EyeWorld India September 2016 Issue

September 2016 EWAP refractive 57 to lift this. Overall, Dr. Rush hopes that practitioners come away from the study with the understanding that there is no need to forgo femtosecond LASIK in such patients and instead offer them premature lens exchange with riskier, invasive surgery. “With this study, we have shown that we can offer them something less invasive, give them good outcomes, and avoid having to do cataract surgery prematurely,” he concluded. EWAP References 1. Rush SW, et al. Femtosecond laser flap creation for laser in situ keratomileusis in the setting of previous radial keratotomy. Asia Pac J Ophthalmol . 2015;4:283–5. Editors’ note: Dr. Rush has no financial interests related to his comments. Contact information Rush: Sloan.rush@paneye.com Views from Asia-Pacific WANG Zheng, MD Director, Guangzhou Aier Eye Hospital 54 Zhongshan Road, Guangzhou, China Tel. no. +86-20-8731-3480 gzstwang@gmail.com I have some patients with previous RK seeking for secondary refractive surgery in recent years. Treating these patients is more complicated. Their vision and refractions fluctuate during the day, the eyes are often highly aberrated, and many of them are pre-presbyopic or even have early cataract. So, I’m very cautious about doing laser vision correction on prior RK eyes. Refractive lens exchange might be a better option for them. When corneal refractive surgery is chosen, LASIK is preferred because many studies have shown that surface ablation may result in healing problems and severe haze. Although the femtosecond laser has many advantages for LASIK on virgin eyes, the situation differs in prior RK eyes. RK cuts are actually filled with epithelial plugs rather than collagen tissue. It’s opaque and fragile, and femtosecond laser cannot pass through. What makes things worse is that these cuts can be perforated by the accumulated pressure during the process of flap creation with femtosecond laser. Even if you’re lucky enough and this doesn’t happen, the radial cuts can still be easily opened during the mechanical seperation of the flap. As a result it may end up with a sliced pizza-like flap, and a series of problems such as epithelial ingrowth, irregular astigmatism, etc. In my opinion, the femtosecond laser brings more risks than advantages under such circumstance. In an experienced surgeon’s hand, a mechanical microkeratome is much safer. In the past years, I’ve done a number of cases successfully with microkeratome. In the mean time I’ve also seen some problematic cases with femtosecond laser in prior RK eyes. Changing the laser setting may ease the flap making, but it does not change the fact that the associated risks actually come from the nature of the RK cuts. Though femtosecond laser can be used successfully in some prior RK eyes, I don’t think it’s worthy to take the risk. Editors’ note: Dr. Wang declared no relevant financial interests. www.jenoptik.com Meet future challenges in the healthcare & life science industry with customized Jenoptik application solutions in the medical technology sector e.g. in ophthalmology. Jenoptik‘s safe and precise complete laser solution JenLas ® MLS Green is certified and has been proven as a perfect tool for laser eye surgery. Our commitment to quality and service will help your customers to a visual future. Enabling Visions Meet us at Compamed/Medica 2016, Duesseldorf, November 14 - 17, Hall 8a, Booth G19.5