The pursuit of perfection is neverending. The desire to see clearly duringlaser ablation with an invisible ultravi-olet laser has always intrigued me.

I have been searching for variousways to control laser delivery in realtime, and I have experience withdevices that include specialized cam-eras to look at laser beam profiles andthe Molectron Inc. unit to measure

energy output at the laser head.

During recent surgery I used a newillumination system designed by AviGrinblat of Advanced Visual Imaging.It has two hinged arms with fiberopticlights that can be brought into the sur-gical field. The hinged arms are custom-fitted to the laser bed. The moduleallows the lights to be used at variousangles, to be adjusted from diffuse to

slit illumination and to be evenlyscanned in different directions.

These special lights can illuminatethe corneal interface during andimmediately after laser ablation tovisualize the ablation pattern andlook for interface debris in any form.

I have used them in tandem withinfrared trackers, and I alternate theirplacement with the tracker arms onthe Bausch & Lomb laser.

Useful throughout surgical stages

I feel this system has an importantrole to play as we perfect our approachto flawless refractive surgery. It can beused at all stages of LASIK surgery:

Before the microkeratome pass ithelps look for subtle epithelial distur-bances and irregularities.

After the microkeratome pass ithelps determine the quality of thestromal bed. During the laser ablationit can discern the laser ablation pattern.

After ablation it can help search theinterface for any debris.

After flap replacement, it allowsvisualization of the flap alignmentand seal.

The visualization of each step insurgery decreases postop surprises andprovides feedback for the operatingsurgeon in real time.

A SLACK Incorporated® Publication

The voice of 65,000 ophthalmologists worldwide™ Vol. 20, No. 22 • November 15, 2002

INNOVATIVE REAL-TIME ILLUMINATIONSYSTEM AIDS IN LASIK

The system enhances visualization at each step of refractive surgery. by Arun C. Gulani, MD

The illumination system on a model head. Diffuse illumination.

Slit illumination. Illuminated ablation pattern;direct diffuse illumination

Ongoing research

I have been investigating and work-ing on various avenues that I feel arevital as we progress from surgical excel-lence to achieving supernormal vision.This illumination system is a welcomeaddition in this direction.

Other fields require due attention.

One area is ocular surface catego-rization toward predictable out-comes, thus decreasing the incidenceof postop surprises (refractive andotherwise).

I have been working on devising amicrokeratome sensing device that willassess IOP and give a signal to proceed.

On the drawing board, we have a

visual system that will accurately show— not just predict — the exact flap sizeand thickness before and during themicrokeratome translation.

Also to be considered are chemicalmodulators (beyond general toxicagents) that can be topically delivered,leading to surface healing modificationas well as alternate outcomes to suitthe expected refractive end point.

In summary, the aim of any surgicalprocedure is to make it foolproof inevery form so that it becomes attain-able by all surgeons. This will lead tostandard platforms of informationexchange and skills transfer.

Presented at the Innovator’s Lecture Series at theAmerican Academy of Ophthalmology meeting.

Illuminated ablation indirect diffuse illumination

Flap replacementwith the Gulani triple function cannula.

Interface debris seen by scanning slit view.

Flap edge check.

Arun C. Gulani, MDInnovative Real Time Illumination

System in LASIK Surgery

Arun C. Gulani, MDInnovative Real Time Illumination

System in LASIK Surgery

Illumination system aids in LASlK cont…