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IOL/IOP Related Studies & Articles PDF Print E-mail
A Correction Formula for the Real Intraocular Pressure After LASIK for the Correction of Myopic Astigmatism - To create a correction formula to determine the real intraocular pressure (IOP) after LASIK considering the altered corneal thickness, corneal curvature, and corneal stability.

Measurement of intraocular pressure after LASIK by dynamic contour tonometry - Changes of corneal properties induced by laser in situ keratomileusis (LASIK) results in low inaccurate intraocular pressure (IOP) readings by Goldmann applanation tonometry (GAT).

Early Transient Visual Acuity Loss After LASIK Due to Steroid-induced Elevation of Intraocular Pressure - To report the clinical course of early transient reduction of uncorrected visual acuity (UCVA) after LASIK surgery resulting from steroid-induced elevation of intraocular pressure (IOP).

Change in IOP measurements after LASIK the effect of the refractive correction and the lamellar flap - To study the relationship between intraocular pressure (IOP) readings after LASIK and the amount of refractive correction.

The AS biometry technique-A novel technique to aid accurate intraocular lens power calculation after corneal laser refractive surgery -IOL calculation for cataract surgery has been shown to be inaccurate after PRK, LASEK, and LASIK. This technique is to determine difference to clinical history method (CHM).

Effect of microkeratome suction during LASIK on ocular structures - To study the effect of microkeratome suction on ocular structures during LASIK.

A predictive model for postoperative intraocular pressure among patients undergoing LASIK - To develop a predictive model based on preoperative variables for estimating postoperative intraocular pressure (IOP) of those eyes undergoing LASIK surgery, to predict the amount of underestimated IOP after LASIK for myopia and myopic astigmatism.

Preventing IOP increase after phacoemulsification and the role of perioperative apraclonidine - To evaluate the effectiveness of prophylactic topical apraclonidine 1% in preventing an intraocular pressure (IOP) rise in the early period after uneventful phacoemulsification with intraocular lens (IOL) implantation.

Accurate intraocular lens power calculation after myopic LASIK, bypassing corneal power - To describe a novel method for calculating intraocular lens (IOL) power after myopic laser in situ keratomileusis (LASIK) without using the inaccuracies of the post-LASIK corneal power.

Angle-supported phakic IOLs withdrawn from the French market  - Angle-supported phakic IOLs will no longer be sold and implanted in France due to an alarming amount of endothelial cell loss found in a significant number of patients 2 to 3 years after implantation.

Ocular Structure Changes During Vacuum by the Hansatome Microkeratome Suction Ring  - To evaluate whether the vacuum of a microkeratome suction ring induces ocular structure changes. 

Patients are not informed that IOP measurements after LASIK are not accurate. This can have serious implications for patients. High IOP must be treated in order to avoid permanent vision loss.

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Other Eye Related Studies & Articles PDF Print E-mail

The Threshold Concept - The point is that refractive surgery has robbed millions of their visual and corneal nerve reserves. Millions of Americans have been pushed nearer the threshold for dry eye, loss of functional night vision, and corneal failure (ectasia).

The Eyes Are The Windows To The Soul - The eyes are the windows to the soul. And the relatively new LASIK procedure supposedly can make those windows crystal clear. An article by Meredith Perry

An Eye For An Eye: Professor O'Reilly Speaks Out - Laser eye surgery is remarkable. Never before in American medical history have 3 million people each year responded to massive advertising by paying for an innovative, elective surgery. Never before have surgeons competed so vigorously on price; and never has a surgery been so skillfully isolated from liability lawsuits. If LASIK eye surgery becomes the Mass Tort of 2025, will Americans regret accepting it as the benign 20/20 solution of today?

Cancer & Laser Eye Surgery - At a time when there has been a significant improvement in the technology of treatment of refractive errors by laser in-situ keratomileusis (LASIK), this author has issued a very timely warning both to patients undergoing the procedure and to the people performing LASIK.

10 million not enough, stronger sales skills needed - Why refractive surgeons must adopt a philosophy of continuous improvement.

What's OK by the FDA... - A surgeon can give patients 2 diopters of induced astigmatism as long as it's less than 5% of eyes. That's a LOT of blurry vision folks, and for the record... induced astigmatism was not in my informed consent materials. Was it in yours?

Surface ablation yielded better biomechanical stability vs. LASIK in study - Regardless of how thick or thin LASIK flaps are made, the flaps cause a considerable reduction in corneal biomechanical stability compared with surface ablation procedures, according to a study presented here.

Visual Field Defect after LASIK - To report a case of visual field defect associated with laser in situ keratomileusis.

Infraorbital nerve palsy: A complication of laser in situ keratomileusis - To report infraorbital nerve dysfunction after laser in situ keratomileusis.

A Cluster of Nocardia Keratitis After LASIK - To report a cluster of Nocardia asteroides keratitis cases after LASIK.

Bilateral Bacterial Keratitis in Three Patients Following Photorefractive Keratectomy - To report clinical manifestations and the bacteriologic profiles of three patients with bilateral bacterial keratitis following photorefractive keratectomy (PRK).

Potential new post-laser refractive surgery complication identified - A new syndrome characterized by noninflammatory corneal opacification  can occur in some patients within 9 days after undergoing LASIK or PRK, according to a study.

Functional optical zone after myopic LASIK as a function of ablation diameter - Glare is induced by rays of light that enter the pupil through the portion of the cornea outside the ablation area.

Vision standards for driving in Canada and the United States - A review for the Canadian Ophthalmological Society.

Dangers of Suction Ring and Laser Acoustic Shock - This barotrauma is analagous to what happens in closed eye injury, and can alter delicate retinal structures, especially small vessels, and induce vitreoretinal traction at the vitreous base and posterior pole.

Effect of microkeratome suction during LASIK on ocular structures - During application of microkeratome suction, the lens thickness decreases, whereas the vitreous distance increases, suggesting anterior traction on the posterior segment.

Survey Finds 1 In 3 Americans Dissatisfied With LASIK - 1 in 3 respondents who encountered post-Lasik problems still wear their glasses or contacts and 1 in 7 of all respondents underwent a second Lasik operation.

13% of post-LASIK eyes have posterior vitreous detachment! - Considering the data from the 100 eyes, this corresponds to 13%;

Plastic particles at the LASIK interface - Numerous plastic particles are generated during microkeratome oscillation and are deposited at the interface during LASIK. The particles persist unaltered for at least 1 year.

Visual symptoms and aberrations - The LADARWave wavefront measurement device is a valuable diagnostic tool in measuring refractive error with ocular aberrations in post-LASIK eyes. 

Ocular Surface Before and After LASIK - Sensory denervation of the ocular surface after bilateral LASIK disrupts ocular surface tear dynamics and causes irritation symptoms.

Pharmacological management of night vision disturbances after refractive surgery: - Diluted aceclidine seemed to be an effective and safe treatment for night vision disturbance following refractive surgery.

Patients Never Really Understand... - “What good is making pupil size measurement a part of the standard of care if it is never utilized (by the doctor, or to communicate to the patient the risks it implies about the surgery they are considering)?"

Hot Compresses Fix Nerve Damage? - "that warm compresses along with other therapies can treat even the worst dry eye patients after LASIK."

Laser Eye Surgery Failure Rate Reported At One In Ten - In 2003, the medical journal Ophthalmology said the failure rate for eye surgery was one in ten, not the one in 1,000 figure widely advertised.

Ectasia known risk of laser vision correction - Ectasia is a known risk of laser vision correction, and if ectasia occurs in a patient following laser vision correction it does not necessarily mean that the patient was a poor candidate for surgery, that the surgery was contraindicated, or that there was a violation of the standard of care.

Floaters - 13% of post-LASIK eyes have posterior vitreous detachment (floaters)! And 25% of high myopes have posterior vitreous detachment after LASIK!

Posterior Vitreous Detachment - Effect of microkeratome suction during LASIK on ocular structures.

Correlations in a change in aqueous tear evaporation with a change in relative humidity and the impact - To establish scientific relationship between relative humidity (RH) and aqueous tear evaporation to elucidate possible significance of this relationship in normals and aqueous tear deficiency patients.

Pressure-induced interface keratitis: a late complication following LASIK - To describe a novel presentation of interface inflammation that resembles DLK in appearance but presents late in the postoperative period, is associated with increased intraocular pressure, and is exacerbated by steroid treatment.

Influence of pupil and optical zone diameter on higher-order aberrations after wavefront-guided myopic LASIK - To investigate the influence of pupil and optical zone (OZ) diameter on higher-order aberrations (HOAs) after myopic wavefront-guided laser in situ keratomileusis (LASIK).

Changes in quality of life after laser in situ keratomileusis for myopia - People presenting for LASIK scored measurably poorer than matched patients not contemplating refractive surgery.

Comparative results of keratometry with three different keratometers after LASIK - This study demonstrates that with common keratometers central corneal power is measured too high after LASIK.

Iris repair after a catastrophic laser in situ keratomileusis complication - This report illustrates the surgical approach to and results of a comples iris reconstruction. The presentation and long-term visual and architectural results (follow-up of 4 years) of the repair of a severe anterior segment injury after entry into the anterior chamber by a microkeratome during LASIK is described.

High Interocular Corneal Symmetry in Average Simulated Keratometry, Central Corneal Thickness, and Posterior Elevation - The purpose of this study was to assess interocular corneal syymetry in average simulated keratometry, corneal thickness, and posterior corneal elevation.

The effect of daily use of brimonidine tartrate on the dark-adapted pupil diameter - To investigate the effect of daily brimonidine tartrate 0.15% on the dark-adapted pupil diameter.

Promises - An insiders journal on the evolution and misinformation of refractive surgery.

An Eye Doctor's Fly in the Ointment - "Dr. X, for every patient you send to our laser center, we'll collect the $5000 and we'll make sure you get back $2000."  "That's an extravagant amount," I said. "Isn't that a kickback?"

Reasons patients recommend LASIK - To evaluate the reasons patients who have had laser in situ keratomileusis (LASIK) recommend it to others and examine the disparity between high levels of satisfaction and patient reports of night-vision symptoms and/or dry eye after LASIK.

LASIK complication: loss of electricity to the microkeratome - This type of unforeseen microkeratome malfunction may result in serious flap or other complications.

LASIK for myopia and astigmatism - safety and efficacy: a report by the American Academy of Ophthalmology

Evaluation of the prophylactic use of mitomycin-C to inhibit haze formation after photorefractive keratectomy - To evaluate the results of the prophylactic use of mitomycin-C to inhibit haze formation after excimer laser PRK for medium and high myopia in eyes that were not good candidates for LASIK.

Keratorefractive Surgery, Success, and the Public Health - "I hope the reader will understand how a patient may have clinically acceptable 20/20 visual acuity in the daytime and still suffer from clinically dangerous visual aberration at night if that patient's visual system must cope with an altered refractive error, increased glare, poorer contrast discrimination, and preferentially degraded peripheral vision.

The Pathophysiology of Regression following LASIK - Part of this study determined that there were significant biomechanical and epithelial effects occurring, and that corneal elastic bowing and epithelium changes could practically account for the inaccuracy of LASIK.

Autorefractometry after LASIK - To correlate cycloplegic subjective refraction with cycloplegic autorefractometry in eyes that have had LASIK.

Bacillus megaterium delayed onset lamellar keratitis after LASIK - To report the history and clinical presentation of a 23-year-old man who developed delayed onset lamellar keratitis in his right eye 2 weeks after uneventful LASIK for correction of myopia.

Hyeropic shift after LASIK induced Diffuse Lamellar Keratitis - Diffuse lamellar keratitis (DLK) is a relatively new syndrome that is increasingly being reported after LASIK. We have observed that a hyperopic shift may be associated with the occurrence of this diffuse lamellar keratitis.

Iatrogenic ring scotoma after LASIK - A 37-year-old ophthalmologist had bilateral simultaneous laser in situ keratomileusis (LASIK) for moderate myopia with astigmatism using the Alcon Summit LADARVision laser; an ablation zone of 5.5 mm was used. Five months after surgery, the uncorrected visual acuity was 20/20 and 20/25 but despite regular corneal topographies, the patient experienced prominent ghost images under photopic and scotopic conditions.

Reverse ptosis-induced corneal steepening and decreased vision after LASIK surgery - To report a patient with a past history of LASIK who had decreased vision and induced corneal steepening after lower eyelid ptosis. Surgical correction of lower eyelid ptosis decreased the corneal steepening and improved visual acuity.

Silence is Golden...for the LASIK Doctors? - As Angry Patients Vent Online, Doctors Sue To Silence Them - An article by David Kesmodel, The Wall Street Journal Online.

When doctors sue to silence - What Are They Hiding?

Let's face it, past and recent articles & studies make a clear case for withdrawal of  FDA approval for the LASIK procedure!

 
Laser Manufacturers: Studies, Letters, & Complaints PDF Print E-mail

FDA MDR on ALCON/Summit Apex Plus - Pupil size issue: Patient has undergone photorefractive keratectomy (prk) at hospital at hospital in a foreign country with a FDA approved laser, i.e. The ApexPlus of the co Summit technology.

FDA Warning Letter - To ALCON Laboratories dated January 18, 2005.

Subject: LASIK, Bausch & Lomb, and TLC, my thoughts - An ex-employee's concern for safety and effectiveness.

From the FDA, Summary of Safety and Effective Data - For the Approval of the Bausch & Lomb Technolas 217A.

What’s really the cause of high retreatment rates? - The debate is growing with one laser (ALCON) squarely in the center.

INTRALASE FS 600 C - Laser System (Model 1), Laser Keratome Recall # Z-0147-3.

FDA Warning Letters - To LaserSight Technologies.

FDA MDR Reports - For problems/injuries by VISX Laser.

VISX - Possible Deception? - VISX reported that 97.7% (84/86) of eyes had UCVA of 20/20 or better at 12 months. These 86 eyes represent only 24.5% of patients. Accountability is reported to be 95.6%, despite the fact that 70.7% (248/351) of patients were labeled “not yet eligible” for analysis at 12 months.

Effect of expanding the treatment zone of the Nidek EC-5000 laser - To evaluate the effect of expanding the treatment zone of the Nidek EC-5000 laser.

Ophthalmologist Sues Laser Manufacturer ALCON - Ophthalmologist, Dr. Sandra Brown is acutely aware of what can go wrong when a surgical laser is applied to someone’s eyes. She waited a long time before consenting to laser eye surgery to correct her own flawed vision.

 
Quotes, Non Peer-Reviewed Articles, and More PDF Print E-mail

Informed Consent

"What concerns me is that if the person informing the patient is themselves poorly or inaccurately informed then how on earth can consent ever be truly informed?" Dr. Sarah Smith.

AND MORE...

Cleaner LASIK: Is it Possible?

http://www.ophmanagement.com/article.aspx?article=86452 

This from a doctor who was fined $1.1 Million from the FDA for damaging 125 patients...

Fixing a lost or slipped flap

http://www.eyeworld.org/article.php?sid=3473

EyeWorld

November 2006

Quote:

“Lost flaps usually will occur in the operating room where the microkeratome just made too superficial a cut,” Dr. Geggel said. “Surgeons have to be comfortable knowing how to take the microkeratome apart, because the lost flap is usually going to be somewhere within the machine.”  

"Make sure the first patient you enroll feels like you have been doing this for years..."

Stephen S. Lane, M.D.:

http://www.eyeworld.org/article.php?sid=2765

EyeWorld

October, 2005

IOL calculations after refractive surgery need extra care

http://www.ophthalmologytimes.com/ophthalmologytimes/article/articleDetail.jsp?id=302330

Excerpt:  The topic of  IOL implantation after refractive surgery and power calculations arose a few years ago. However, Dr. O'Brien noted that now this situation is arising on a daily basis in practices as the number of refractive procedures increases each year and as the population ages.  "There has been a question of whether laser refractive surgery is accelerating the development of cataract. This is controversial, but I see it more and more often in my practice," he said. Dr. O'Brien is professor of ophthalmology and director of the Refractive Surgery Service, Bascom Palmer Eye Institute, Miami.  The problem, he pointed out, is that the patients who have undergone refractive surgery and then develop cataract are different in mindset from the traditional patient with cataract in that they have extraordinarily high expectations; they want immediate results; and they want no surgical discomfort, sutures, or downtime after the procedure.

"These patients who develop cataract after refractive surgery want a perfect outcome. They are potentially frustrated and angry because their quality of vision has suffered as the result of the refractive surgery, and the results may be unpredictable. Interestingly, incorrect power is the most common reason for IOL explantation. This is the result of our not being able to determine the power as accurately as we would like," he stated and advised exercising extra care with these patients.

"Successful LASIK" is an oxymoron

Found on LasikFlap bulletin board: http://www.lasikflap.com/forum

The flap never heals. It cannot heal. All it can do is form a scar at the margin of the flap which is only 28% as strong as a normal cornea. The flap itself does not bond to the underlying cornea and can be dislodged or lifted years later.

The corneal nerves that play a vital role in tear production never fully regenerate. A scientific peer-reviewed study proved that at 3 years post-op the corneal nerves are still less than 60% of pre-op densities. LASIK induced dry eyes is common and for many patients is a life-long sentence.

The suction ring used during the cutting of the flap damages the delicate structures inside the eye including the retina, vitreous, and optic nerve. Many patients report increased floaters (posterior vitreous detachment) after LASIK, and some experience retinal tears or detachment, lacquer cracks, macular holes, macular hemorrhages, optic neuropathy, and retinal vein occlusion.

LASIK corneas are not as stable as normal corneas and can begin to bulge weeks, months, or even years later, potentially resulting in loss of the cornea. This bulging is a response to the normal intraocular pressure. A LASIK-weakened cornea sometimes can no longer withstand this outward force. The FDA used a best-guess safety limit of 250 microns of cornea under the flap when LASIK was approved. Since then it has been shown in the medical literature that 250 is not a safe limit, even though the vast majority of LASIK surgeons, who are too busy doing LASIK to follow the research, are still using an unsafe limit of 250 microns. And the FDA does not have the backbone to modify the approval, allowing the LASIK industry to continue this unsafe practice that jeopardizes the well-being of millions of patients.

There is permanent damage in 100% of LASIK corneas -- debris in the space between the flap and the underlying cornea, undulations and microfolds in the Bowman's layer -- presumably because the flap doesn't fit to the altered corneal bed, haze, epithelial cells under the flap, acutely and chronically reduced keratocytes, epithelial thickening, collagen fibril disorganization, collagen lamellar disarray, and abnormalities of the Descemet membrane.

Quote from one peer-reviewed study: "However, the presence of pathologic findings up to 7 years after LASIK indicates that the process of corneal stroma wound healing never completely regenerates histopathologically normal corneal stroma."

Loss of night vision quality after LASIK occurs frequently, according to a 2002 report by the American Academy of Ophthalmology. For some patients, particularly those with large pupils, this complication can be debilitating. Since this is a "frequent" problem after LASIK, I wonder how many of the approximately 8 million Americans who have had LASIK are out there on the roads at night endangering their life and the lives of others who share the roads with them? A recent study showed that up to 50% of LASIK patients are impaired when driving at night. Yet this serious threat to the public health is down-played and swept under the rug by the LASIK industry.

And then we have the problem of the white wall of silence. Doctors are pressured by their peers not to testify for patients who are victims of LASIK malpractice. They are threatened by their own insurance carriers, which could put them out of business. And they are concerned about giving LASIK a black eye by helping a patient seek justice for the harm done to him or her in a public forum like a court of law. They cave in to the pressures, leaving patients without any recourse -- medical, legal or otherwise. So doctors just get away with it and standard of care and informed consent continue to be basically non-existent. And the FDA says it's not their problem (they regulate the devices, not the doctors).

So who's looking out for the patients? Who's going to warn them that 1/3 of their corneas will be nearly sliced off, leaving them with a structurally weakened cornea that can begin to bulge years down the road? Who's going to warn them of the seriousness of LASIK-induced dry eyes, that the nerves never regenerate, and that painful dry eyes can be permanent? Who's going to warn them that LASIK, all LASIK -- conventional and custom, induces higher order aberrations in all virgin corneas, effectively reducing the quality of their vision? Who's going to warn them of the damage the suction ring can do to the structures inside the eye? Who's going to warn them that the flap never heals?

You would think doctors would be protecting patients. Wake up and smell the coffee. Money is what drives them, not a desire to heal the sick. They don't deserve to be called doctors. They are no better than used car salesmen.

American Academy of Ophthalmology. For some patients, particularly those with large pupils, this complication can be debilitating. Since this is a "frequent" problem after LASIK, I wonder how many of the approximately 8 million Americans who have had LASIK are out there on the roads at night endangering their life and the lives of others who share the roads with them? A recent study showed that up to 50% of LASIK patients are impaired when driving at night. Yet this serious threat to the public health is down-played and swept under the rug by the LASIK industry.

Mistakes / Errors 

JOURNAL OF REFRACTIVE SURGERY
Vol. 22 No. 3 March 2006 
Dan Z. Reinstein, MD, MA(Cantab), FRCSC; Cynthia Roberts, PhD 

Excerpt:  "Some of the evidence pointing to the impact of corneal biomechanical properties on surgical outcomes lies in the measurement of intraocular pressure (IOP), both before and after refractive surgery. It is well known that measured IOP is reduced, on average, following a refractive procedure. It has been assumed that this is the result of reduced curvature and thickness in myopic procedures. However, Chang and Stulting performed a retrospective review of over 8000 myopic LASIK patients, and determined that although measured pressure was reduced on average by approximately 2 mmHg, the range of change was approximately +10 to -15 mmHg. Every patient in this population had reduced thickness and curvature, and yet almost half of them had an increase in measured IOP.  

Clearly, the artifact in IOP measurement cannot be explained by thickness alone, and “correction” of measured IOP postoperatively using a linear correction factor based on thickness is problematic. This leads to the conclusion that refractive surgery likely alters the fundamental biomechanical properties of the cornea.

Lasers or Surgeons: What's really the cause of high retreatment rates?

http://www.eyeworld.org/article.php?sid=2267

EyeWorld
January 2005

“I had one time where I had to put the flap back with a flashlight because the illumination light went off so I couldn’t figure out where the flap was,” Dr. Rubinfeld said.

Interface fluid after LASIK

J Cataract Refract Surg. 2001 Sep;27(9):1526-8.

Fogla R, Rao SK, Padmanabhan P.  Cornea Services, Sankara Nethralaya, Chennai 600 006, Tamil, Nadu, India. mrf@sankaranethralaya.orgThis email address is being protected from spam bots, you need Javascript enabled to view it  

We report a case in which raised intraocular pressure (IOP) was associated with interface fluid after uneventful bilateral laser in situ keratomileusis (LASIK). The patient presented with diffuse lamellar keratitis in both eyes 3 weeks postoperatively that was treated aggressively with topical corticosteroids. A steroid-induced rise in IOP resulted in interface fluid accumulation and microcystic edema. Measurements with the Goldmann tonometer revealed an IOP of 3.0 mm Hg in both eyes. However, Schiotz tonometry recorded a pressure of 54.7 mm Hg in both eyes. Reduction in the dosage of topical corticosteroid and medical treatment of the raised IOP resulted in resolution of the microcystic edema and interface fluid accumulation. This case highlights the inaccuracies of IOP measurement after LASIK and the resulting complications.

LASIK: three unexpected complications

J Refract Surg. 2001 Mar-Apr;17(2 Suppl):S177-9.  Rosa DA.

PURPOSE: To report unexpected outcomes in three patients after uneventful laser in situ keratomileusis (LASIK) performed using the Nidek EC-5000 excimer laser and the Hansatome microkeratome (Bausch & Lomb Surgical).

METHODS: LASIK was performed with the Nidek EC-5000 excimer laser and the Hansatome microkeratome (Bausch & Lomb Surgical) in three patients.

RESULTS: In three patients, unexpected outcomes were observed. One patient treated for -3.00 D of myopia presented with a central island. One patient treated for +2.00 D (+1.00 x 90 degrees) of hyperopia in both eyes ended up emmetropic in one eye and overcorrected in the fellow eye. The third patient with -12.00 D (-2.00 x 180 degrees) of myopia was treated as -8.60 -1.00 x 180 degrees and at last examination was +4.00 D. During these sessions, all other patients treated were within +/-0.50 D of emmetropia.

CONCLUSION: After LASIK with the Nidek EC-5000 excimer laser and the Hansatome microkeratome (Bausch & Lomb Surgical), unexpected outcomes may still occur, despite controlling all the usual variables.

Oculocardiac reflex in a nonsedated LASIK patient

J Cataract Refract Surg. 2002 Sep;28(9):1698-9. 

Baykara M, Dogru M, Ozmen AT, Ozcetin H.  Uludag University Faculty of Medicine, Department of Ophthalmology, Bursa, Turkey

A healthy 21-year-old man had laser in situ keratomileusis (LASIK) in the right eye for a refractive error of -7.0 diopters. The electrocardiogram findings and heart rate were recorded before LASIK; during eye lid speculum insertion, vacuum application, corneal flap preparation, and excimer laser keratectomy; and after the procedure.

The pre-LASIK heart rate was 90 pulses/min. Severe bradycardia of 40 beats/min developed during vacuum application, and the procedure was terminated. Severe bradycardia caused by an oculocardiac reflex may occur during LASIK, and patients should be closely monitored during the procedure.

LASIK complication: loss of electricity to the microkeratome during the forward pass

Acta Ophthalmol Scand. 2003 Oct;81(5):530-2. 

Tuominen IS, Tervo TM.  Department of Ophthalmology, Helsinki University Hospital, PO Box 220, HUS, SF-00029 Helsinki, Finland. ilpo.tuominen@hus.fiThis email address is being protected from spam bots, you need Javascript enabled to view it  

CONTEXT: A 32-year-old woman was scheduled for myopic laser in situ keratomileusis (LASIK) because of myopia and anisometropia caused by retinal detachment surgery. 

CASE REPORT: During surgery, a sudden malfunction of the microkeratome during the forward pass was experienced. It was not possible to reverse the blade manually along the suction ring. Moreover, disconnecting the suction from the control unit did not help at first, because the suction ring was firmly attached to the ocular surface. However, detaching the suction line from the control unit aborted the vacuum and allowed the surgeon to turn the whole microkeratome backwards, mimicking the normal blade movement. Finally, an almost normal flap was observed, and the operation was successfully completed. Afterwards, the wire to the electromotor of the microkeratome was found to be broken and subsequently replaced.  

CONCLUSION: This type of unforeseen microkeratome malfunction may result in serious flap or other complications.

Refractive surprise after LASIK

Arch Soc Esp Oftalmol. 2005 Sep;80(9):547-9. Related Articles, Links

CASE REPORT: A female patient underwent laser in situ keratomileusis (LASIK) in both eyes. The final degree of astigmatism in her left eye was double the preoperative value due to an error in data management. Complex surgery to both eyes was necessary to resolve the mistake.

DISCUSSION: Complications in refractive surgery can occur, however errors in data management must be minimized by double-checking. Solutions to resolve the errors made can be difficult and the entire staff must share responsibility to avoid these undesirable outcomes.

Failure to verify treatment parameters can lead to LASIK errors

http://www.osnsupersite.com/ 

TOP STORIES 3/24/2006 

Quote: In the last case, the patient allowed the surgeon to call him “José” several times, believing the surgeon was making a joke. Only after one eye had been treated incorrectly did he clarify his name was “Carlos,” Dr. Sonal said.

Turn Around These LASIK Letdowns

Review of Optometry 

Excerpt:  For most carefully chosen patients, LASIK continues to improve their quality of life significantly. However, the popular media that once portrayed LASIK as a somewhat miraculous procedure now tell horror stories of people visually disabled by LASIK gone awry. 

Read the entire article at:

http://www.revoptom.com/index.asp?ArticleType=SiteSpec&page=osc/oct01/lesson_1001.htm

What's Next for LASIK?

Ophthalmology Management Issue:
September 2004 

Outcomes are better than ever, but its place as the dominant refractive procedure is now in doubt.  By Jerry Helzner

http://www.ophmanagement.com/article.aspx?article=86168

These additional studies (all PDF format) also interesting to read:

Adhesion abnormalities associated with LASIK 

Artificial cornea transplant 

Contrast sensitivity function 

Cornea donation 

Corneal reinnervation after lasik 

Donnenfeld flap experiment 

Ectasia after LASIK 

Environmental factors myopic LASIK 

Epithelial adhesion abnormalities 

Flap complications aborted surgery

Flap tear during enhancement 

Gayton rejects LASIK 

Humidity temperature risks 

Infections following LASIK

Informed consent doctor tool

Intralase causes macular hemorrhage

Intralase vs microkeratomes

LASIK causes glaucoma

Measuring cornea thickness

Microkeratome assessment

Microkeratome evaluation 1

Microkeratome evaluation 2

Microkeratome evaluation 3

Microkeratome evaluation 4

Night vision complaints 1

Night vision complaints 2

Night vision complaints 3

Non-surgical eyewash problems

Peripheral relaxing incisions after LASIK

Pupil size night vision

RGP discontinuation before LASIK

Severe central epithelial defects

Thick and thin LASIK flaps

Visx - Measuring Pupil Size Preoperatively

Visx Requirement of Patient Information Booklet 

 
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