A Case Series From A Neophyte Surgeon: What I Have Learnt From My First Ten Lasiks

To describe how a young ophthalmic surgeon has started femto-LASIKs with a background of only surface ablations (PRK), mainly performed during his residency; what he has learnt and what is being mainly important for his (and probably your) future practice, difficulties and complication rate are reported.

O.U. Santorso Hospital, Vicenza Italy daily surgical public activity

All refractive procedure were done at Vista  Vision Centre,  Verona, Italy

Ten patients (20 eyes) were operated during the 2022 (Vista Vision Center Verona). The mean age was 35 +- 18 years ,8 males and 2 females. All of them underwent to a bilateral procedure with Visumax 500 (Zeiss) as femto-laser to create the flap and Teneo (B+L) as excimer laser to ablate the stroma.  14 myopic treatments (ranging from -1,75 to -6,50 as spherical equivalent) and 6 hyperopic/presbyopic treatments (ranging from +0,75 to +1,50 as SE). Patients selection, treatment choice and expected outcomes for myopic and hyperopic treatments were discussed in advance with the mentor (Dr.ssa S. Morselli). All patients were visited 30 min after the laser procedure, the day after and after 1 month

All patients were treated as planned with a bilateral procedure, under topical anestesia. Flap thickness ranged from 100 to 120 microns and optic zone from 6,5 to 7,2 mm. Residual stromal bed was calculated to be above 300 microns. No loss of suction or other intraoperative major complications were reported. One of the eye that underwent to a hyperopic treatment was observed for a suspect diffuse lamellar keratitis that showed up to be debris under the flap, not in optical zone. Contact lenses were used only for the first patient for a minor epithelial defect.

All myopic patients achieved 20/20 the day after,  results were stable at 1st post-op month. Hyperopic patients regained far vision after 1st  to 3rd months.

One of the main difficulties for a beginner is probably to find the right patient to start and the courage to propone a refractive procedure on a naive and healthy eye. The daily activity is mainly focused on cataract, retina, glaucoma and cornea. No space for refractive surgery is given in a public setting, in Italy. All this procedures have been performed in private practice. Patients were enrolled in territorial ambulatory and between friends.

The importance of a mentor that can correct and encourage doing the right choice, and his/her presence during the procedures to be ready to help in case of difficulties, is probably the most important lesson that I have learnt.

And now, what’s next? Eventually SMILE, Probably many other LASIKs.