BRUSSELS - Hyperthermic treatment is a safe effective
and easy-to-perform procedure for treating the
corneal flap striae that may occur in patients
who have undergone LASIK and which can reduce their
visual acuity significantly, A. John Kanellopoulos,
MD, Manhattan Eye Ear and Throat Hospital, New
York, N.Y. will tell the ESCRS Congress here.
Dr. Kanellopoulos
noted that the flap striae following LASIK surgery
can reduce both BCVA and UCVA significantly as well
as increasing glare and visual distortion. They usually
occur in the early post-operative period, and may be
associated with trauma, such as eye rubbing, dry eye,
and the deep ablations used in patients with very high
myopia. In his ESCRS presentation he reports on application
of the hyperthermic technique in 15 patients whose
UCVA was less than 20/20 after LASIK, and who also
experienced glare, and irregular topographic astigmatism.
"The procedure
is designed to smooth out the
striae by relaxing the collagen fibrils which
contribute to their formation"
The procedure is designed
to smooth out the striae by relaxing the collagen fibrils
which contribute to their formation via two mechanisms:
the hypotonic solution produces transient flap swelling
and stretching resulting in spontaneous striae resolution.
The heat transferred to the flap stromal collagen enables
the restoration of the original stromal texture without
inducing stromal scarring and/or shrinkage, he told
EuroTimes.
Smoothing Out The
Striae
The procedure begins
by marking and lifting the flap and then using a "golf-club" type
spatula heated in a bath of hypotonic sterile water
at 65° to "iron out" the folds from the back side of
the flap. In addition, collagen and/or other debris
which has accumulated in the striae are removed from
the underside of the flap and the stromal bed, Dr.
Kanellopoulos explained.
Then a Johnston applanator,
heated in sterile water, is used to "press-iron" the
re-positioned flap for 15-30 seconds, taking care to
slide the instrument away from the hinge. For striae
which have persisted for more than two weeks it is
important to separate the epithelium underlying the
flap. If this is not removed, they may produce resilient
epithelial "layer memory" that can reintroduce the
striae after the initial treatment, he pointed out.
Post-operatively,
Dr. Kanellopoulos applies a drop of CelluviscR to the
repositioned flap to avoid eyelid traction and the
patient then wears a bandage contact lens for one day
in most cases and for three days, when the epithelium
has been removed. He also uses OcuflowR/PredforteR
for from 4 days to one week and follows the patient
with evaluations of visual acuity, topography and biomicroscopy
to determine if striae remain.
At a mean follow-up
of 6.5 months, the patient's mean UCVA improved from
the pro-operative value of 20/35 to 20/24, while mean
BCVA improved from 20/30 too 20/21. There was also
a marked topographic improvement in irregular astigmatism.
There were no complications associated with the procedure,
he concluded.
In addition to
his position as director of residency training at
Manhattan Eye, Ear and Throat Hospital, Dr. Kanellopoulos
is also clinical professor at New York
University Medical School.
His co-author was
Eric D. Donnenfeld, MD, Medical Director, TLC Laser
Centers, Garden City, New York.
Source: Eurotimes,
vol. 5, Issue 6, September 2000 |
