Eyeworld Daily News

ASCRS NEWS Dr. Farid discusses using the femtosecond laser and OCT in DALK. by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor T he second session of the 2019 Cornea Day fo- cused on corneal lamellar and transplant surgery. Marjan Farid, MD, Ir- vine, California, discussed innovations in DALK, specifically how the femtosecond laser and OCT can be used. She began by mentioning how "big bubble" DALK was first de- scribed by Dr. Agarwal, and it put DALK on the map. However, it is difficult to achieve a successful bubble, and there is a 30 to 70% chance of failure (perforation of the Descemet's membrane). Meanwhile, deep posterior lamellar manual dissection is more predictable, Dr. Farid said, but it's difficult to achieve a perfectly smooth cut. So can the femtosecond laser and OCT help? Dr. Farid said that the femtosecond laser can provide a customized trephination pat- tern. This results in better wound alignment, which also results in improved astigmatism and optics. Dr. Farid said there is more sur- face area, meaning more rapid and stronger wound healing. She added that there is also faster recovery of vision with the femtosecond laser. Dr. Farid discussed the precise and programmable cut depths with a femtosecond laser. For lamellar dissection, she said to program the lamellar cut inner diameter to 3 mm, and this allows precise removal of 300 microns anterior stroma. The femtosecond laser can guide more exact needle insertion and air injection. Meanwhile, OCT guidance can help enhance surgical visibility. Dr. Farid said OCT can help in assessing all levels of the cornea during DALK. This may be partic- ularly helpful with positioning of viscoelastic or positioning scissors to make the final cut because Descemet's membrane can be visualized the entire time during this process. Dr. Farid concluded that she thinks femtosecond laser-enabled keratoplasty is the future of PKP and DALK because it offers better precision, predictability, and wound healing. In the future, she thinks there will be integration of technologies (like OCT and newer generation lasers) and optimiza- tion of settings to make DALK surgery predictable in every hand. We need advocacy and solutions to bring this technology into the hand of every corneal surgeon, she said. During a section of video case presentations, Jennifer Li, MD, Sacramento, California, shared two cases side by side: one where the surgeon attempted to push through a case that ended with a serious complication and one where the surgeon proceeded with caution and was able to prevent the complication from occurring. Both cases began with the surgeon attempting to insert an Cornea Day highlights corneal lamellar and transplant topics GFC debate tackles topic of 24-hour IOP monitoring D ouglas Rhee, MD, Cleveland, remains the undefeated, reigning champ of the Glauco- ma Fighting Champi- onship (GFC), defend- ing his title against Iqbal "Ike" Ahmed, MD, Toronto, Canada, on the topic of whether 24-hour IOP monitoring is relevant. Steve Sarkisian, MD, Okla- homa City, refereed the event, tell- ing the contenders that he wanted a "clean fight." "Ike, you only get two short jokes. Doug, you only get two hair jokes," he quipped. Dr. Ahmed and Dr. Rhee were a bit tamer in the personal punch- es they pulled at each other than in years past, but they left everything IOL and encountering resistance. Additionally, posterior pressure was building. In the first video, the surgeon attempted to keep going, while in the second, the surgeon paused to recompress the eye and wait for the posterior pressure to decrease. Dr. Li said the surgeon in the first video realized too late that there was an issue, and this result- ed in expulsive choroidal hemor- rhage. She noted the importance of recompressing the eye and decreasing posterior pressure to avoid this, and at the end of her presentation, Dr. Li revealed that both cases were actually from the same surgeon, her colleague Mark Mannis, MD. Editors' note: Dr. Farid has financial interests with various ophthalmic com- panies. Dr. Li has no financial interests related to her comments. continued on page 14 12 | EYEWORLD DAILY NEWS | MAY 4, 2019 Dr. Rhee defends his title as the reigning champ of the GFC. by Liz Hillman EyeWorld Senior Staff Writer

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