We read with interest the Case Report in the Archives by Crews et al.1 We share concerns similar to those of the authors and agree that we have a duty to our patients to ensure the safety and efficacy of the procedures that we, as surgeons, choose to perform. As was true with the introduction of phacoemulsification, there is a significant learning curve with this advanced surgical technique. As surgeons in a tertiary referral center with experience in many primary lamellar procedures, we have identified some salient points that may help to prevent these problems addressed in the Case Report.
The two cases represent the most common complication of any lamellar surgery—irregular astigmatism. In case 2, the authors comment, "Slit-lamp examination revealed a hazy interface between the lathed cornea and stromal bed."1 Did the patient undergo automated lamellar keratectomy (ALK) or freeze myopic keratomileusis? Of course, significant irregular
Slade SG, Updegraff SA. Complications of Automated Lamellar Keratectomy. Arch Ophthalmol. 1995;113(9):1092. doi:10.1001/archopht.1995.01100090014002