CONFERENCE HIGHLIGHTS AAO 2019 Posters
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Retreatment, Relationships and Regimens at AAO 2019 by Brooke Herron
T
he Refractive, Glaucoma and Cornea Subspecialty Days at the recent American Academy of Ophthalmology (AAO 2019) annual meeting were chock full of new research, including updates on treatment and ongoing studies. Below, we’re presenting some of the anterior segment highlights from the meeting’s exciting scientific program.
CIRCLE Enhancement After Myopic SMILE It’s clear that small incision lenticule extraction (SMILE) is gaining popularity in the refractive sphere. However, enhancement using re-SMILE is neither approved nor commercially available on the VisuMax platform from Carl Zeiss Meditec (Jena, Germany), and very little data exists on its safety and efficacy. As a result, alternative enhancements like surface ablation, cap-to-flap conversion (using the CIRCLE program) and thinflap laser-assisted in situ keratomileusis (LASIK) have been proposed and established as retreatment options. Looking further into one of these methods, Dr. Jakob Siedlecki discussed the advantages and disadvantages of CIRCLE retreatment after SMILE, which converts the SMILE cap into a femtosecond LASIK flap. (Note: While the CIRCLE software is integrated into the VisuMax platform, it is not currently available in the United States.) There are four CIRCLE patterns with different sequential laser cuts available, although Riau et al., found that pattern D was the easiest to lift. And this step-by-step surgical technique was described by Dr. Siedlecki. Results from a study comparing CIRCLE with other retreatments were
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Relationships ain't easy: Glaucoma (and its medications) can exacerbate problems in the cornea.
presented. It was found that CIRCLE after SMILE provides outcomes noninferior to surface ablation. And CIRCLE was also non-inferior in terms of safety and efficacy when compared to LASIK retreatments. Another study by Siedlecki et al., found comparable results for both CIRCLE and surface ablation at three months, while CIRCLE retreated eyes showed a markedly quicker visual recovery. CIRCLE is also easy to use and requires less preoperative planning than thin-flap LASIK above the SMILE interface. Additionally, the painless nature of the procedure may also appeal to patients, especially in conjunction with a quicker visual recovery. However, a disadvantage of the CIRCLE approach is that it sacrifices the
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idea of the flap-free approach, which is often touted as a primary benefit of SMILE. In fact, when the anterior stroma is separated above the flap from the posterior corneal structures, more biomechanical weakening is induced than in surface ablation or in thin-cap LASIK. Dr. Siedlecki said this will be especially pronounced in deep caps: “In these cases, thin-flap LASIK anteriorly to the SMILE interface might provide better outcomes.” This led Dr. Siedlecki to conclude that “CIRCLE offers an easy to use, safe and efficient option for refractive enhancement after SMILE. And from a surgical prospective, cap thickness of the primary SMILE procedure might be the most prominent guiding factor”.
