The eye is prepared with topical anaesthetic instilled 3-4 times prior to taking the patient on the table.The area around the eye is cleaned with povidone-iodine solution.The lids are separated with Tegaderm ,this prevents the eyelashes from coming onto the surgical field.An eye speculum is inserted and good exposure of the eyeball with equal distance between the upper lid and the lower lid distance from the limbus.
If the surgeon desires to keep the epithelial cap ,a marker can be used before epithelial separation.
The AMADEUS II (AMO) uses a specially designed head for Epi-Lasik . The Epi-Lasik flap created by the AMADEUS II Microkeratome consists of the entire epithelium, and does not contain any parts of underlying tissue. This flap structure is obtained by the use of the specially designed Epi-Lasik blade in combination with the Epi-Lasik blade holder.
1 = Epi-Lasik Blade Holder
2 = Epi-Lasik Blade
3 = Plastic Guide
4 = Epi-Lasik Blade with Plastic Guide
Choose the Suction Unit to perform the Epi-Lasik flap. Unpack the Epi-Lasik Blade just before inserting in the Epi Lasik Blade Holder. Lubricate each side of the Epi-Lasik Blade prior to insertion in the Epi-Lasik Blade Holder.
After lubrication insert the blade completely into the Blade Holder.
Define the cut variables according to the patients needs.
Lubrication must be performed immediately before placing the Motor Unit on the patients eye.
If you wait longer than 1 minute between lubrication and cutting of the flap, the applanation area of the Blade Holder will be dry and lubrication must be performed again prior to cutting the flap. Place the Suction Unit on the eye.
Keep the Suction Unit in place during vacuum build up. After vacuum has been created, check intraocular pressure with a Tonometer before starting the cut. This is to confirm correct placement of the Suction Unit on the eye and correct vacuum level.
Immediately before the cut apply sufficient lubrication to the eye and perform the cut (the liquid functions as a lubricant). Without sufficient lubrication between the cornea and the Epi-Lasik Blade Holder there is a risk of a flawed Epi flap.
The Amadeus II is programmed in case a free cap is desired or if the epithelium sheet is to be maintained it can be programmed with a 1.2 mm hinge width.The Amadeus II is a among the only microkeratomes to be programmed according to the surgeons preference.
After the bed is dried ablation is performed.If ablation exceeds more than 50 microns Mitomycin C usage is strongly recommended in the concentration of 0.02%.This is applied on a Sponge approx 6 mm in diameter for approx time varying between 25 secs 1 min depending on the ablation.
Haze and Mitomycin-C
Mitomycin-C is used in all surface ablation cases in which there is a significant risk of haze. Mitomycin C in combination with and steroids decreases the fibrosis associated with healing after surface ablation.
The specific regimen is based on the patient's correction, as follows:
• Under -5 D: no prophylaxis for haze
• -5 to -8 D: mitomycin-C applied for 30 seconds
• -8 to -10 D: mitomycin-C applied for 45 seconds
• -10 to -12 D: mitomycin-C applied one minute