Posters

SOPs in LASIK centre

Poster Details

First Author: J.Bathia INDIA

Co Author(s):    N. Malkan   P. Punamia   C. Shah        

Abstract Details

Purpose:

A retrospective analysis of LASIK results in a Multi-Surgeon Operative LASIK Centre (23 operating surgeons ) where consistent acceptable results, were found in a wide range of patient presentations in 974 eyes operated over a period of 1 year. To set up Standards of Practise in similar such Multi- Operative setups for Group Practice to deliver optimal visual outcomes, thus minimizing post operative complications and dissatisfied patients.

Setting:

Universal LASIK Centre - Mumbai India. Office - type Lasik Centre

Methods:

514 patients presented to the Lasik Centre of which 487 patients were operated with satisfied results evaluated with a 6 month follow up. 54 patients were not operated due to on adequate ocular findings set up by the centre 5 patients With keratoconnus, 2 borderline, 7 hyperopic, 11 with inadequate thickness and 7 with dry eyes were excluded. All patients were evaluated only after 7 days of Discontinuation of RGP contact lenses. Manifest, where appropriate, cycloplegic refraction were taken. Zeiss's ATLAS Topographer was used. Always the Operating Surgeon confirms the identity of the patient, and the parameters are correctly entered into the laser's computer. All patients were operated on a Carl Zeiss Mel 80 eximer Laser system. Calibratation and fluence was done prior to each procedure. Moria SBK keratome was used. A time of 1 minute was maintained after the repositioning of the flap.. A variety of 23 surgeons operate at the centre following a similar surgical pattern and procedure. Keratome nommograms as recommended by Moria were strictly adhered to. The Operating surgeon only follows up with the patient. Examination within 12 hours following surgery,1week postoperatively,4 weeks and a follow up with a Topography at the end of 6 months.

Results:

487 (974 eyes) patients were successfully treated and evaluated over 6 months period for any regression One eye had a free cap, though the reason to that was an excessively un cooperative patient. However the ablation was completed with the flap repositioning and use of a bandage contact lens for 5 days At 4 weeks, 97.53% of eyes (950) had a UDVA of 20/20 or better and 99.07% (965eyes ) had 20/32 or better; 92.4% (900) of eyes had no residual cylinder and 96.50% (940 eyes ) had a postoperative astigmatism of less than 0.50 D. All eyes had a postoperative CDVA of 20/20 or better. These results were fairly acceptable with a safety index of about 1.

Conclusions:

Adherence to Standards of Practice Patterns will not only ensure a successful outcome in every situation, but also increases the satisfaction of the patients. It helps the Lasik centre to deliver consistent results to a varied strata of patients. Whenever many surgeons operate in a single setup, the chance of variabily in the results increases and this leads to suboptimum outcomes. At Universal Lasik Centre where 23 different surgeons operated at a single centre a standard protocol was maintained for the preoperative evaluation, surgical method and post operative care with a standard regimen followed. Having standardization of preoperative evaluation in terms of disuse of RGP lens to a minimum of 7 days, using a similar using only the CRS Master to enter the data and evaluation for the therapeutic treatment for the laser, the optimization of the room temperature and humidity. The operating surgeon himself checking and confirming the entry in the laser machine reduces errors. Fluence prior to each surgery. And a time gap of atleaset a minute for the flap to adhere once repositioning is done reduces the chance of flap complication minimum Regular follow ups till six months aid in the patient comfort and assist in the treatment of delayed complications such as dryness and regressions. It also supports the patients confidence in the Lasik Centre. Maintaing Standards of Practice generally meet the needs of most patients, they cannot possibly best meet the needs of all patients. However the physician must make the ultimate judgment about the care of a particular patient in light of all of the circumstances presented by that patient. But following the regimes of Practice at the centre reduces the risks and assists all the operating surgeons to achive similar or better results in cohesion of decision FINANCIAL INTEREST: NONE