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Trephine for ASA and alternate alcohol

Q:

Emil:

I’d like to try your technique.

Can you share what your preferred trephine for ASA is (vendor, size, catalog #) ?

For yours and the group’s interest: I’ve been using a corneal light protector sponge saturated with 70% Isopropyl alcohol (yep good old rubbing alcohol!) for 12 secs followed by chilled BSS rinse. The epi comes off beautifully but not with a clean outer edge like a trephine.

I think the clean epi removal and ice cold BSS both after alcohol and after ablation are most helpful for pain control. I use Oasys 8.4,  NSAIDS for only 2 days, FML tapered over 3-4 months.

Mike

 

A by Emil Chynn MD:

it’s the same exact thing, ie using a mechanical microkeratome which uses a blunt separator that’s too blunt to go into the cornea, to push off the epithelium in one clean sheet, without needing any EtOH (in most cases), where the surgeon can choose to replace the epithelium or not (about 50% of surgeons do and 50% do not, bc they have observed quicker brand-new epithelium when they stimulate epi regrowth by leaving the area denuded for a few days w a BCL, surprisingly wo any increase in discomfort, and sometimes epi-off is actually more comfortable, probably bc the old epi isn’t dying off and releasing cytokines and other inflammatory mediators)

there has been a movement to renaming this procedure epiLASEK rather than epiLASIK, as it is clearly closer to LASEK (ie another ASA or Advanced Surface Ablation procedure) than LASIK, and the former (better) nomenclature is also more clear to the consumer/lay patient (ie they understand it is different than LASIK)
this is also why i have a problem w “bladeless” LASIK, as we all know that many lay patients think that this means there is no flap being cut at all, when in reality it means a flap is being cut with a laser. i do understand the branding/marketing value of this term, as it reduces fear, but i have actually seen a few patients over the last 20 yrs come in w flap dislocations from extreme sports after “bladeless” LASIK, and they were SHOCKED that they had a flap, and said “if my doctor had been more clear/honest w me that i had a flap cut into my cornea w a laser, i would have been more careful and worn eye protection”
long answer to a short question, but i hope it will be helpful and perhaps stimulate discussion!:)

 

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