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Temporal hinge may be preferable for IntraLase flap

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ROME — A temporal hinge may be the safest and most effective option when using a femtosecond laser to create LASIK flaps, said a surgeon speaking here at the OSN Rome Symposium.

“The original microkeratomes were designed to create a nasal hinge. However, superior hinge rapidly gained popularity because of the less likelihood of gravitation-induced flap distortion. But the superior approach also has limitations,” said Dmitri Azar, MD. “When the flap is everted, it may rest on the upper eyelid or eyelashes, which are a potential source of epithelial scratching and infection. In addition, it has been hypothesized that the effects of a superior cut on the long ciliary nerves might have a role in the onset of dry eye after LASIK.”

Because of technical difficulty and limited availability of the option in most microkeratomes, “a temporal approach was never really considered,” Dr. Azar said. He said there are several advantages to using a temporal hinge.

“It leaves a larger stromal surface available for ablation, which produces better treatments with less chances of developing glare and halos,” he said. The surgeon can also create a larger hinge without sacrificing exposed stromal surface area, adding stability to the flap, Dr. Azar said.

“In addition, the long ciliary nerves are not affected, which lowers the chances of developing dry eye symptoms. Finally, since most trauma to the eye comes from a temporal to a nasal direction, with a temporal hinge there would be less chance of flap dislocation and tearing of the flap,” he said.

Dr. Azar added that patients with mixed against-the-rule astigmatism, both hyperopic and myopic, may benefit from a temporal hinge, which leaves plenty of space for the characteristic oval treatment pattern along the vertical axis.

“The hinge will not interfere at all with the treatment zone,” he said. Conversely, a superior hinge might be preferable for patients with with-the-rule astigmatism, he said.

The OSN Rome Symposium is a meeting held jointly by Ocular Surgery News, the Italian Society of Ophthalmology, the Italian Association of Cataract and Refractive Surgeons and the International Society of Refractive Surgery/American Academy of Ophthalmology.