Advanced surface ablation finding increasing role in refractive surgery, surgeon says

MIAMI — Surgeons are seeing "excellent" visual results and low degrees of pain using the advanced surface ablation procedures available for refractive surgery today, according to William B. Trattler, MD.

"I do think it is extremely safe and provides great vision with the ability to use it in advanced situations, such as post-LASIK. It is playing an increasing role in our armamentarium," Dr. Trattler said in a presentation here at Bascom Palmer Eye Institute's Inter-American Course on Clinical Ophthalmology.

Earlier versions of surface ablation were often painful for patients, but a number of approaches to reducing pain have been introduced, including preoperative use of Restasis (cyclosporine ophthalmic emulsion, Allergan), punctal plugs, topical anesthetics, oral medications and chilling the cornea with chilled saline, Dr. Trattler said. He also recommended placing a bandage soft contact lens on the eye postoperatively.

With deeper understanding and improvement in techniques, indications for surface ablation have also been expanded to include some patients who are not candidates for LASIK, he said, such as those with thin corneas, suspicious topographies or dry eyes, as well as those with previous LASIK flap complications.

Additionally, there are now a variety of techniques for removing the corneal epithelium, including brush, laser, manual scrape, alcohol-assisted LASEK and epi-LASIK, Dr. Trattler said.

He noted that surgeons should wait 3 to 6 months after LASIK before performing surface ablation for a residual error, to give the flap a chance to "settle down."