Journal of Cataract & Refractive Surgery
Volume 32, Issue 11 , Pages 1877-1883, November 2006

Artemis very high-frequency digital ultrasound-guided repositioning of a free cap after laser in situ keratomileusis

From London Vision Clinic (Reinstein, Couch, Archer), and St. Thomas' Hospital–Kings College (Reinstein), London, United Kingdom; Weill Medical College of Cornell University (Reinstein), New York, New York, USA; Centre Hospitalier National Ophtalmologie (Reinstein), Paris, France; and a private practice (Rothman), Las Vegas, Nevada, USA

Accepted 6 December 2005.

We present a patient in whom a symmetrically round free cap occurred during laser in situ keratomileusis (LASIK), and flap repositioning was performed without laser ablation. A loss of 3 lines of best spectacle-corrected visual acuity (BSCVA), monocular diplopia, and topographic irregular astigmatism confirmed that the free cap orientation was incorrect. Two subsequent free cap rotations based on refraction failed to realign the free cap into its original position. Artemis 3-dimensional very high-frequency digital ultrasound analysis found the thickness profiles of the free cap and bed to be irregular and mismatched. The rotation required for anatomic realignment was determined by digitally generating a “lock and key” superimposition of the free cap and stromal bed thickness profiles. After Artemis-guided free cap rotation, the eye regained preoperative BSCVA and symmetrical corneal topography with a +0.50 diopter change in spherical equivalent.

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 Presented in part at the 7th Alicante Refractiva International Meeting, Alicante, Spain, March 2005.Dr. Reinstein has a proprietary interest in the Artemis technology (Ultralink, LLC) through patents administered by the Cornell Research Foundation, Ithaca, NY. Dr. Reinstein is a consultant to Carl Zeiss Meditec. None of the other authors has a proprietary or financial interest in the materials presented.Preparation in part fulfillment of the requirements for doctoral thesis, University of Cambridge, for Dr. Reinstein.

PII: S0886-3350(06)00304-X

doi:10.1016/j.jcrs.2006.03.013

Journal of Cataract & Refractive Surgery
Volume 32, Issue 11 , Pages 1877-1883, November 2006

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