Custom Flap Formation: Advantages of Elliptical Flaps for LASIK Patients Custom Flap Formation: Advantages of Elliptical Flaps for LASIK Patients Henry.

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Presentation transcript:

Custom Flap Formation: Advantages of Elliptical Flaps for LASIK Patients Custom Flap Formation: Advantages of Elliptical Flaps for LASIK Patients Henry Perry MD 1, Eric Donnenfeld MD 1, & Kerry Solomon, MD 2 1 Ophthalmic Consultants of Long Island, Rockville Centre, NY 2 Ophthalmology, Medical University of South Carolina, Charleston, SC 2 Ophthalmology, Medical University of South Carolina, Charleston, SC Drs. Donnenfeld and Solomon are Consultants with AMO

Ophthalmic Consultants of Long Island Surgical Techniques to Reduce Dry Eye Following LASIK  Small flaps with large hinges reduce the risk of post-operative dry eye. 1,2  Thin planar flaps result in less post-operative dry eye disease. 3 1 Donnenfeld, ED, Solomon, K, Perry HD, et al. The Effect of Hinge Position on Corneal Sensation and Dry Eye Following LASIK. Ophthalmology Donnenfeld ED, Ehrenhaus M, Solomon R, et al. The Effect of Hinge Width on Corneal Sensation and Dry Eye Following LASIK. JCRS Durrie ASCRS 2007

New IntraLase Technology 5 th Generation Femtosecond Laser  Inverted Bevel-In Side Cut Angle: Provides better wound healing. 1,2 Provides better wound healing. 1,2 Increased flap adhesion post-operatively Increased flap adhesion post-operatively 3x more flap stability for iFS laser (150° side cut) vs microkeratome during flap lift. 2 3x more flap stability for iFS laser (150° side cut) vs microkeratome during flap lift. 2 Significantly reduced flap gutter improves nerve apposition. 3 Significantly reduced flap gutter improves nerve apposition. 3 Ophthalmic Consultants of Long Island 1 Prof J Marshall. Presented ASCRS Prof M Knorz. Presented ASCRS P Binder MD & A Chayet MD. Presented ASCRS 2008.

New IntraLase Technology 5 th Generation Femtosecond Laser  Elliptical Flap Option: Moves the hinge peripherally for maximum stromal bed exposure and full delivery of excimer ablation. Moves the hinge peripherally for maximum stromal bed exposure and full delivery of excimer ablation. Allows use of wider hinge angle for greater flap stability and improved preservation of corneal nerves. Allows use of wider hinge angle for greater flap stability and improved preservation of corneal nerves. Ophthalmic Consultants of Long Island Ablation Zone Flap

Study: Purpose   To evaluate the effect of an elliptical flap with reverse side cut on corneal sensation after LASIK.

Study: Methods  Prospective open label trial.  150 kHZ femtosecond flaps.  20 eyes of 10 consecutive patients who underwent bilateral simultaneous LASIK using elliptical/reverse side cut flaps (150 o ) & 4mm hinges were compared to 20 eyes of 10 consecutive patients who underwent bilateral simultaneous LASIK using round flaps with 70 o flaps & 3mm hinges.  All procedures with VISXS4 Excimer laser custom treatment for myopia.  All nasal hinge flaps 110 microns.  All flaps 8.5 mm diameter.

Study: Methods   Pre-operative baseline visual acuity and Cochet-Bonnet esthesiometry.   Patients seen 1 day, 1 week, 1 month, & 3 months after procedure.   Visual acuity measured at 1 day & 1 week visits.   All tests repeated at all subsequent visits.

Mean Corneal Sensation Elliptical Flap with Reverse Side Cut vs. Conventional Round P>0.05

Discussion  Elliptical flaps allow customization of flaps to fit the patient.  Elliptical flap shapes prevent resection of the vital peripheral corneal fibers, moves the hinge peripherally to maximize stromal bed exposure for full delivery of excimer laser ablation, and allows use of wider hinge for greater flap stability and preservation of corneal nerves.  Reverse side cut improves flap stability and severed nerve apposition which improves corneal sensation and reduces dry eye.

Conclusion  The latest generation femtosecond laser appears to offer clinical advantages, not only for custom flap creation in unusual eyes, but also for improving flap architecture, stability and corneal sensation in routine cases.  A larger, masked controlled trial is necessary to establish clinical significance.

Ophthalmic Consultants of Long Island Summary: Surgical Techniques to Reduce Dry Eye Following LASIK  Small elliptical flaps with large hinges reduce the risk of post-operative dry eye Customize the flap to the ablation. Customize the flap to the ablation.  Thin planar flaps.  Bevel-in side cut to improve corneal nerve apposition.