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    Managing LASIK complications

    From preop to postop dryness and IOP, stay on track

     

    Postoperative concerns

    In the early 2000s we talked about the “shifting sands of the Sahara,” a cute moniker for diffuse lamellar keratitis (DLK) or the inflammatory appearance seen in a large percentage of LASIK patients. The understanding of this inflammatory response from exotoxins has led to a significant decrease in the occurrence. However, every LASIK procedure is not immune and recognizing the granular inflammatory response early in the process and increasing anti-inflammatory medications has proven to resolve this side effect.2

    Frankly, I don’t consider DLK as much of a complication as I do an over response of the inflammatory mediators. This is in contrast to central toxic keratopathy (CTK), which is a direct insult to the stromal tissue and often is accompanied by inflammation, as seen in DLK. The CTK patient will have a reduction in vision and may take months to reestablish a healthy stromal bed. Although no treatment is advised, it is important keep the patient close to the practice with monthly evaluations to see the progress.

    Related: Are your patient's eyes healthy enough for LASIK?

    As the patient heals from this kerato-refractive procedure, there may be slight sensitivity or light sensitivity. Patients may experience—usually around 30 days postop—an inordinate amount of photosensitivity. The origin is unknown, although it is hypothesized that that regeneration of the nerve endings creates this discomfort. Patients should be placed on a steroid and monitored bi-monthly until resolution.

    The inflammation from the procedure may also induce dryness that may be symptomatic. The use of Restasis (cyclosporine, Allergan) around LASIK has been widely reported to help stabilize the vision and reduce symptoms.3 Empirically, this would also help to stabilize glare and halos. The treatment of the inflammation and time has the remarkable ability to eliminate or reduce any unwanted night effects. 

    Lastly, the change in the curvature and thickness of this refracting tissue is going to create a false reading with your standard measuring of intraocular pressure (IOP). Care should be taken to obtain the most accurate pressure, especially in glaucoma patients in which each mm Hg is critical for stabilization. The use of a handheld tonometer, such as Reichert’s Avia, can measure pressure away from the ablated cornea and record a measurement that is more accurate. An even more impressive way to measure post-refractive pressure is to incorporate the biomechanics of the cornea, hysteresis. For example, the Ocular Response Analyzer and the 7C-R, both from Reichert, provide a measurement of the IOP that compensates for changes to the cornea.

    As clinicians, we are fortunate to be able to have technologically advanced procedures for our patients. Be diligent in your preoperative discussion and as conscientious in your efforts to manage the postoperative eyes. LASIK is like Bey’s Lemonade, just sweeter!

    Click here to check out the latest comangement advice

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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