EyeWorld Korea December 2025 Issue

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Dr. Tim Roberts Dr. Hiroko Bissen-Miyajima Dr. Rahil Chaudhary

Dr. Pooja Khamar

Dr. Mahipal Sachdev

Dr. Aditya Desai

Dr. Khamar also found that the PEEL technique had an advantage in wound healing. She hypothesized that, with SILK™, there is minimal activation of keratocytes with minimal spot separation, leading to no conversion of keratocytes to myofibroblasts. In her personal experience with SILK™, Dr. Khamar found that the quality of vision of her patients’ postoperative day one was good. In contrast, Dr. Khamar noticed that, with traditional dissection techniques, the tissue bridges between the laser spots may cause difficulty during dissection. As a result of a more difficult dissec tion, she believes that keratocytes may activate, leading to myofibroblast proliferation. With over 20,000 laser vision correction procedures and more than 1,000 SILK™ procedures completed, Aditya Desai, MS Ophth (India) found SILK™ to be more of an instinct than a surgical tool. “I was the first and only person in Gujarat to use SILK™ with no peers to fall on and no one to ask what to do if I got stuck,” he said. “Slowly, I refined my techniques with time and it overall became a very nice procedure.” One issue Dr. Desai faced initially was marking the axis. On the ELITA™ platform, marking at 0-180 is done before surgery to compensate for cyclotorsion. “I prefer to mark the axis on the slit lamp by making a thin horizontal slit and marking the position with the pen,” he said. “Some patients may squeeze their eyes or the mark gets rubbed off due to tear in flow, so I apply a little bit more pressure so I can see the faint white line.” “The key to the success of this surgery is marking the pupil center,” Dr. Desai continued. “Marking the pupil center helps when the cone is appla nated with the cornea, so then we can manually adjust the cyclorotation just before firing the laser.” In Dr. Desai’s personal experience, he found that 89% of his patients achieved 20/20 or better binocular uncorrected visual acuity (UCVA) on postoperative day one. “This 89% increased to a range of 96% to 97% by one month after the surgery,” Dr. Desai stated. Even in patients with astigmatism or high myopia (spherical equivalent more than -6.0 D), Dr. Desai found that 93% and 92% of patients, respectively, achieved 20/20 or better binocular UCVA on the first day after surgery. By one month, these rates climbed to 96%. Dr. Sachdev gave one tip to surgeons wishing to start using the ELITA™ SILK™ platform: for the first 100 eyes, perform energy optimization on the machine. “Anything that gives you the least amount of energy with an easy dissection is what you need to titrate the machine to,” he said. “Less energy going into the cornea means a faster recovery, and you will get excellent results.” “ A smooth dissection of SILK TM is a result of bridgeless laser spots spaced next to each other. ”

New Advancements in Femtosecond Laser Technology: Clinical Outcomes and the PEEL Technique

The ELITA™ Smooth Incision Lenticular Keratomileusis (SILK™) platform takes a generational leap in corneal refractive technology in order to deliver both precision and performance for a smooth surgical experience. With SILK™, surgeons can perform, through a minimally invasive process, refractive correction on patients with myopia using an extremely precise laser pulse and a fast laser system. The ELITA™ SILK™ platform performs at up to 10 MHz while delivering low energy per pulse at 30 to 50 nJ, resulting in less collateral damage. “The highlight of this technology is its biconvex design,” Rahil Chaudhary, MD (India) stated. The advantage of a biconvex lenticule is that it is nerve-sparing. The smooth dissection of SILK™ is a result of the bridgeless laser spots that the platform is able to deliver. Because the spots are next to each other, surgeons may not have to struggle to find the planes, dissect, and remove the lenticule. “We wanted to use this minimal spot separation to our advantage,” Pooja Khamar, MS, FCRS, PhD (India) said. “We are able to do something similar to what we do in a femtosecond laser-assisted cataract surgery (FLACS) procedure: take the forceps, hold the lenticule, and take it off.” What Dr. Khamar described is the PEEL technique: pressure exerted extraction of the lenticule. “If you are doing the PEEL technique, you are doing minimal manual manipulation, and that’s why the quality of vision on postoperative day one should be very good,” Dr. Khamar said. When Dr. Khamar compared the conventional dissection technique with the PEEL technique in a population of 500 eyes in each group, she found that the objective scatter index (OSI) was significantly lower in the PEEL group on postoperative day one compared to the conventional dissection group. “Patients in both groups had 20/20 vision, but the quality of vision using the PEEL technique was much better with a significantly lower OSI,” she said.

References: 1. Corbett D et al. Eye (Lond). 2024. 38(Suppl 1):9-14. 2. Bissen-Miyajima H et al. Ophthalmol Ther. 2023;12(6):3099-3108.

In Dr. Desai’s personal experience, he found that 89% of his patients achieved 20/20 or better binocular UCVA on postoperative day one. Credit: Cure Sight Laser Centre

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EyeWorld Asia-Pacific | December 2025

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