-----Original Message-----
From: Gerri L. Goodman [mailto:laservision@starpower.net]
Sent: Monday, April 15, 2002 10:14 AM
To: ISRSNet
Subject: [isrsnet] Re: How long for flap lift

----- Original Message -----
From: Sharpevision@aol.com
To: ISRSNet
Sent: Saturday, April 13, 2002 3:10 AM
Subject: [isrsnet] Re: How long for flap lift


Dr Stahl,
I have found that I can tell relatively easily how hard the flap will be to lift, and there is no time limit to when you can re-lift. At the slit-lamp, if you observe a dense circumlinear scar at the old flap edge, especially combined with some haze at the interface, this will be very hard to lift, and should be considered in your consultation with the patient about doing anything at all (i.e. don't do plano-.75). However, if you have trouble finding the edge, the flap will lift as though you did the primary procedure yesterday, even if it has been 2 years. This frightens me for the minor blunt trauma that we will one day see causing flap dislocation years out. I really hate recutting and avoid it if at all possible. I've had one patient with a mincemeat cornea at the time of recut who miraculously recovered, but not everyone would be so lucky.

Matt Sharpe, MD
Columbus, Ohio ---
You are currently subscribed to isrsnet as: laservision@starpower.net





Date: Wed, 15 May 2002 11:33:59 -0700 (PDT)
From: Val Zudans <zudans@yahoo.com>
Subject: [isrsnet] Re: striae
To: "ISRSNet"
I had a similar case where macrostriae developed between the 1 day and
1 week visit, presumably from eye rubbing. I debrided the epithelium
over the striae, applied sterile water, smoothed perpendicular to the
striae with dry sponges, lifted the flap, further removed striae
through smoothing perpendicular to the striae with dry sponges,
smoothed the flap, and applied a contact lens. A complete video as
well as presentation is available at
http://129.171.73.73/GR_PPT/031402/Zudans_GR_031402_files/frame.htm
The patient did very well, although he had mild DLK from the ked, that
responded well to standard topical and p.o. steroids. His final UCVA
was 20/15- and no residual striae remained. It has been suggested that
the epithelial remodeling in cases greater than 1 day "lock in" the
striae. This may be why either epithelial debridement or prolonged
suture placement is needed for cases that are not treated on post-op
day 1. Has anyone who has placed sutures had difficulties with
irregular / induced astigmatism related to the sutures? If so, the
above described procedure may eliminate this astigmatism problem.

--- PedKera@aol.com wrote:
> as I was leaving the office i got a frantic phone call from a distant
>
> colleague-lasik done 7 days ago in her area on a patient that lives
> near
> me-first day post op a "few" striae noted at edge of visual axis;
> nothing was
> done since patient was happy and comfortable; today VA=20/50,
> corrects to a
> poor 20/25 and the striae now appear to be closer to the visual
> axis-patient
> is flying back home on tuesday and will see me later this
> week(between 9-11
> days post op)-judging from these changes over this time frame what
> would be
> your preferred approach
>
> jerry zaidman

Date: Mon, 15 Apr 2002 09:05:15 -0700 (PDT)
From: Val Zudans <zudans@yahoo.com>
Subject: [isrsnet] long term consequences of mmc
To: "ISRSNet"
It seems that even intraoperative mmc may have long term consequences
based on the long term results of mmc for pterygium. We had 3 scleral
melt cases after pterygium excisions with mmc from South America at
last week's grand rounds at Bascom Palmer. Is anyone concerned about
late corneal melts from mmc? Has anyone seen anything like this?

--- "Randy Epstein, M.D." <repstein@chicagocornea.com> wrote:
> We strongly urge everyone to limit MMC to a single intra-operative
> dose.
> You have no idea what the patients will do with the drops and are
> asking
> for trouble long term.
>
> Randy J. Epstein, MD
> e-mail: "repstein@chicagocornea.com"
> phone: 847-432-6010
> fax: 847-432-8241
> address: Suite 300
> 806 Central ave.
> Highland Park, IL 60035
>
> -----Original Message-----
> From: TODDBEYER@aol.com [mailto:TODDBEYER@aol.com]
> Sent: Friday, April 12, 2002 2:16 PM
> To: ISRSNet
> Subject: [isrsnet] Re: Lasek Haze
>
> Dear Joe,
>
> I have used mitomycin .02% gtts bid for 2 months starting 3 wks
> post-op
> prk
> in patient with higher risk of corneal haze. Everything went well
> and
> no
> haze occured in this patient. Some are saying that .02% MMC applied
> in
> the
> ablated area only with a topical murocel sponge for 2 min. is even
> better. I
> have not tried this method yet but soon will most likely.
>
> Todd Beyer
>
> ---
> You are currently subscribed to isrsnet as:
> repstein@chicagocornea.com

From: "Tyrie Lee Jenkins" <tyrielee@gte.net>
To: "ISRSNet" Cc: <tyrielee@gte.net>
Subject: [isrsnet] Re: DLK with new blades
Date: Tue, 4 Jun 2002 05:19:56 -1000

I had the exact same experience with the Moria CB about three months ago.
We had eight cases of DLK one day that we related to the blades. We had
just opened a new box and in each instance the DLK was worse in the first
eye and was worse at the entering edge. One case was so bad that I had to
lift and irrigate at day three. Fortunately all cases did well. This
particular batch of blades had many defects on the surface and those blades
with visible stuff on the surface my technian rejected. The company
initially totally denied that it could be the blades and finally admitted
that they may have had a few calls. The told us we needed to clean the
keratome with a different solution which they provide. We had a hard time
getting them to give us credit of that batch of blades. I have never had
the problem with blades made for the Moria CB from Oasis in fact the quality
of those blades is better (I think better cuts), no DLK and more consistant
(fewer rejections). Of course the company was rabid about the suggestion
that we use blades from another company. Would be interested to know the
lot number the the blades you had problems and a little distressed to know
that the problems still exists after our series of phone call with them

Ty Jenkins
Honolulu
----- Original Message -----
From: <s.cherne@att.net>
To: ISRSNet
Sent: Saturday, June 01, 2002 8:02 AM
Subject: [isrsnet] DLK with new blades


> I have used and been very happy with a Moria M2 keratome
> for about a year now but recently have had several cases
> of DLK noted first day postop. OD (first eye treated)
> has been the worst. Moria sent out a memo stating that
> they changed their manufacturing technique for their
> blades. In my discussions with them they noted that
> they did have several calls from CB keratome users and
> one other M2 user noting episodes of DLK. The DLK
> response seems to be less prevalent with soaking and
> wiping the blades prior to use with sterile water which
> apparently removes a salt residue according to Moria. A
> trial with another company's keratome had no episodes of
> DLK. Any other surgeons using an M2 or CB noting
> similar findings? Does anyone have a written protocol
> to share when episodes of DLK are noted?
>

From: TODDBEYER@aol.com
Date: Wed, 23 Oct 2002 14:15:23 EDT
Subject: [isrsnet] Re: large pupils
To: "ISRSNet" <isrsnet@list.isrs.org>

I agree, certain experts from Canada who fly down to testify against US physicians claiming "wavefront" abaltions should have been used for airline pilots with normal size pupils for money are dispicable. This particular physician also has interest int a wavefront company. Gee, we should trust him and attend his lectures? Not!!

Todd Beyer ---

From: TODDBEYER@aol.com
Date: Wed, 23 Oct 2002 7:43 AM
Subject: [isrsnet] Re: large pupils
To: "ISRSNet" <isrsnet@list.isrs.org>

I would word that allthough pupil size in three recent papers does not appear to correlate with post-operative glare and haloes, you should be aware that you are at an increased risk for these problems due to large pupils. Also, be sure to center ablation well, use large zones with blend 6.5/8.0 and be sure to watch your flap thickness so you can leave 270 preferably in the bed. Our Hansatome 160 plate cuts a 120 flap with possible variability of 15 microns either way. Good Luck and don't be shy about using intraoperative pacymetry do verify flap thickness. Todd Beyer ---

From: TODDBEYER@aol.com
Date: Thu, 24 Oct 2002 08:54:32 EDT
Subject: [isrsnet] Re: large pupils
To: "ISRSNet" <isrsnet@list.isrs.org>
Nick, I think boycotting these guys is a great idea given their status as something less than prostitutes. Todd ---

----- Original Message -----
From: Parag Majmudar, M.D.
To: ISRSNet
Cc: Eugenio Candal
Sent: Wednesday, December 04, 2002 2:36 PM
Subject: [isrsnet] Re: thanksgiving refractive surgical case#1


I just saw a similar patient. He had mixed cylinder (oblique axis) and the topography had just a HINT of appearing as if someone were bending the 2 meridians closer together. Not much on exam, but orb showed some posterior elevation inferotemporally exactly where the "bending" was taking place.

-----Original Message-----
From: David Kent [mailto:david@lasik.co.nz]
Sent: Tuesday, December 03, 2002 5:25 PM
To: ISRSNet
Subject: [isrsnet] Re: thanksgiving refractive surgical case#1


I would be very suspicious that this patient had corneal topography consistent with sub-clinical pellucid marginal degeneration (PMD) prior to LASIK. The pre-op refraction is consistent with PMD with against-the-rule astigmatism and the post-operative course also consistent with it. The topography of PMD is described in the literature by Maguire et al in Ophthalmology 1987 but is not well recognised by most refractive surgeons. There is typically vertical flattening centrally and against-the-rule corneal astigmatism. There is steepening in the inferior, inferonasal and inferotemporal areas in a "claw" shaped, "heart" shaped, "C" shaped or "butterfly" shape. Subtle cases also exist, usually with a "heart" shaped pattern. The central cornea is not thin. It is often asymmetrical. Following LASIK keratectasia often occurs.

-----Original Message-----
From: Hatsis@aol.com [mailto:Hatsis@aol.com]
Sent: Thursday, 28 November 2002 8:53 a.m.
To: ISRSNet
Subject: [isrsnet] Re: thanksgiving refractive surgical case#1

----- Original Message -----
From: NCCaro@aol.com
To: ISRSNet
Sent: Wednesday, October 23, 2002 8:12 PM
Subject: [isrsnet] Re: large pupils


Herman,

Hope is well by you. I also did not attend lectures given by the experts.

Hope our colleagues catch on. If their lectures are not attended then the companies will not pay their way to the meetings or their honorariums. They will also lose their research grants.

Are you shedding tears yet? ---
You are currently subscribed to isrsnet as: rismd@attbi.com




From: "Robert Schnipper" <rismd@attbi.com>
To: "ISRSNet" <isrsnet@list.isrs.org>
Subject: [isrsnet] Re: large pupils
Date: Wed, 23 Oct 2002 17:47:23 -0400

Please mention these ophthalmic whores by name. If they have the chutzpah
to act as plaintiffs experts we should know who they are.

Robert I. Schnipper, M.D.
Jacksonville Eye Center
2001 College St.
Jacksonville, Fl. 32204
800 223 3038
rismd@attbi.com
----- Original Message -----
From: "Herman Sloane" <hds@drsloane.com>
To: "ISRSNet" <isrsnet@list.isrs.org>
Sent: Wednesday, October 23, 2002 1:27 PM
Subject: [isrsnet] Re: large pupils


> Could not agree more Nick. As I was leaving the RSIG session on Friday,
one
> notorious old "expert" was discussing with a younger expert on what and
how
> to charge plaintiff's attorneys.
>
> Shockingly, both these guys are loved by the manufacturers and made
numerous
> presentations at booths.
>
> Likewise, I attended none.
>
> Herman
> ----- Original Message -----
> From: <NCCaro@aol.com>
> To: "ISRSNet" <isrsnet@sand.lyris.net>
> Sent: Wednesday, October 23, 2002 11:42 AM
> Subject: [isrsnet] Re: large pupils
>
>
> > I just returned from Orlando and couldn't believe my eyes.
> >
> > Doctors were attending lectures given by fellow doctors that also
> specialize as expert witnesses. How can I trust what these experts are
> stating as facts when under oath for money they are lying about the care
> rendered by their colleagues.
> >
> > When will we learn that these doctors cannot be trusted. The only way
to
> let them know this is to boycott their lectures. That way at the next
> meeting they will not be sponsored by the eye care manufactures.
>
> > You are currently subscribed to isrsnet as: hds@drsloane.com

From: "Robert Lehmann" <lehmann@cox-internet.com>
To: "ISRSNet" <isrsnet@list.isrs.org>
Subject: [isrsnet] Re: late flap cut
Date: Thu, 31 Oct 2002 20:26:23 -0600

Sounds like the blade became engaged after the pass had begun. Have had several times when there was no cut at all due the blade non-engagement. The good news is that these partial cuts all seem to do very well if you give them a few months and recut. RPL

----- Original Message -----
From: Alan Leahey
To: ISRSNet
Sent: Wednesday, October 30, 2002 2:27 PM
Subject: [isrsnet] late flap cut


23 year old male, OD -3.50 + 1.25 X 177, K's 43.9, 44.8 @169, pach 594.
Aborted case today after hansatome 180/9.5 cut a 50% in vertical diam(superior 50% of cornea to a perfect sup hinge), normal horizontal diam.
The flap started at mid pupil and went superior to a normal hinge. No signs of any flap, nor epi defect inferior. It looked like a perfect flap, but missing the inferior 50%. I have reviewed the video several times, but saw no torsion of eye, no loss of suction, no different action with track or gears, and IOP was checked before keratome pass.
We use 2 hansatomes each day, and this one had been used on eight previous eyes today, with same depth plate and ring size. All perfect flaps. The blade was checked and was new as it was a right eye. We stopped using this unit and sent it and blade to B and L for inspection.
Any ideas? I have seen a buttonhole, incomplete and a free flap, but nothing like this. I have not read about a flap like this. Comments please. Alan Leahey


---
You are currently subscribed to isrsnet as: lehmann@cox-internet.com





From: "Robert Lehmann" <lehmann@cox-internet.com>
To: "ISRSNet" <isrsnet@list.isrs.org>
Subject: [isrsnet] Re: lift or cut
Date: Fri, 4 Oct 2002 22:01:48 -0500

I have been able to relift flaps well over three years post lasik and if you
can find the edge of the original flap at slit lamp tease under it with a
Slade cannula then procede with the lift under the laser. You "almost never"
should have to recut. Bob
----- Original Message -----
From: "Oscar E Pineros" <ospinero@mafalda.univalle.edu.co>
To: "ISRSNet" <isrsnet@list.isrs.org>
Sent: Wednesday, October 02, 2002 6:56 PM
Subject: [isrsnet] lift or cut


> Dear Group:
> Male 50 years old
> Pre op manifest Rx OD:-5.50-1.00x90 20/20
> OS:-5.75-1.00x90 20/20
> Nov 2000 bilateral LASIK: Chiron Technolas 117 C Excimer laser, CB
> microkeratome. I got a normal 9.5 mm diameter flap.
> Nov 2002: manifest Rx OD:+2.50-1.00x100 20/25
> OS:+2.00-0.75x95 20/20
> I'll proceed with re treatment
> The point is: Lift the flap or cut? (2 years later), If cut: Any special
> tip for the CB microkeratome use?
> Thanks
>
> --
> Oscar Pineros MD
> Clinica de Oftalmologia de Cali
> Carrera 47 No. 8C - 94
> Cali - Colombia - South America
> Phone: 572 552 0887
> e-mail: ospinero@mafalda.univalle.edu.co
>
>
>
>
> ---
> You are currently subscribed to isrsnet as: lehmann@cox-internet.com

From: RLEpstein@aol.com
Date: Wed, 1 Jan 2003 13:40:01 EST
Subject: [isrsnet] Re: metallic foreign body after lasik
To: "ISRSNet" <isrsnet@list.isrs.org>

Ken,
Try your very very very best to leave it alone unless vision blurs. If you needed to remove a toxic region , which you will not, one alternative to a flap lift, and with possibly a better outcome is a 1mm trephination and removal of the flap over the FB.
But really, your first answer is probably right.
Bob Epstein

In a message dated 12/30/2002 5:55:28 PM Central Standard Time, kdloph@yahoo.com writes:

4 month post-op routine lasik patient noted a FB sensation and blurriness in one eye 3 wks ago, and it gradually resolved over 2 wks. Now he is 20/15 and comfortable in that eye and has about a .3mm rusty fb just outside the pupillary center; there is a surrounding .75mm area of stromal edema (full flap thickness) with no infiltrate; it has reepithelized and has only trace staining late. I chose to leave it alone. What would you do especially if it had an active toxic infiltrate and or a persistent epithelial defect? Anyone tried to remove a foreign body off a flap?

Thanks, Ken

From: "Kent Wellish" <wellish@lvcm.com>
To: "ISRSNet" <isrsnet@list.isrs.org>
Subject: [isrsnet] Re: malpractice "experts"
Date: Thu, 24 Oct 2002 06:19:41 -0700

I would also sign such a petition. I'm curious to know who these people are, so I too can boycott their talks. Could someone send me a private e-mail with the names of these "hired guns"

Thanks!

Kent Wellish
Las Vegas

-----Original Message-----
From: JoeDelloRussoMD@aol.com [mailto:JoeDelloRussoMD@aol.com]
Sent: Wednesday, October 23, 2002 4:32 PM
To: ISRSNet
Subject: [isrsnet] Re: malpractice "experts"

To prevent expert whores from appearing on the podiums of our national meetings, we can complain directly to the organization running the meeting and protest. If you want to formulate a complaint to the Academy, I would be happy to co-sign it. There may be other 'netters who would sign as well. Count me in. How can you trust what a whore will say on a podium if his "expertness" can be bought. His credibility is in question. Of course they should be allowed to defend themselves in a public manner.

Joe

Date: Wed, 16 Oct 2002 17:41:35 -0700 (PDT)
From: kenneth lipstock <kdloph@yahoo.com>
Subject: [isrsnet] Re: Laser vision correction public relations
To: "ISRSNet" <isrsnet@list.isrs.org>

"Richard L. Lindstrom" <rllindstrom@mneye.com> wrote:

ASCRS has a current program funded by the society, its Foundation and a group of Manufacturers including Visx,Alcon,B&L and TLC to do exactly what you are requesting, advocate for the Lasik procedure and Lasik surgeon. It is called the Eye Surgery Education Council. You can get more information from ASCRS or look it up on their web site. You can also support it by making a donation to the ASCRS Foundation. Manufacturer contributions to date are near $700,000 and Ophthalmic Surgeons have pledged over $3,000,000 to the Foundation. Best: Dick Lindstrom
-----Original Message-----
From: kenneth lipstock [mailto:kdloph@yahoo.com]
Sent: Monday, October 14, 2002 8:49 PM
To: ISRSNet
Subject: [isrsnet] Re: Laser vision correction public relations

Yes, I guess it would be a long shot. It would certainly take some leadership on the part of an isrs or ascrs. Why couldn`t they together just set up a fund for a national PR campaign; a portion of every physician member`s yearly dues would go towards it as well as a portion of the cost of advertising for refractive surgery related companies. Certainly the devil is in the details. It just seems to me that sometimes a unified and united effort can sometimes raise the level of all the ships in the sea. So I put the onus on our professional societies and not necessarily on the manufacturers. Ken JLGayton@aol.com wrote:

In a message dated 10/14/02 9:04:33 AM Eastern Daylight Time, JoeDelloRussoMD@aol.com writes:


It would seem like a reasonable strategy to have an organization to bring industry together and promote LVC. However , as you may have experienced in the past, it is difficult to get even surgeons to agree on a single adenda.

Secondly, marketing the whole country is probably not cost effective. There was a laser company a year or so ago which launched a $ 750,000 PR campaign without any results. It would take millions of dollars to even raise public awareness even a smidgen {?} You can just imagine trying to get the heads of all the companies together in one room and try to hammer out an agreement that they would feel is just and equally beneficial to all.

. There would ego incidents. How much would each kick in ? Who would benefit the most ? The small or the large companies ?. And all of this would take a lot of time. The idea is good but I doubt that it is workable. Sorry, but that's the wauy I see it.

Joe---

I agree. You bring up excellent points that would probably make cooperation on public relations efforts impossible.
Johnny Gayton ---