Lamellar surgery

The key to success in any type of new ophthalmic surgery is affordability as well as reproducibility and standardisation of the required technique, Massimo Busin MD told the Joint Irish/UKISCRS Refractive Surgery Meeting in Dublin, Ireland.

Dr Busin, Head of Ophthalmology, Villa Igea Hospital, Forli, Italy, gave the Tom Casey Memorial Lecture on corneal surgery, describing in detail the development of various corneal procedures including penetrating keratoplasty (PK), Descemet’s stripping automated endothelial keratoplasty (DSAEK), Descemet’s membrane endothelial keratoplasty (DMEK), the latest move to ultra-thin DSAEK (UT-DSAEK) as well as the increasing use of femtosecond laser.

“For solid advancement in any type of surgery, you must develop something that is affordable for every surgeon. If you have something that is only applicable by an elite group of surgeons I don’t think it will ever become popular and make it through. My efforts were always devoted to trying to develop ways to perform difficult things in an easy way,” he told EuroTimes.

During the course of his lecture, Dr Busin strongly advocated the use of UT-DSAEK, praising its ability to provide the best form of DSAEK, resulting in good visual outcomes, faster healing and lower immunologic rejection risk, as shown by his own studies.

Dr Busin described how he originally carried out UT-DSAEK graft preparation using the ‘double pass’ method but, with the new linear microkeratomes that cut at a uniform depth, now uses a ‘single pass’ technique.

“Most of the time now I’m performing UT-DSAEK, which I developed, though DMEK can also be performed with good success rates these days, especially if you try to standardise it like I did. However, I think the jury is still out about which one is superior to the other,” he said.

While UT-DSAEK is still a relatively new procedure, Dr Busin said it is increasing in use, particularly due to the increased availability of donor tissue and its pre-surgery preparation from eye banks.

“The problem with thinner tissue concerns mainly manipulation during surgery, but the more experience the surgeons gain, the more requests there are for thinner tissue and that is the trend all over the world,” he told EuroTimes.

Discussing corneal dissection, he said femtosecond laser is expensive but precise, but does not cut through opacities. In terms of anterior lamellar grafts Dr Busin believes pneumatic dissection does not have rivals against other procedures.

Massimo Busin: mbusin@yahoo.com