IntraLase side-cut for enhancement reduces complications

WASHINGTON — The IntraLase FS laser can be programmed to perform a side-cut for late LASIK enhancement that avoids some of the problems with flap lifting, said Jon G. Dishler, MD.

At the American Society of Cataract and Refractive Surgery meeting, Dr. Dishler reported on the use of the FS laser to create a new flap in eyes undergoing enhancement at 3 to 7 years after initial LASIK surgery. He said the “side-cut only” setting on the IntraLase can create a flap deeper and smaller in diameter than the original keratectomy.

All flaps lifted easily, had smooth interfaces and healed uneventfully, Dr. Dishler said. Postoperative day 1 visual outcomes were “excellent,” he said.

“Ten years ago, we would wait about 6 months to do enhancement. Five years ago, relifting became ‘standard of care,’ but we saw a high incidence of epithelial ingrowth,” Dr. Dishler said. This new application of the FS laser allows easy access to the original, smooth corneal bed, he said

“Centration is key” when making the new cut, he said. Dilating the pupil aids in centering the new incision because it allows the surgeon to see the old cut. Overlap of the two cuts has not been a problem, as it has been with making a second flap with mechanical microkeratomes, he said.

Dr. Dishler also said that IntraLase flaps are stronger than ones cut by a mechanical microkeratome.