EyeWorld India December 2020 Issue

Supplement to EyeWorld Asia-Pacific December 2020 surgery. First, she studied whether aerosols are generated while incising a microkeratome. In this study, Dr. Khamar stained the microkeratome and placed a sheet of paper at the bottom of the stand while creating the flap during incision. What resulted were droplets dispersing at a max- imum distance of 10 to 11 inches towards the surgeon side and the opposite side (See Figure 2). The next question Dr. Khamar studied was aerosol generation with a hansatome. Incising a hansatome utilizes a circular motion with a lower speed. The droplets traveled a much less distance with this technique than with the microkeratome. With femto- second LASIK, there were no visible aerosols while incising a flap. In Small Incision Lenticule Extraction, there were also no visible aerosols. Dr. Khamar then provided recom- mendations for refractive surgery for the COVID-19 pandemic according to the Preferred Practice Guidelines, published by the All India Ophthal- mological Society. Before starting surgery, it is recommended to use 0.25% betadine solution, wait for ten minutes, and then wash before be- ginning surgery. At times, there may be pooling of fluid in the cul de sac while cleaning, which is a potential for generating aerosols. To resolve this, one can take a dry swab to dry the ocular surface. To work with social distancing guidelines, the foot pedal may be moved away from the patient headrest as much as possible. While performing the laser portion of the Small Incision Lenticule Extraction New Advancements in Refractive Surgery: Imaging, Aerosol Generation, and Retreatment Copyright 2020 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. Retreatment Post SMILE Dr. Ritika Sachdev presented next on Retreatment Post-SMILE. Since Lenticule Extraction with SMILE, (Carl Zeiss Meditec AG, Jena, Germany), was introduced nearly a decade ago, there was much debate and specula- tion of the procedure and post-proce- dure treatment. There are now many options to treat a patient post-SMILE. Recent literature shows that refractive enhancement rates range from 1% to 6% for LASIK and 2% to 4% for Lenticule Extraction with many factors influencing the enhancement rate including age, preoperative-refractive error, corneal thickness, and ocular condition. If a patient does require en- hancement after Lenticule Extraction, options exist which include surface ablation, creating a thin-flap or a cap-to-flap, or secondary small-in- cision lenticule extraction (SMILE “ Recent literature shows that refractive enhancement rates range from 1% to 6% for LASIK and 2% to 4% for SMILE with many factors influencing the enhancement rate including age, preoperative-refractive error, corneal thickness, and ocular condition. ” Dr. Ritika Sachdev, India interface after cleaning with proper disinfectant as a last step is import- ant. After surgery, Dr. Khamar will take a shower so that she is safe on her end as well. procedure, surgeons can use a screen to protect both themselves and the patient. Additionally, one can cover the patient completely as well as changing gloves after operating on each eye. Finally, disposal of patient Figure 3. In two near normal eyes, the green color represents tightly bound fibers and the blue represents less tightly bound fibers. This fibrous orientation is strikingly similar to imaging from polarization sensitive OCT. Source: Meek KM et al. Prog Retin Eye Res 2009