My Techniques in Surface Treatments

Massimo Camellin, MD, SEKAL Micro Chirurgia, Rovigo, Italy

Massimo Camellin performs exclusively surface treatments (LASEK/ EpiLASEK) with the SCHWIND AMARIS.

He sees the advantages particularly in the high safety of these methods because no preparation of a corneal flap takes place, thus no enduring weakening of the cornea: “The treatments are in nearly every case painless. Quality of vision is restored within 10 days and remains stable over the long-term.“ In the following Dr. Camellin outlines his techniques and treatment ranges.

Technik LASEK

  • Kraftvoller Einsatz eines Mikrotrepans im Epithel, um eine 270° Behandlungszone abzugrenzen
  • Applizieren von 20% Alkohol in destilliertem Wasser (32° C) auf das Epithel für 20 Sekunden
  • Aufsaugen der alkoholischen Lösung mit einem Tupfer und anschließendes Spülen mit einer konservierungsmittelfreien Diclofenac-Lösung
  • Ablösen der Epithelkanten und anschließendes Aufrollen des Flaps mit entsprechenden Spateln
  • Durchführen der Laserbehandlung im Oberflächenmodus
  • Gabe einer kleinen Einheit BSS auf den Flap und das Hornhautgewebe
  • Zurückschieben des Epithels, an der Kante mit einem Tupfer andrücken und 30 Sek. mit einem Gebläse trocknen
  • Einsetzen einer weichen Kontakt­linse für 4-5 Tage
  • Medikation mit konservierungsmittelfreien Gentamicin, Tropicamid, Ketotiphen, Desametazon

Technik EpiLASEK

  • Der einzige Unterschied gegenüber der LASEK-Technik ist der Einsatz eines Epikeratoms (nasaler Hinge) für das Ablösen des Epithels
  • Dies ist meine bevorzugte Technik, weil sich das Epithel leicht ablösen lässt, ich in allen Fällen exzellente Hinge-Breiten erziele und das Zurücklegen des Epithels einfacher ist als bei der LASEK oder EpiLASIK

Treatment ranges

In myopia, a central residual corneal thickness of at least 350µm including the epithelium must be considered. The postoperative corneal curvature should be ≥ 32 D to ensure achievement of good vision quality.

The optical zone should normally be at least 7 mm and correspond with the mesopic pupil diameter; I never go below 6.5 mm. In hyperopia, an optical zone of 7.5 mm is preferred in order to minimize the risk of regression and possible halos at night. I never go below 7 mm. When necessary I protect the hinge with a spatula.

Additionally, the postoperative corneal curvature should be around 49 D, on the other side pay attention to preoperative very flat corneas (i.e. 40-42 D), because there might be a bad peripheral transition in case of high corrections (i.e. a significant step).

Auflistung des Behandlungsspektrums von Dr. Camellin in deutsch

Treatment spectrum; Camellin: "If the mesopic pupil is larger than 8 mm, I place a limit on the treatment spectrum of -4 to +1.5 D."

PRK profile based on corneal wavefront measurement

PRK profile based on corneal wavefront measurement

Corneal wavefront

I use corneal wavefront for hyperopia in combination with astigmatism in cases where the pupil centre differs more than 0.5 mm from the centre of the astigmatism (= corneal vertex).  In this way, results and centration are improved. I also use corneal wavefront for all retreatments in order to eliminate higher order aberrations.

TransPRK profile based on corneal wavefront measurement

TransPRK profile based on corneal wavefront measurement


TransPRK in combination with corneal wavefront is my treatment of choice for retreatments after a radial keratectomy or transplants. I also use it for haze, scarred corneal tissue and for keratoconus after crosslinking. In keratoconus, I aim at minimizing the ablation of tissue and smoothing the existing astigmatism.

This method makes sense in all cases where a difficult epithelial flap is expected or where the epithelium covers corneal irregularities of the stromal tissue.

Special Medication

Autoserum is used in all cases in the first five postoperative days. Mitomycin C is diluted and applied with a merocel sponge:

  1. 0.02 % in TransPRK and retreatments over a time period of two minutes.
  2. 0.01 % for hyperopia and astigmatism more than 2 D (just a brushstroke) as well as for myopia more than 6 D.
  3. 0.005 % in all other cases (just a brushstroke). The surface is rinsed with a few drops of diclofenac. The usual administration of a larger amount of BSS is not necessary.

The TransPRK (Transepithelial Photorefractive Keratectomy) with the SCHWIND AMARIS is the most advanced version of surface treatments as LASEK, EpiLASEK and PRK. Thereby the epithelium, which is the regenerative surface of the eye, is ablated by the laser system. The TransPRK is the only surface treatment where the eye doesn’t require contact with an instrument. Furthermore, the epithelium is removed more precisely and more easily than through manual abrasion. Because the wound surface is smaller than, for example, with manual PRK, the healing process is shorter. Additionally, both the epithelium and the stroma are ablated in a single procedure. This shortens the overall treatment time significantly and minimises the risk of corneal dehydration.

Dr. Massimo Camellin of Sekal Rovigo Microsurgery from Rovigo
Sekal Rovigo Microsurgery
Rovigo, Italy
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