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    Managing LASIK complications

    From preop to postop dryness and IOP, stay on track


    Post-LASIK patient recovery and care

    Managing a LASIK patient requires quick response time to complications to ensure a favorable recovery. When this procedure was first introduced, surgeons used a blade that rolled over a cornea bulging from tremendous pressures greater than a bottle of root beer filled with Mentos (try it!). Fortunately the introduction of IntraLase from Advanced Medical Optics and femtosecond technology have made this process bladeless. It is hard to imagine this procedure without the use of the laser; however, it still happens.

    Related: Topography-guided LASIK provides personalized vision

    Although complications can occur with the laser—such as losing suction or having a short flap or a smaller-than-normal flap—these are limited and scarce. The flap is the one place where you can get a “redo”—that is, if the surgeon does not lift it or try to ablate under the mishap. Short flaps or irregular flaps are limiting for vision only if the ablation is performed. Thus, doing nothing and waiting is the best treatment.

    The same cannot be said about a displaced flap, which needs to be replaced immediately. Striae and folds should be distinguished as clinically significant because they will limit best-corrected visual acuity (BCVA). The use of NaFL stain will give a good indication of the magnitude of these folds. The appearance of negative staining at the area of the striae is an indication that a re-float (lifting the flap and floating it back onto the striae) is warranted. However, lifting the flap is a catch-22. Lifting the flap means the edges need to re-epithelialize and consequently could initiate cell downgrowth.

    Related: Quality of life after LASIK

    The flap should be lifted when there is an imminent threat to the central vision. Therefore, when the patient has central striae, central epithelial cell downgrowth, changes in the refraction from epithelial cells or an elevated flap from cells, the flap should be lifted and treated. Differential of flap debris is also important because meibum can be mistaken as epithelial cells. The brownish, glistening of the meibum is easily distinguished from the grayish, dull appearance of the epithelial cell growth. Meibum doesn’t propagate and thus is not a complication that should elicit any great response.

    Next: Postoperative concerns

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      LASIK, although considered a surgery is less invasive and more convenient. To be able to enjoy its full benefits, a patients must first understand the procedures, benefits and downside of LASIK. Patients must first remember that LASIK is not for everyone, they need to undergo an eye exam and consider the risk and benefits of a LASIK surgery as it may lead to dry eyes syndrome, over or under correction. Also, consider finding the right surgeon who will perform the surgery as it plays an important role in the success of your treatment. If you are anywhere near Sun City in Arizona, who else would be the best eye doctor to perfom LASIK, the inventor himself Dr. Peyman who heads the Arizona Retinal Specialists (arizonaretinalspecialists.com). You are ensured that you get the best eye health care when you are in the hands of a world renowned ophthalmologist.

    Optometry Times A/V