Ocular Surgery News: Customized treatments

http://www.pconsupersite.com/view.asp?ID=8597

The following is an excerpt from a larger summary-type article entitled: "Cataract and refractive surgery develop new, gentler approaches; OSN meeting in Naples reviews current technologies and surgical innovations."

By Michela Cimberle

Wavefront-guided LASIK with both the LADARWave CustomCornea (Alcon) and the Visx CustomVue software, respectively presented by Dr. Manche and Stephen F. Brint, MD, was said to be safe and effective in reducing higher-order aberrations and enhancing visual quality in patients with prior history of conventional refractive surgery.

Previous treatments with small optical zones, which have induced spherical aberrations and coma, can be improved with the topo-aberrometry-based ORK-W re-treatment program, linking the CSO Eye-top and the Schwind Esiris excimer laser, according to Ugo Cimberle, MD.

“In all cases I have obtained a considerable enlargement of the optical zones and recentration of the treatment,” he said.

Paolo Vinciguerra, MD, introduced a new method for improving re-treatment outcomes, using CSO and Optikon topographic imaging intraoperatively.

“Topographic mapping is performed following the removal of the epithelium in PRK or LASEK or under the LASIK flap so that the customized treatment program can be based on a more lifelike and accurate mapping of corneal morphology,” he said.

Moose's Editorial: This article raises more questions than it answers. But it is something and there has been little published lately on the treatment of rs-induced aberrations. The Alcon and Visx platforms have only been shown to be effective at reducing aberrations through the 4th level (and not much higher). This is the first account that Moose has seen on topo-aberrometry-based treatments in at least a year. If doing a flap-lift it makes sense to raise the flap before doing the topography measurement, as the epithelium will thin and thicken itself in an attempt to smooth over the irregularities left by the laser. If doing a PRK it also makes sense to remove the epithelium so that the underlying stroma is made smooth.

I agree that this raises more questions than it answers. There have been reports of some very irregular flap cuts, as evidenced by Artemis scans. A flap might be 120 microns here, and 165 microns there... how would this work if the measurements are taken of the stromal bed and then an irregular flap put back down on top of a smooth bed?