New LASIK instruments may reduce flap complications

By Roibeard O’hEineachain

Alicante — A new spatula and cannula for flap manipulation and cleaning during LASIK may help reduce the incidence of interface complications debris and epithelial trauma, says Jose Rodriguez-Prats MD.

The new spatula, the Alio-Rodriguez spatula, has a special forked design for lifting and manipulating LASIK flaps more easily.

According to the Spanish ophthalmologist, the new Alio-Rodriguez cannula has irrigation/aspiration ports that enable the surgeon to clean the interface while removing the irrigating fluid.
“Our standard LASIK spatula is now the Alio-Rodriguez spatula. Since we started using it we have had no cases of epithelial trauma, epithelial in-growth, or trapped fluid at the interface.

“In cases of re-treatment, the edge of the flap elevated with the spatula is smoother and more regular that that elevated with other instruments together with less epithelial injury while trying to locate the flap edge. Cleaning the interface with Alio-Rodriguez cannula has significantly reduced the incidence of interface debris and metallic particles,” he said.

Primary and re-treatment techniques
In primary LASIK procedures, Dr Rodriguez –Prats and his associates from the Instituto Oftalmológico de Alicante introduce the spatula in between the flap and the stroma 90° from the hinge once they have performed the microkeratome cut.

They then quickly advance the spatula first towards the hinge and then in the opposite direction until they have freed the flap from the underlying stroma. The excimer laser treatment is then applied.
In re-treatment procedures they gently apply the ends of the spatula to the cornea adjacent to the flap edge until they can identify the edge of the flap, free and lift the flap as in primary procedures.

Following the excimer ablation, the Alicante team uses the Rodriguez-Prats cannula to irrigate the interface. Then they introduce the flap between the two blunt arms of the spatula and, with a slow fine movement, pass the spatula across the bed to reposition the flap, squeezing the fluid at the interface and testing flap adhesion to the underlying stroma.

Dr Rodriguez-Prats explained that the idea of the cannula is to use continuous irrigation while performing automatic aspiration. This will help proper and complete cleaning of the interface with less incidence of stromal hydration which might affect the flap adhesiveness.

Stroking the surface of the flap with the Alio- Rodriguez spatula ensures the flap is completely smooth and the width of the gutter is equidistant throughout the recession curvature.

“Our new Alio- Rodriguez spatula and irrigation/aspiration cannula are safe and effective in flap elevation and manipulation, especially in cases of re-operation.

“The new instruments minimise the interface deposits and metallic particles epithelial in-growth and they prevent entrapment of filaments and irrigation saline at the interface. We recommend their use as routine during LASIK procedures,” Dr Rodriguez-Prats said.

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