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Up Front | Jul 2012

Editor’s Page

This month, my editorial is brief and to the point. The reason for this is that the seven featured cover focus articles, each of which recaps a complicated surgical case and outlines the chosen remedy, speak for themselves.

Cataract and Refractive Surgery Today Europe is a much-appreciated journal. In my opinion, this is well deserved, because the publication not only reports on innovative, cutting-edge technologies, but it also covers more fundamental issues—issues that we are confronted with daily in the operating room. Advice on how to tackle challenging and complicated cases will always remain one of the most interesting topics that CRST Europe features.

As readers can appreciate, we all face some awkward surprises from time to time. Sharing those situations with others, however, can be a bit embarrassing. This month, 10 esteemed colleagues were kind enough to detail some of their most challenging cases. It is through these examples that we can hone our skills for managing unexpected complications and outcomes in refractive and cataract surgery. I urge others to also share their challenging cases with CRST Europe.

In their article, Allon Barsam, MD, MA, FRCOphth, and Ali Mearza, FRCOphth, describe a case of epithelial ingrowth after LASIK. The authors provide a clear strategy for resolving this unwanted situation. They suggest treating only when there are more than 2 clock-hours of involvement or when the ingrowth interferes with vision. Aylin Kiliç, MD, reports on an even scarier complication during LASIK: free cap formation by a mechanical microkeratome. Every refractive surgeon should have a strategy ready when such a nasty surprise pops up.

Cati Albou-Ganem, MD, and Julien Bullet, MD, report on a ReLEx femtosecond lenticule extraction (flex) procedure with postoperative inflammation that turned out to be diffuse lamellar keratitis instead of the suspected bacterial infection. In another article, Johan Blanckaert, MD, presents a case during which he felt saved by a medical representative, who provided him with a new (at that time) device, the Malyugin Ring (MicroSurgical Technology), to manage a very stubborn nondilating pupil. In our hospital, the Malyugin Ring is our primary solution for narrow pupil cases. Once the ring is placed, the challenging situation is immediately transformed into a perfectly manageable case.

Kristina Mikek, MD, explores an interesting refractive surprise case. Our inability to predict the final IOL position is painfully demonstrated in her article. I sincerely hope that the newer calculation formulas and future technologies will solve the remaining problem of nailing the final effective lens position. It would absolutely make our lives easier.

The final two articles, the first of which is written by Stephan Kaminski, MD, and the second by Nikica Gabric, MD, PhD, and Iva Dekaris, MD, PhD, describe very different but equally challenging posttrauma cases. Although not many of us will ever manage such complicated cases, it is always extremely interesting to read how experts manage these hazardous situations. I think you will enjoy reading these articles as much as I did.