No-flap surgery for myopia

January 1, 2012
Cheryl Guttman Krader, BS, Pharm

Refractive lenticule extraction performed using a proprietary femtosecond laser platform is a safe and effective minimally invasive technique for correcting myopia and astigmatism.

Vienna, Austria-Refractive lenticule extraction (ReLEx) performed using a proprietary femtosecond laser platform (Visu Max, Carl Zeiss Meditec) is a safe and effective minimally invasive technique for correcting myopia and astigmatism. The procedure also offers a number of advantages compared with excimer laser ablation procedures, according to experienced surgeons who reported results during the 2011 congress of the European Society of Cataract and Refractive Surgeons.

ReLEx received the CE mark in 2008 for treatment of myopia between –0.50 and –10 D, astigmatism up to 5 D, and SEQ between –0.75 to –10 D. It is not FDA approved.

"Compared with excimer laser vision correction, the accuracy of ReLEx smile is not affected by corneal hydration or environmental conditions in the operating room, and eye movement is also not an issue once the eye is fixed to the laser," he said. "Theoretically, it should be associated with greater biomechanical stability than LASIK, but ongoing research is focusing on establishing that benefit as well as determining the role of customized treatments, identifying the best way to treat residual refractive errors, and developing a hyperopic correction technique."

Predictability analyses showed a few outliers initially, which Dr. Ibrahim attributed to intentional undercorrection either because the patient was presbyopic or the cornea was too thin to allow for full correction. At 1 week, SE was within 1 D of intended in 93% of eyes and ±0.5 D in 85%.

Postop UCVA was better than preop best spectacle-corrected visual acuity (BSCVA) for most patients and among cases with 20/20 or better best-corrected visual acuity (BCVA) preoperatively, it was 20/20 or better in about 75% of patients at 1 week and 86% of patients at 1 year.

Excluding some early cases performed during the learning curve stage for the procedure that had BSCVA loss of 1 or 2 lines, safety was good. At 1 year, BSCVA was unchanged from the preoperative level in 94% of eyes.

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