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Standardization of laser in situ keratomileusis surgical technique evaluated by comparison of procedure time between
Dan Z Reinstein1, Glenn I Carp1, Daria de Benedictis1
1From the London Vision Clinic (Reinstein, Carp, de Benedictis, Archer, Gobbe, Khan, von Borch), London, United Kingdom; the Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France.
Purpose:
To evaluate the concordance of surgical step pacing between 2 experienced surgeons following a standardized surgical protocol for bilateral laser in situ keratomileusis (LASIK).
Setting:
London Vision Clinic, London, United Kingdom.
Design:
Retrospective comparative case series.
Method:
This was a video review comprising an equal number of consecutive bilateral LASIK patients for 2 surgeons following a standardized surgical protocol using the Visumax femtosecond laser and MEL 80 excimer laser. Timestamps were recorded for flap creation, flap lift, excimer laser ablation, and flap replacement. Total surgery time was defined with the endpoints of speculum insertion and removal.
Results:
Each surgeon performed bilateral LASIK on 30 patients. The mean total surgery time was 11 minutes 17 seconds ± 1 minute 46 seconds (SD) for surgeon 1 and 12 minutes 13 seconds ± 1 minute 37 seconds for surgeon 2. The mean bilateral flap creation time was 3 minutes 5 seconds ± 24 seconds and 3 minutes 42 seconds ± 25 seconds, respectively. The mean suction time for an individual eye was 26 seconds ± 4 seconds for surgeon 1 and 23 seconds ± 1 second for surgeon 2. The difference in timing was accounted for by differences in the length of surgeon conversation with patients rather than by physical surgical steps.
Conclusions:
Bilateral LASIK procedure time was highly concordant within and between surgeons using a standardized surgical protocol. Use of a standardized surgical protocol can optimize the efficiency of corneal suction time as well as total surgical time while providing the expected equivalency in visual outcomes between surgeons.
