1. Safety of Flap Lift Enhancements after IntraLase Lasik Lewis R Groden, MD (1,2) Lewis R Groden, MD (1,2) Sunir Joshi, MD (1) Sunir Joshi, MD (1) 1 Department of Ophthalmology, University of South Florida, Tampa FL 2 LasikPlus Vision Center Tampa, FL The authors have no financial interests in this presentation

2. Financial Disclosure LRG: speaker list : Allergan Johnson&Johnson/Vistakon LRG: speaker list : Allergan Johnson&Johnson/Vistakon shareholder: LCAV (LasikPlus) shareholder: LCAV (LasikPlus) SJ: none SJ: none The authors have no financial interests in any of the material discussed in this presentation. The authors have no financial interests in any of the material discussed in this presentation.

3. Purpose: To determine the safety of performing enhancements via flap lift after thin flap IntraLase lasik To determine the safety of performing enhancements via flap lift after thin flap IntraLase lasik

4. Methods Retrospective chart review Retrospective chart review 57 consecutive eyes of 44 IntraLase lasik patients who had undergone flap lift enhancements 57 consecutive eyes of 44 IntraLase lasik patients who had undergone flap lift enhancements Enhancements performed 4 - 13 months post lasik, mean 8 months Enhancements performed 4 - 13 months post lasik, mean 8 months Follow-up post enhancement: 3 – 8 months Follow-up post enhancement: 3 – 8 months

5. Primary IntraLase settings Flap depth: 100 microns (range 90-120) Flap depth: 100 microns (range 90-120) Flap diameter: 8.5 mm (myopes) Flap diameter: 8.5 mm (myopes) 9.0 mm (hyperopes) 9.0 mm (hyperopes) Side cut angle: 90 degrees Side cut angle: 90 degrees Side cut energy: 1.00 Side cut energy: 1.00 Bed energy: 0.90 Bed energy: 0.90 Spot sep: 9 Spot sep: 9 Line sep: 9 Line sep: 9

6. Flap lift technique At slit lamp, Sinskey hook to crack wound At slit lamp, Sinskey hook to crack wound Under laser microscope, Sinskey hook to unzip the wound up to hinge (12:00) Under laser microscope, Sinskey hook to unzip the wound up to hinge (12:00) Slade cannula to gently sweep open the flap from hinge to 6:00 Slade cannula to gently sweep open the flap from hinge to 6:00 - gentle but firm downward pressure, do not pull upward on flap - gentle but firm downward pressure, do not pull upward on flap

7. Technique: Precautions Do not enter the pocket while unzipping the wound, may get a free cap. Do not enter the pocket while unzipping the wound, may get a free cap. Do not tug on flap, may get flap buttonhole/tear. Gently break adhesions with firm downward sweeping motions. Do not tug on flap, may get flap buttonhole/tear. Gently break adhesions with firm downward sweeping motions.

8. Results No intra-operative complications No intra-operative complications No peri-operative complications No peri-operative complications No post-operative complications No post-operative complications

9. Conclusions Thin IntraLase flaps can be safely lifted in order to perform enhancement procedures Thin IntraLase flaps can be safely lifted in order to perform enhancement procedures