Aiming for fewer retreatments

One surgeon's quest to reduce intraoperative LASIK complications has led to the development of a new multifunctional instrument, which is hoped will help standardize surgical manoeuvres and reduce the need for retreatment. The LAHayeSIK Surgical System has been designed to perform cleaner LASIK for more consistent outcomes and fewer complications, according to inventor/developer Leon LaHaye, MD of Lafayette, Louisiana, USA.

The LAHayeSIK instrument (Vision Pro, LLC; USA) comes in either a compact table-top console or a surgical cart consisting of a multifunctional handpiece, a pivoting surgical tray, a foot pedal controlled irrigation/aspiration and sterile filtered air delivery system, disposable tubing sets, and smoke and fluid collection receptacles. The system is approximately the size of a phacoemulsification instrument.

"As we know, keratotomy complications are almost nil today thanks to the advanced, automated technology of modern microkeratomes and the femtosecond laser. Hence, the early difficulties associated with creating the corneal flap have largely become a thing of the past. Most of the LASIK complications we still see occur in what I refer to as the second stage of the procedure, or in other words, during the manoeuvres and the laser treatment that follow the keratotomy," says Dr LaHaye. "There remain less than optimal issues associated with traditional LASIK such as: direct exposure of the open stroma and flap to contamination from lids, secretions, conjunctiva; non-uniform hydration of the target stroma and associated etch variability; extraneous instrumentation; excessive manipulations; sub-optimal intraoperative flap management; ineffective means of cleansing and rinsing post ablation; backwash contamination; involuntary eye movements; non-uniform and poor flap adherence. All of these sub-optimal issues are, in my opinion, synergistically addressed by the LAHayeSIK device," insists Dr LaHaye.

"In addition to reducing complications, I wanted to create a system by which I could standardize and automate the procedure for more consistent outcomes," says Dr LaHaye. "By reducing the number of instruments normally used, I have found certain ergonomic economies are achieved and the procedure is substantially shortened and made more reproducible."

Performing the procedure

After the flap has been created but prior to exposure of the stroma, the LAHayeSIK handpiece is placed on the eye. It remains in position throughout the remainder of the procedure, held in place by the surgeon or assistant. The stainless steel conical wall of the instrument forms a fluid tight barrier at the margins of the cornea to reduce the area of the surgical field and prevent contact contamination by lashes, lid secretions, conjunctiva and surgical debris.

The multifunctional handpiece also provides 360° haemostasis against potential bleeding that can sometimes occur with today's large keratotomies. Throughout the procedure, sterile, pulsed irrigation at the rate of 1.8 cc/second and simultaneous aspiration of the surgical field is available on demand to flush away surgical debris via a foot control. Antibiotics may be added to the irrigating solution at the surgeon's discretion.

Laminar flow sterile filtered air is delivered in the same manner at the rate of 30 ml/minute, evaporating excess moisture as needed. The instrument's aspiration ports are strategically located at the lowest possible point in the handpiece preventing pooling and backwash of irrigation fluids, or occlusion by the conjunctiva, delivering a cleaner interface.