Eyeworld Supplements

8 Speed, convenience, customization—the list goes on for why integrated lasers work so well W hen we first started doing LASIK years ago, we used a broad beam laser. Treat- ments were long be- cause of the speed of the laser. The broad beam laser had the potential to create hot spots, or central is- lands, in the center of the treatment. These central islands, which are ele- vations in the central treatment zone of the cornea if the laser does not remove enough tissue here, can interfere with vision. Today this has all changed. We have been using the WaveLight Allegretto Wave Eye-Q laser (Alcon, Fort Worth, Texas), which is a flying spot laser. We don't get the central islands that we would with a broad beam laser. The speed is extremely fast, which means that patients have less chance to move their eyes dur- ing treatment and the corneas have less chance to dry out—both of which could affect outcomes. The tracker today is wonderful, as are the optics of the laser. We also now have the option of doing a wavefront-guided or a Wavefront Optimized (Alcon) treatment with the Allegretto Wave Laser. We added the WaveLight FS200 femtosecond laser (Alcon) about a year ago. The combination of the femtosecond and excimer lasers works extremely well together. They were built to match each other, so they work in an integrated surgical way. The flow and operation is sim- ple. We begin the procedure under the FS200 laser for flap creation. Then the table swings from the FS200 laser to the Allegretto Wave Eye-Q excimer laser without the patient having to get up. This makes the refractive surgery quick, and it's a benefit not having to walk a pa- tient from one machine to the next. This is especially true for sedated pa- tients. After all, when you have just made a flap and the patient has to get up and walk across the hall and can't see well, it could be problem- atic. Now all the patient has to do is lay there during the transfer. The FS200 laser has many advantages. It's fast, for one. A flap is made in just 6 seconds. This is helpful not only for speed purposes, but also because it means there is less time for suction to become dislocated. Second, the pressure is not high enough for patients to have a complete temporary loss of vision. The culmination of the speed and minimal pressure can potentially enhance the overall procedure. The FS200 laser is capable of making a large LASIK flap up to 10 mm long. This is nice for doing large ablations, such as ones for hyperopic treatments. It has the ability to customize a flap in any way you want. For example, it can make an oval flap, move the hinge around, change the size of the hinge, etc. You can modify flaps for other prob- lems going on in the cornea, such as pterygium being present. You can optimize the thickness of the flap— depending upon the starting thickness of the cornea versus the planned ablation. You can customize flap shape based on the excimer treatment that will be carried out. If an excimer treatment pattern is more or less oblong or oval, for example, then a flap can be made to that same shape. You're not making the flap any larger than it needs to be. These all are ways you can customize the procedure for the pa- tient and for the surgical technique. All in all, I think the integration of the FS200 and the Allegretto Wave Eye-Q lasers makes for extraor- dinary outcomes. Notably, we are also having good experiences performing pene- trating keratoplasty (PK), anterior lamellar keratoplasty (ALK), and deep anterior lamellar keratoplasty (DALK) using the FS200 laser. We are very happy with these procedures. For example, a patient was treated recently with a corneal scar from a previous infection and an irregular flat cornea as a result. We performed ALK. We turned the donor lamella that was created with the FS200 laser upside down and did a steepening treatment on the backside of it. We then transplanted that into the recipient, hoping to steepen the cornea to a more normal configura- tion as opposed to what she had. So both the Allegretto Wave Eye-Q and the FS200 lasers had roles to play in facilitating this lamellar corneal transplantation. It is interesting that we did the transplantation under the WaveLight optics, because they are so good. The fact that the surgeon can see so well is helpful in this type of procedure. Without the optics, surgeons should ask if they know what they are missing. There's no doubt in my mind that from LASIK to keratoplasty, the integration of femtosecond and excimer systems help provide excellent outcomes. Dr. Culbertson is the Lou Higgins Distinguished Chair in Ophthalmology, Bascom Palmer Eye Institute, University of Miami. Contact information Culbertson: 305-243-2020, wculbertson@med.miami.edu EW Chicago 2012 Monday, April 23, 2012 8 Femtosecond and excimer lasers combine for excellent outcomes by William Culbertson, M.D. The WaveLight Refractive Suite Source: Alcon " The combination of the femtosecond and excimer lasers works extremely well together. They were built to match each other, so they work in an integrated surgical way " William Culbertson, M.D. Please refer to pages 10-12 for important safety information about the Alcon surgical products described in this supplement.

• Cover