35
EW SHOW DAILY
byline plus fade
ASCRS•ASOA Symposium & Congress, New Orleans 2016
35
EW SHOW DAILY
ASCRS•ASOA Symposium & Congress, New Orleans 2016
But most of all, she emphasized,
jesting: avoid cousins!
The invisible flap
Dr. Jacob presented her own night-
mare scenario. She was performing
an otherwise uncomplicated LASIK.
She had just lifted the flap and was
wiping the flap bed with a Weck-
Cel sponge when a nurse or orderly
peeked into the operating room to
ask if she had everything she need-
ed. She looked up—for just a sec-
ond—and when she looked down,
the flap had disappeared.
She and her fellow frantically
reviewed the surgical video to see
what happened—the brief instant
that she'd looked up, she wiped the
eye with a sponge and the flap had
apparently been pulled off along
with it. They scoured the operating
field, checked all the sponges they'd
used for the procedure; Dr. Jacob
even pulled the patient's eye up,
down, sideways, desperately everting
the lids to search in the fornices.
After 10 minutes, Dr. Jacob gave
up on the search, told the patient
the procedure was over and that
they might have to go back for
additional procedures—measuring
the bed, thinking of where to source
some donor corneal tissue, already
planning a keratoplasty procedure.
Removing the drapes, perform-
ing one last search—Dr. Jacob found
the LASIK free cap, practically invis-
ible, floating in a drop of balanced
salt solution clinging to the surface
of the surgical drape.
They redraped the surprised pa-
tient. But Dr. Jacob was confronted
with a new problem: Which side was
the epithelium, which the stroma?
Dr. Jacob turned the cap over
and over, fitting it into the bed,
thinking. Eventually, she wiped the
tissue and found her answer: Drying
the surface on 1 side revealed the
rough texture of the femto cut; the
epithelial surface remained smooth.
Dr. Jacob completed the proce-
dure, breathing a sigh of relief.
Allogeneic inlay
Dr. Jacob also presented a new
concept for treating presbyopia
made possible by the development
of small incision lenticule extraction
(SMILE)—the use of an allogeneic
lenticule refractive inlay. Taking a
lenticule from a prior SMILE proce-
dure, Dr. Jacob cut out an inlay-sized
piece of tissue, which she inserted
into a pocket created with a femto-
second laser.
The lenticule, she said, alters
the shape of the cornea, giving it an
enhanced hyperprolate shape. This
serves to increase the eye's depth of
focus. EW
Editors' note: Drs. Agarwal and Jacob
have no financial interests related to
their comments.
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