left; binocular uncorrected near visual acuity (UNVA) of N6; uniocular UNVA of N8+ in the right eye, N6 in the left. Postop refraction, he said, was “bang on target”: 0.00 Sph +0.62 Cyl@130 6/6p, N6 in the right eye; +0.50 Sph –0.50 Cyl@160 6/6p, N6 in the left. There was no difference, he said, between a post-SMILE patient and a post-LASIK patient; however, post-SMILE patients have fewer aberrations, with better EKR graphs especially for very high myopia correction, so post-SMILE eyes may be better suited to multifocal IOL implantation than post-LASIK eyes. Meanwhile, true keratometry with the IOLMaster 700 may pro- vide better or comparable refractive outcomes. Finally, he said, ZEISS has the solution for correcting the complete range of refractive needs—correct- ing refractive errors with SMILE or the MEL90; correcting presbyopia with PRESBYOND; accurate mea- surements with the IOLMaster 700 with Total Keratometry for post-re- fractive surgery cases; and a large complement of IOLs. Enhancements: Rounding out ZEISS’s cataract and refractive solutions ZEISS’s cutting-edge technologies provide a number of options should a patient require enhancement after surgery. “CIRCLE completes the arma- mentarium for enhancement,” said Iain Dunlop, MD , Canberra, Aus- tralia. “Although one might only use it on very rare occasions, ZEISS has provided this solution for an enhancement that turns the SMILE procedure essentially into a LASIK procedure.” SMILE, Dr. Dunlop said, is more robust than LASIK and theoretical- Shaping Tomorrow’s Vision: Pearls for cataract and refractive surgery Supplement to EyeWorld Asia-Pacific September 2019 Copyright 2019 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. ly creates lower dry eye states due to preservation of corneal nerves. SMILE is currently for myopia and myopic astigmatism; FLEx is half way to SMILE, still useful as a closed procedure (PseudoSMILE), and use- ful if enhancement is expected. Glenn Carp, MBBCh, FC Ophth (SA), recommends perform- ing thin-flap LASIK after SMILE (OFF Label). The thin flap creates a more superficial flap compared to CIRCLE which forces the flap to be the same depth as the original cap. Dr Carp’s standard cap thick- ness in SMILE is between 135 to 145 μm, which gives plenty of room to create a 100 μm flap. Dr Carp’s Golden Rule is “don’t operate blind- ly.” Every femtosecond laser has a standard deviation that must be taken into account, he said. There- fore, it is essential to use OCT or VHF digital ultrasound to precisely measure the epithelial thickness and original cap thickness when plan- ning a retreatment. When lifting the thin LASIK flap, Dr. Carp noted that it is im- portant for surgeons not to enter near the original SMILE incisions to decrease the chance of crossing “ There was no difference, he said, between a post-SMILE patient and a post-LASIK patient; however, post-SMILE patients have fewer aberrations, with better EKR graphs especially for very high myopia correction, so post-SMILE eyes may be better suited to multifocal IOL implantation than post-LASIK eyes. ” Sri Ganesh, MD, Bangalore, India Figure 2. CIRCLE parameters. Source: Iain Dunlapk, MD