LaZrPlastique technique provides a 'non cutting' edge over LASIK

Ophthalmology Times EuropeOphthalmology Times Europe May 2023
Volume 19
Issue 04

Dr Arun C. Gulani explains how his corneal surface technique offers a contrast to cutting procedures without risk, pain or drama.

©Galaxy_love_design /
In contrast to LASIK, LaZrPlastique does not require flap creation. (©Galaxy_love_design /

Where is the pain? Where is the haze? Eureka, we got it!

More than 3 decades ago when I performed my surface refractive surgeries on regular and irregular corneas, I was pleasantly surprised that no patient complained of pain, nobody had regression, and there was no scarring or haziness, which is the Achilles’ heel of photorefractive keratoplasty (PRK) surgery.

With experienced refractive surgeons visiting my practice in Jacksonville, Florida, US, I allowed them to question every patient of mine about the presence of pain intraoperatively, day 1 postoperatively, day 5 postoperatively (when I removed their bandage contact lenses) or years later. Not one patient complained of pain despite being among a population of patients who were extremely intelligent, very demanding, and most often skeptical, having had past surgical experiences elsewhere.

This made me think about what I was doing differently. Analysis of my technique showed that the difference may be in the way I removed the surface epithelium (my proprietary MASSTER technique) and the avoidance of the use of toxic materials such as alcohol or hypertonic fluids. I did use mitomycin C for every patient.

Most patients received a hydrocodone tablet the night before surgery took place because many were from out of state or out of country and I wanted to ensure they did not go partying and were resting and sleeping in a hotel.

This was when I also started my video recording of patients (because of the exceedingly high accountability I placed on my shoulders) intraoperatively, immediately postoperatively, 1 day postoperatively and during long-term follow-up. This was to share with colleagues my own amazement about how patients were not only being corrected despite having high and irregular refractive errors, including corneal scars and previous corneal surgeries, but also their level of comfort and gratified reactions to flawless-looking eyes. All these patients were fully paying and very intelligent and hence had no reason to be on video or say anything complimentary about their surgical experience.

I first performed LASIK more than 3 decades ago, much before FDA approval, and I was enamored by my results with zero enhancement and zero complication rates, which I attribute to always refracting each patient personally. Due to my experience and range of refractive, corneal and lenticular surgeries, I was uniquely becoming a practice that was seeing patients for second opinions and LASIK complications from around the world and had already designed my Gulani LASIK Complication Correction instrument set (Bausch + Lomb) for this super specialty that would eventually give birth to my concepts of Corneoplastique.

As I studied these referred patients from around the world, based on my refraction even more than the topographic and wavefront data, I realised the direct correlation between refraction and every corneal refractive component (regular or irregular) and decided that surface laser surgery would indeed be the future; there would be no corneal cutting or any anatomically destabilizing impact.

With my confirmed concept and decades of experience with patients from all parts of the planet of different cultures and complexity levels, I created what I feel is a universally applicable, safe, and consistent corneal refractive surgery. Additionally, since I do not like hype or advertising, I did not give it the prefix of LASIK but chose the name LaZrPlastique, which is in line with my plastique thought process and work because it is a term that surgeons can use (rather than an advertised hype or lure for patients).

(Figure courtesy of Arun C. Gulani, MD)

In contrast to LASIK, LaZrPlastique does not require flap creation. I developed LaZrPlastique, a corneal surface technique, as a solution for and superior choice to correct the potential problems associated with LASIK, PRK and SMILE performed by referring refractive surgeons. What started as a quest for a safe and universally applicable corneal refractive technique with all the positives of LASIK and PRK without their negative aspects was applied to normal myopic, hyperopic and astigmatic cases to achieve excellent and consistent vision.

Any cut that is made in the cornea will ultimately cause some instability in the near or far future that might be undiagnosable at the time of the procedure while also resulting in a physiologic imbalance, including dry eyes.

Wide applicability of LaZrPlastique

I now regularly perform LaZrPlastique to correct a wide spectrum of conditions besides normal refractive errors, such as against-the-rule astigmatism; corneal scars; complications associated with LASIK, collagen cross-linking, SMILE, PRK, radial keratotomy and cataract surgery; and adverse effects associated with implantation of premium intraocular lenses (IOLs). The procedure also can be used to treat refractive errors in patients with thin corneas and relatively dry eyes (which can be corrected first if needed).

(Images courtesy of Arun C. Gulani, MD)

In addition, LaZrPlastique can be performed in combination with other procedures, such as cataract surgery, which I refer to as ‘inside out’ and ‘outside in’ techniques. In an example of the latter in which a patient with a corneal scar also has a cataract, the scar is corrected first, which makes the cornea measurable to obtain the appropriate IOL power, and then the cataract is extracted. For an inside-out technique, the optics can be manipulated with an IOL to obtain a desirable refractive error that then lends itself to correction of both the refractive error and the associated corneal pathology—and it is straight to emmetropia.

This concept allows me to correct many unhappy premium cataract surgery patients and make them ‘20/20 happy.’ The applications are unlimited.

Visual results after treating a series of corneal scars and irregular corneas

Data from a series of patients with corneal scars treated with LaZrPlastique were reported at the recent World Cornea Congress in Chicago, Illinois, US. A total of 64 eyes (53 patients) were followed for from 1 month to 15 years. All of the patients who were treated using LaZrPlastique had improved postoperative vision compared with the preoperative level, with none losing any line of best corrected vision.

The corneal scars in these patients were the results of LASIK, PRK, corneal dystrophy, contact lens infections, including scarring from Acanthamoeba, and herpes simplex virus.

The mean preoperative unaided vision improved from 20/165.26 (136.47) to 20/50.00 (26.49) day 1 after undergoing LaZrPlastique, with a mean improvement in unaided vision to 20/23.55 (7.05) at an average of 53.70 (52.50) months postoperatively.

LaZrPlastique provides good levels of vision to patients who might not have been considered candidates for a refractive procedure. The level of vision that they achieve can be life changing.

In my hands, after 3 decades of performing LaZrPlastique, this procedure is safe, consistent and stable and is highly applicable to a wide range of ophthalmic scenarios, including regular and irregular ametropia, and can be performed alone or in combination with other procedures.

Arun C. Gulani, MD, MS
Arun C. Gulani, MD, MS, is founder of the Gulani Vision Institute in Jacksonville, Florida, US. LaZrPlastique is a registered trademark.
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