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Innovative instruments simplify LASEK
A variation of the butterfly trephine, a curved microplow and an epithelial repositor cannula are among new surgical tools for LASIK.
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WILMINGTON, N.C. – Several novel devices can make laser epithelial keratomileusis surgery easier and more precise, according to a surgeon here.
Alan W. Brown, MD, in practice here, discussed his experience with several instruments for LASEK made by Rhein Medical. These include a nested epithelial trephine; a variation on the butterfly trephine that scores the epithelium for the surgeon but avoids the visual axis; a microplow that follows the natural radius of curvature of the cornea; and a combination spatula and cannula that consolidates two steps into one.
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Two-part trephine
The nested trephine is a two-part instrument that serves both to score the epithelium and to hold the alcohol solution. The lower portion of the device is a well with a small beveled edge for easy insertion and withdrawal of the trephine portion. Dr. Brown said this results in perfect alignment, because when it is placed on the eye as one unit, the surgeon can simply score the epithelium, then remove the trephine. The well is already in place, so the alcohol reaches only the scored epithelium, allowing better epithelial loosening.
Another instrument, a variation of a butterfly trephine, allows the surgeon to trephine the epithelium, make whatever score he or she wants and then peel back the trephined epithelium in two flaps instead of one.
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“I think it is easier to pull back two hemiflaps than one flap,” Dr. Brown said. “Some people are a little bit uncomfortable about scoring near the visual axis. This is a variation of the butterfly; the new trephine actually has a scoring mechanism near the central cornea that spares the visual axis. By softening these curves, it makes it a little easier to retract.”
Another device, the microplow, a variation of a microhoe, is used to pull back the epithelium.
“The original instrument was good, but I found that in certain areas, if the epithelium was tough, the microhoe was not as sharp as I would like,” Dr. Brown said. “Additionally, it has flat sides, and the cornea has a radius of curvature, so if I put a flat instrument across a curve I can delaminate some of the epithelial cells and leave some behind.”
The microplow follows the curvature of the cornea. It does a better job of removing the epithelium, he said.
Dr. Brown discussed one more instrument, the epithelial repositor cannula.
“The original technique used saline on the epithelium and then a spatula that nicely brings the epithelium back into position, and it was pretty easy to just make this [spatula] into a cannula. The new epithelial repositor cannula has the same shape as the spatula but has tiny holes so that saline can be used, instead of going back and forth between two instruments,” he said.
For Your Information:
- Alan W. Brown, MD, is director of the Vision Research Center. He can be reached at Summit Center, 1717 Shipyard Blvd., Suite 140, Wilmington, NC 28403; (910) 796-8600; fax: (910) 796-8644. Dr. Brown has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any company mentioned.
- Rhein Medical can be reached at 5460 Beaumont Center Blvd., Tampa, FL 33634; (813) 885-5050; fax: (813) 885-9346; Web site: www.rheinmedical.com.