FEMTO-LASIK and BEYOND - Carl Zeiss, Inc.

24
Ophthalmology WORLD REPORT
International Refractive User Symposium
Kuala Lumpur, Malaysia
VisuMax
in Keratoplasties
Dr Khaled Ben Amor on “Keratoplasties
with VisuMax”
“Even in DLK, the results of
femtosecond laser are very nice
optically and we have much more
success rate with the technique.”
Keratoplasties with VisuMax: : Dr Ben Amor shared his
experiences about the keratoplasty with VisuMax which
according to him is “the obligation of the VisuMax,
much beyond refractive surgery”. Discussing the advantages
of the VisuMax he said that it offered a curved corneal interface
and a planar cut. He then showed the high performance
optics in ZEISS that was the key to optimum cut. He shared
videos showing how it was easy to lift a donor graft and those
for keratoconus hydrops, corneal scarring, bullous keratopathy
and adherent leucoma. Dr Ben Amor also discussed the
advantages of the femto penetrating keratoplasty due to the
regular side cut. “Better centration and better donor recipient
fit give a nice optical result better than that with a manual
keratoplasty,” he said.
Deep lamellar keratoplasty (DLK): He explained the principle
approach in a DLK which required the separation of
the endothelium from the stroma by injecting a bubble. In
manual DLK, the bubble layer is seen in around 52% cases
which necessitate desiccation of the rest of the stroma. According
to him, Femto DLK ensures precision during surgery.
Dpt
Dense central corneal scarring (Dr. Burjor P. Banaji, India)
“The cut can easily be lifted and then a big bubble is injected
which works in 75% of cases. It is much easier to take off the
remaining stroma. So, you have a complete Descemet barring
which is very important. This happens in 90% of the
Femto DLK cases versus 60% in manual DLK,” Dr Ben
Amor added.
Dr Burjor P. Banaji on “Challenging Cases
Corrected with Topography-Linked LASIK”
Clinical experiences: Dr Banaji shared his experiences
with topography-guided LASIK in some “weird”
cases he has done over the past few years, which
otherwise would be very difficult if not impossible to treat
with the standard modalities of LASIK. He showed the
topographical picture of a corneal central island. He shared
another case of multiple prior corneal surgeries. He then
shared interesting results in a patient who had dense corneal
scarring after a lacerating full thickness injury to the cornea
many years ago and was complaining of haloes, scatter and
distortion of images. The refraction was -8D spherical with
-5D cylindrical and BCVA was approximately 6/36. The scar
was right in the center of the pupil and the corneal thickness
was almost 600μm. “We smoothened the bed and about 4-5
months later lifted the flap and corrected the residual error
again with a topography guided treatment,” he specified. He
showed the large 10D shift in the center of the pupil that was
causing debilitating symptoms and how just smoothing it
with topography brought down the dioptric shift by 6D, thus
abating the symptoms. LASIK was planned as the patient was
still severely myopic. The pre-op refraction was -8D/-5D and
post-op it miraculously was -0.75D. “I could not have done
it with anything other than a topography-guided treatment,”
added Dr Banaji.
Further, he discussed a post-op cataract case, which was
referred to him in not very distant past. A well-centered
multifocal IOL was given and there was a residual
astigmatism.“Confirm that your central rim
and the lights are like a bull’s eye, one within
the other when the patient is asked to look into
the microscope after the procedure. Then you
see that your lens is centered properly. You
will often need to decenter your lens nasally
for that to happen. When you look at your eye
postoperatively, that ring should, if you have
done your job properly, never be in the center
of our pupil,” he explained. He attributed the
astigmatism to an LRI that “had done something
very naughty to the cornea”. The patient
was not only having an asymmetrical astigmatism,
it was non-orthogonal. “Post-op the
patient was very happy and the topography has
worked very well,” he said in delight.