Deegan M. Lew, O.D., FAAO
Clinical Instructor
University of Colorado, Denver
Department of Ophthalmology
The Rocky Mountain Lions Eye Institute
Email: deegan.lew@ucdenver.edu
The Co-management of Non-LASIK Corneal Laser Surgery
Abstract: Corneal refractive Excimer lasers have evolved to applications beyond
refractive procedures. Optometrists, as general medical eye professionals, have
the responsibility of understanding surgically treatable corneal diseases, many of
which can be co-managed in their own offices. This course will expose those
laser procedures and their corresponding peri-operative protocols.
Goals: To assist in recognizing potential corneal surgical cases in a general
optometrist’s office; to describe the type of surgery to better counsel patients;
and to describe pre- and post-op procedures.
General Overview:
I. Traditional Corneal Transplant Surgery
II.
Traditional Excimer Laser Applications
III. Non-LASIK Excimer Laser Applications
IV. Corneal Diseases and Dystrophies
V.
Post-op Co-management Guidelines
VI. Future Applications
I. Traditional Corneal Surgery
A. Indications
1. Keratoconus
2. Surgically-induced Bullous Keratopathy
3. Post-Herpetic Corneal Scars
4. Sight-impairing Corneal Dystrophies
B. Corneal Keratoplasty
1. Full Penetrating Keratoplasty
a. Description
i. Full trephination
ii. Donor cornea
iii. Running suture; multiple interrupted sutures
b. Indications
c. Advantages
i. Improves the appearance of cornea.
ii. Increases visual function
d. Disadvantages
i. Graft rejection
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ii. Visual outcome
iii. Induced irregular astigmatism
2. Lamellar Keratoplasty
a. Description
b. Trephine procedure of replacing 95% of anterior cornea
i. Decemet’s and endothelium remain.
c. Indications
d. Advantages
i. Less chance of rejection
e. Disadvantages
i. Visual outcome poorer than full keratoplasty
II. Traditional Excimer Laser Applications
A. Photo-Refractive Keratectomy (PRK)
1. Mechanism of Action
A. Laser-Assisted Insitiu Keratectomy
1. Mechanism of Action
III. Non-LASIK Applications
A. Photo-Therapeutic Keratectomy (PTK)
1. Mechanism
a. Masking
b. Trans-epithelial PRK
B. Femto-Second Decemets Stripping Endothelial Keratoplasty (FS-DSEK)
1. Mechanism
C. Femto-Second Assisted Intacts for Keratoconus
1. Mechanism
2. Indications
I.
Fixable Corneal Diseases and Dystrophies:
A. Corneal Scars
1. Post-Herpetic Ulcers
2. Diabetic Ulcers
3. Bacterial-Ulcer induced scars
4. Partial-Penetrating Trauma
B. Salzmann’s Nodular Degeneration
C. Band Keratopathy
D. Corneal Dystrophies
1. Lattice
2. Granular Dystrophy
3. Reis-Buckler Dystrophy
4. Fuchs Dystrophy
E.
Recurrent Erosion
F.
Irregular Astigmatism
1. Keratoconus
2. Surgically-induced astigmatism
2
3. Corneal Trauma
I. Co-Management Guidelines
A. PTK
1. Pre-operative Evaluation
a. Contraindications
2. Post-operative Evaluation
a. Post-operative Schedule
b. Expectations
c. Medications
d. Bandage Contact Lens
e. Billing and Coding
B. Intacts for Keratoconus
1. Candidates
2. Expectations
3. Results
C. FS-DSEK
1. Candidates
2. Expectations
3. Results
VI. Future applications
A. Corneal Ectasia
1. Corneal Cross-Linking
2. Keratoconus
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