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LASIK & Eye Related Studies
TOP TEN REASONS NOT TO HAVE LASIK EYE SURGERY PDF Print E-mail

Opinions By Damaged LASIK Patients For Those Considering LASIK

1. LASIK causes dry eye

Dry eye is the most common complication of LASIK. Corneal nerves that are responsible for tear production are severed when the flap is cut. Medical studies have shown that these severed nerves never return to normal densities. Symptoms of dry eye include pain, burning, foreign body sensation, and eyelid sticking to the eyeball. The FDA website warns that LASIK-induced dry eye may be permanent.

2. LASIK results in loss of visual quality

LASIK patients have more difficulty seeing detail in dim light (known as loss of contrast sensitivity), and also experience an increase in visual distortion at night (multiple images, halos, and starbursts). The FDA website warns that patients with large pupils may suffer from debilitating visual symptoms at night.

3. The cornea is incapable of complete wound healing after LASIK

Researchers found that the flap heals to only 2.4% of normal tensile strength. LASIK flaps can be surgically lifted or accidentally dislodged for the remainder of a patient’s life. For these reasons, the FDA website warns that patients who participate in contact sports are not good candidates for LASIK.

Collagen bands of the cornea provide its form and strength. LASIK severs these collagen bands and thins the cornea, resulting in permanent weakening. The thinner, weaker post-LASIK cornea is more susceptible to forward bulging due to normal intraocular pressure, which may progress to a condition known as keratectasia and corneal failure, requiring corneal transplant.

4. The true rate of LASIK complications is unknown

There is no clearinghouse for reporting of LASIK complications. Side effects occur frequently but are downplayed by LASIK surgeons. Moreover, there is no consensus among LASIK surgeons on the definition of a complication.

5. LASIK results in loss of near vision

Nearsighted patients who do not have LASIK retain the ability to see up close naturally after the age of 40 simply by removing their glasses. LASIK patients over the age of 40 may discover they have traded one pair of glasses for another.

6. There are long-term negative consequences of LASIK

LASIK affects the accuracy of intraocular pressure measurements, exposing patients to risk of blindness from undiagnosed glaucoma.

Like the general population, LASIK patients will develop cataracts later in life. Calculation of intraocular lens power for cataract surgery is inaccurate after LASIK. This may result in poor vision following cataract surgery and exposes patients to increased risk of repeat surgeries. Ironically, steroid drops routinely prescribed after LASIK hasten the onset of cataracts.

7. Bilateral simultaneous LASIK is not in patients’ best interest

In a 2003 survey of American Society of Cataract and Refractive Surgery (ASCRS) members, 91% of surgeons who responded did not offer patients the choice of having one eye done at a time. Performing LASIK on both eyes in the same day places patients at risk of vision loss in both eyes, and denies patients informed consent for the second eye.

8. Serious complications may emerge later

The medical literature is filled with reports of late onset LASIK complications such as loss of the cornea due to biomechanical instability, vision-threatening infection, inflammation resulting in corneal haze, flap dislocation, and retinal detachment. Complications may emerge weeks, months, or years after “successful” LASIK.

9. Rehabilitation options after LASIK are limited

LASIK is irreversible, and treatment options for complications are extremely limited. Hard contact lenses may provide visual improvement if the patient can obtain a good fit and tolerate lenses. The post-LASIK contact lens fitting process can be time consuming, costly and ultimately unsuccessful. Many patients eventually give up on hard contacts and struggle to function with impaired vision. In extreme cases, a corneal transplant is the last resort and does not always result in improved vision.

10. Safer alternatives to LASIK exist

Some leading surgeons have already abandoned LASIK for surface treatments, such as PRK, which do not involve cutting a corneal flap. It is important to remember that LASIK is elective surgery. There is no sound medical reason to risk vision loss from unnecessary surgery. Glasses and contact lenses are the safest alternatives.

 
Flap Studies & Articles PDF Print E-mail

These quick-links will provide you faster access to the studies & articles provided: 

Accidental self-removal of a flap - a rare complication of LASIK surgery  - - To report a rare complication in which the patient accidentally removed the LASIK corneal flap.

LASIK Flap Only 2.4% as strong as Normal Cornea  - The human corneal stroma typically heals after LASIK in a limited and incomplete fashion; this results in a weak, central and paracentral hypocellular primitive stromal scar that averages 2.4% as strong as normal corneal stroma.

Traumatic corneal flap dislocation one to six years after LASIK in nine eyes with a favorable outcome - To report our experience treating eye trauma after LASIK refractive surgery.

Comparison of residual stromal bed and flap thickness in primary and repeat laser in situ keratomileusis in myopic patients - To compare the change in residual stromal thickness and flap thickness between primary laser in situ keratomileusis (LASIK) and repeat LASIK in myopic patients.

Central Flap Necrosis After LASIK With Microkeratome and Femtosecond Laser Created Flaps - To report nine cases of severe central flap inflammation and necrosis after LASIK.

Flap Displacement during Vitrectomy 24 months after LASER IN SITU KERATOMILEUSIS  - “The LASIK flap never heals… the LASIK flap can be easily dislodged from simple contact with the eye such as a finger poke.”

Traumatic flap displacement and DLK after LASIK  - Traumatic flap displacement and subsequent diffuse lamellar keratitis after laser in situ keratomileusis.

Late-onset flap folds and partial dehiscence of flap  - Late-onset repetitive traumatic flap folds and partial dehiscence of flap edge after laser in situ keratomileusis.

Late traumatic dislocation of LASIK flaps  (1)  - A case of traumatic flap displacement with a fingernail injury four years after LASIK is reported.

Late traumatic dislocation of LASIK flaps  (2)  - The second patient had a blunt trauma that caused a dislocation of the flap.

Flap tearing during lift-flap laser in situ keratomileusis retreatment  - This report suggests that flaps with margins near the limbus or a corneal pannus may be prone to an earlier and stronger healing process at the edge that may lead to a flap tear during LASIK retreatment.

Precision of flap measurements for laser in situ keratomileusis in 4428 eyes  - Flap thickness varies significantly depending on the microkeratome used. Factors that influence flap thickness are primarily corneal thickness, patient age, preoperative keratometry, preoperative refraction including astigmatism, and corneal diameter.

Predictability of corneal flap thickness in laser in situ keratomileusis using three different microkeratomes  - Corneal flap thickness tended to be considerably thinner than expected on both eyes using the ACS and Hansatome.

Inaccurate Flap Cut  - Here is a case report of a woman who developed ectasia following LASIK due to in accurate flap cut.

Late traumatic displacement of laser in situ keratomileusis flaps  - Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which can occur more than 2 years after the procedure.

Traumatic flap dislocation 4 years after LASIK  - The patient was examined 5 days after being struck in the face and found to have a flap dislocation.

Mismatch between flap and stromal areas after laser in situ keratomileusis as source of flap striae  - Excess flap area may cause striae because of wrinkling.

Uveitis-associated flap edema and lamellar interface fluid collection after LASIK - To report two cases of corneal pathology associated with anterior uveitis after LASIK.

Noninflammatory flap edema after lasik associated with asymmetrical preoperative corneal pachymetry - To report persistent unilateral flap edema following LASIK in patients with asymmetrical central corneal thickness.

Evaluation of corneal flap dimensions and cut quality using the SKBM automated microkeratome - To evaluate flap dimensions and cut quality with repeated blade use of the automated Summit Krumeich-Barraquer microkeratome (SKBM [LadarVision])

Flap-related complications present challenges for surgeons

Surgeons review some common flap-related problems and how to handle them.

By Amar Agarwal, MS, FRCS, FRCOphth; Jairo Hoyos, MD; Melania Cigales, M

Flap-related problems after LASIK are a concern for any refractive surgeon. Common causative factors are inadequate suction, microkeratome malfunction and corneal curvature anomalies. This article reviews some common complications and ways to avoid or manage them.

Read the FULL ARTICLE

Microstriae

 

Quote:  Microstriae are very faint, small, disorganized, superficial wrinkles in the LASIK flap. Unlike macrostriae, which result from the flap’s slippage, microstriae are produced by the mechanical forces of a LASIK flap...

Traumatic late flap dehiscence and Enterobacter keratitis following LASIK - To report a case of traumatic flap dehiscence and Enterobacter keratitis 34 months after LASIK.

Flap interface particles are another finding whose clinical significance is undetermined.

A Finnish study found that particles of various sizes and reflectivity were clinically visible in 38.7% of eyes examined via slit lamp biomicroscopy, but apparent in 100% of eyes using confocal microscopy.

Some patients have reported large chunks of metal in their corneas after lasik.

Watch a video of a confocal exam of another LASIK patient with an extraordinary amount of metallic debris from the LASIK microkeratome blade.

LASIK Blade Leaves Metal Under Flap

LASIK flap disintegrates during lifting

Read more...
 
Dry Eye Studies & Articles PDF Print E-mail

Dry Eye After LASIK  - The risk of chronic dry eye after LASIK was significantly higher in Asian eyes. Contributing factors could include racial differences in eyelid and orbital anatomy, tear film parameters and blinking dynamics and higher attempted refractive corrections in Asian eyes.

Chronic dry eye and regression after laser in situ keratomileusis for myopia - The risk for refractive regression after LASIK was increased in patients with chronic dry eye.

The incidence and risk factors for developing dry eye after myopic LASIK - To determine the incidence and risk factors after myopic LASIK.

Autologous Serum Eye Drops for dry eye after LASIK - To evaluate the efficacy of these drops for dry eye after LASIK in a prospective, randomized study. 

Symptoms of dry eye and recurrent erosion syndrome after refractive surgery - These symptoms occurred commonly after excimer laser procedures but were significantly more common, more severe, and more prolonged after PRK.

Dealing With Dry Eye - An article written for FDA Consumer magazine.

Dry Eye and Corneal Sensitivity After High Myopic LASIK - To assess subjective symptoms and objective clinical signs of dry eye and investigate corneal sensitivity after high myopic LASIK.

 
Pupil Related Studies & Articles PDF Print E-mail

Pupil measurement using the Colvard pupillometer and a standard pupil card with a cobalt blue filter penlight - To compare scotopic pupil measurements obtained with a Colvard pupillometer with measurements taken with a printed pupil gauge and penlight with a cobalt blue filter attachment in mesopic and scotopic luminance.

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)

Pupillary Dilation

1) Pupillary dilation from 3 to 7 mm in post-refractive surgery patients found to cause 28- to 46-fold increase in aberrations! - Both photorefractive keratectomy and laser in situ keratomileusis increase the wavefront aberrations of the cornea and change the relative contribution of coma- and spherical-like aberrations.

2) Pupillary dilation from 3 to 7 mm in post - PRK patients found to cause 25-to 32-fold increase increase in aberrations! - After surgery, the same dilation resulted in a 25- to 32-fold increase in the photorefractive keratectomy group and a 28- to 46-fold increase in the laser in situ keratomileusis group.

Pupil Size

Pupil size and night vision disturbances after LASIK for myopia. - Large pupil size measured preoperatively is correlated with an increased frequency of subjectively experienced post-LASIK visual disturbances during scotopic conditions.

Large pupils lead to night vision problems, physicians suggest

http://www.eyeworld.org/article.php?sid=2813

 

EyeWorld

November, 2005

Excerpt:

While some studies have suggested pupil size has little to no effect on nighttime vision post-refractive surgery, some ophthalmologists point to new evidence that there is a correlation.

“If you compare patients of the same prescriptions, the larger the pupil size, the bigger the chance that they’re going to have more night vision problems,” said William B. Trattler, M.D., Center for Excellence in Eye Care, Miami.

To back up his assertion, Dr. Trattler performed his own studies, one of which included 119 myopic eyes that underwent LASEK or PRK with either a standard VISX (Advanced Medical Optics, Santa Ana, Calif.) Star S3 or S4 laser.

Using a Larson Glarometer, he found that the radius of starbursts was greater in patients with large pupils compared with those in patients with small ones. Dr. Trattler presentedthe results at the most recent ASCRS•ASOA Symposium & Congress. The Larson Glarometer does not have a corporate manufacturer yet. It was developed and is distributed by Bruce Larson, M.D., Hinsdale, Ill.

Meanwhile, James Salz, M.D., clinical professor of ophthalmology, University of Southern California, Los Angeles, also believes large pupils can lead to night vision complaints after refractive surgery.

“The larger the pupil size, the greater the aberrations will be,” said Dr. Salz.

Pupil diameter changes and reaction after posterior chamber phakic intraocular lens implantation - To compare the different aspects of pupil constriction before and after the implantation of an implantable contact lens (ICL).

Effect of pupil size on visual function under monocular and binocular conditions in LASIK and non-LASIK patients - To compare binocular and monocular vision in patients treated with laser in situ keratomileusis (LASIK) and in non-LASIK patients.

Read more...
 
Corneal Studies & Articles PDF Print E-mail

Wound healing in the cornea: a review of refractive surgery complications and new prospects for therapy - The corneal wound healing response is of particular relevance for refractive surgical procedures since it is a major determinant of efficacy and safety. The purpose of this review is to provide an overview of the healing response in refractive surgery procedures.

Long-term corneal keratoctye deficits after photorefractive keratectomy and laser in situ keratomileusis - To measure changes in keratocyte density up to 5 years after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

Estimation of true corneal power after keratorefractive surgery in eyes requiring cataract surgery: BESSt formula - To describe a new formula, BESSt, to estimate true corneal power after keratorefractive surgery in eyes requiring cataract surgery.

Considerations of glaucoma in patients undergoing corneal refractive surgery - Corneal thickness, which is modified during corneal refractive surgery, plays an important role in monitoring glaucoma patients because of its effect on the measured intraocular pressure.

Corneal Keratocyte Deficits After PRK and LASIK - To measure changes in keratocyte density up to 5 years after PRK and LASIK.

Effective corneal refractive diameter as a function of the object tangent angle in visual space - To determine whether the currently accepted method of selecting a minimum optical zone diameter for laser refractive surgery that is equal to or slightly greater than the dark-adapted pupil diameter provides a sufficient diameter of corneal surface to focus light arising from objects in the paracentral and peripheral visual field.

Evaluation of Corneal Sensitivity to Mechanical and Chemical Stimuli After LASIK: A Pilot Study - To evaluate the effect of laser in situ keratomileusis (LASIK) on corneal sensitivity, nerve morphology, and tear film characteristics.

Changes in corneal thickness and curvature after different excimer laser photorefractive procedures and their impact on intraocular pressure measurements - To analyze the changes in central corneal thickness (CCT) and curvature before and after different excimer laser photorefractive procedures and their possible impact on intraocular pressure (IOP) estimations with Goldmann applanation tonometry.

Effect of Corneal Curvature and Corneal Thickness on the Assessment of Intraocular Pressure Using Noncontact Tonometry in Patients After Myopic LASIK Surgery - To evaluate the effect of corneal curvature and corneal thickness on the assessment of intraocular pressure (IOP) using noncontact tonometry (NCT) in patients after myopic LASIK surgery.

Failed LASIK Depleting Supply Of Donor Corneas - Optometrist specializing in post-refractive surgery disaster claims that FAILED LASIK EYE SURGERY IS DEPLETING SUPPLY OF DONOR CORNEAS.

Epidemic of Corneal Weakening After Refractive Surgery - Here is an excerpt and link to a comment posted by Optometrist Dr. Greg Gemoules who specializes in the treatment of patients damaged by refractive surgery by fitting them with rigid gas permeable contact lenses.

Effect of Corneal Curvature and Corneal Thickness on the Assessment of Intraocular Pressure Using Noncontact Tonometry in Patients After Myopic LASIK Surgery -  Even if a residual corneal bed of 300 microm or thicker is preserved, anterior bulging of the cornea after LASIK can occur.

Structural Analysis of the Cornea Using Scanning-Slit Corneal Topography in Eyes Undergoing Excimer Laser Refractive Surgery - Myopic PRK and LASIK induce significant forward shifts of the cornea, which are not true corneal ectasia.

Permanent Disease Changes Present in all Post-LASIK Corneas! - Permanent pathologic changes were present in all post-LASIK corneas. These changes were most prevalent in the lamellar interface wound. These changes along with other pathologic alterations in post-LASIK corneas may change the functionality of the cornea after LASIK.

Corneal Nerve Damage Continues to Increase years 2-3 after LASIK - Both subbasal and stromal corneal nerves in LASIK flaps recover slowly and do not return to preoperative densities by 3 years after LASIK.

Critical thoughts on current laser surgery of the cornea (1995) - If we look at refractive surgery, especially laser photoablation, in the context of the needs for ophthalmic care of the whole world, then this type of surgery is out of proportion.

Theoretical Elastic Response of the Cornea to Refractive Surgery: Risk Factors for Keratectasia - "In particular, a forward shift and an increase in power of the posterior surface was predicted for myopic LASIK, in agreement with previous experimental findings." 

Cohesive tensile strength of human LASIK wounds with histologic, ultrastructural, and clinical correlations - The human corneal stroma typically heals after LASIK in a limited and incomplete fashion; this results in a weak, central and paracentral hypocellular primitive stromal scar that averages 2.4% as strong as normal coeneal stroma.

Pathologic findings in postmortem corneas after successful laser in situ keratomileusis - Permanent pathologic changes were present in all post-LASIK corneas. These changes were most prevalent in the lamellar interface wound. These changes along with other pathologic alterations in post-LASIK corneas may change the functionality of the cornea after LASIK.

Ex vivo confocal microscopy of human LASIK corneas with histologic and ultrastructural correlation - Confocal microscopy, along with histologic and ultrastructural correlations, demonstrated that the most prevalent alterations in the centers of LASIK corneas were a slightly thickened epithelium caused by focal basal epithelial cell hypertrophic modifications, random undulations in Bowman's layer over the flap surface, and a variably thick hypocellular primitive stromal interface scar.

Corneal reinnervation after LASIK: prospective 3-year longitudinal study - Both subbasal and stromal corneal nerves in LASIK flaps recover slowly and do not return to preoperative densities by 3 years after LASIK.

Progression to end-stage glaucoma after LASIK - 2 patients, one a glaucoma suspect because of family history and the other with juvenile glaucoma.

Steroid-induced glaucoma after laser in situ keratomileusis associated with interface fluid - To report the ocular manifestations and clinical course of eyes developing interface fluid after LASIK.

Biomechanical modeling of refractive corneal surgery - A biomechanical study before surgery is therefore very convenient to assess quantitatively the effect of each parameter on the optical outcome.

Confocal Microscopy of Corneal Flap Microfolds After LASIK - To describe the morphological characteristics of microfolds that appear at the corneal flap after LASIK, as seen under confocal microscopy.

Objective method to measure corneal clarity before and after LASIK - To develop, evaluate, and use an objective method to determine the effect of LASIK on corneal clarity.

Histopathology of corneal melting associated with diclofenac use after refractive surgery - To describe the histopathology of the cornea in 3 cases of corneal melting associated with diclofenac therapy after refractive surgery procedures.

Central corneal iron deposition after myopic LASIK - To describe central corneal iron deposition after myopic LASIK.

Corneal ectasia after LASIK in patients without apparent preoperative risk factors - To evaluate patients who developed ectasia with no apparent preoperative risk factors.

Interface Corneal Edema Secondary to Steroid-induced Elevation of Intraocular Pressure Simulating DLK - To describe interface corneal edema secondary to steroid-induced elevation of intraocular pressure (IOP) following LASIK.

Delayed Ectasia Following LASIK With No Risk Factors: Is a 300-µm Stromal Bed Enough? - To report a case of ectasia occurring >4 years following LASIK with no risk factors and a residual stromal bed >300 µm.

Steroid glaucoma after laser in situ keratomileusis - A steroid-induced glaucoma may develop after bilateral laser in situ keratomileusis (LASIK)  with normal intraocular pressure in applanation tonometry.

Keratocytes' Density Remains Low After Refractive Surgery  - According to a paper presented this month at the 6th International Congress on Advanced Surface Ablation and SBK, keratocytes' density decreases substantially in the anterior stroma of  refractive surgery patients during the first postoperative year and remains low for several years.

Risk Assessment for Ectasia after Corneal Refractive Surgery - To analyze the epidemiologic features of ectasia after excimer laser corneal refractive surgery, to identify risk factors for its development, and to devise a screening strategy to minimize its occurrence.

More on the cornea...

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Spherical Aberrations PDF Print E-mail

Spherical Aberration and Its Symptoms - Theories on why it occurs and how new technology may address the problem.

Spherical Aberrations - Spherical aberration is one of the most important problems that can occur after laser eye surgery, in particular with high myopic corrections.

 
Femtosecond Lasers & LASIK Studies & Articles PDF Print E-mail

IntraLase: Changing the LASIK Landscape - Though the exact cause of TLS is still uncertain, some surgeons believe that the inflammation is caused by necrotic cellular debris…

Transient light sensitivity a minor complication of IntraLase use - Some users of the IntraLase femtosecond laser keratome first noticed the complication when they began working with the system more than 2 years ago. Since then, the phenomenon has gone under multiple names.

Transient light-sensitivity syndrome after LASIK with the femtosecond laser Incidence and prevention - To describe the incidence of transient light-sensitivity syndrome (TLSS) after laser in situ keratomileusis (LASIK) with the femtosecond laser and to identify preventive strategies.

Flap folds after femtosecond LASIK - To report a case of bilateral flap folds after a laser-assisted in situ keratomileusis (LASIK) procedure in which the flap was created by the femtosecond laser.

Macular hemorrhage after laser in situ keratomileusis (LASIK) with femtosecond laser flap creation - To report the first case of macular hemorrhage following LASIK with femtosecond laser flap creation.

Refractive surgery: lessons to be learned - "Indeed the long-term problems created by laser refractive surgery are not yet a major issue, but soon will be."

Complications of refractive excimer laser surgery - A German article related to complications.

A comparative confocal microscopy analysis after LASIK with the IntraLase femtosecond laser vs Hansatome microkeratome - To evaluate and compare confocal microscopy findings between a femtosecond laser and a mechanical microkeratome.

Comparison of goblet cell density after femtosecond laser and mechanical microkeratome in LASIK - To study the effect of the LASIK procedure performed with a femtosecond laser and a manual microkeratome on the conjunctival goblet cell and epithelial cell populations.
Read more...
 
Wavefront Related Studies & Articles PDF Print E-mail

Wavefront analysis in post-LASIK eyes - In post-LASIK eyes, wavefront refraction components were poorly correlated to manifest and cycloplegic components.

Complex wavefront-guided retreatments with the Alcon CustomCornea platform after prior LASIK - To report the results of complex wavefront-guided LASIK retreatments.

Wavefront-guided LASIK and fractional clearance - The optical zone/pupil ratio (fractional clearance, FC) has a significant impact on HOA induction after wavefront guided LASIK.

Predicting Patients' Night Vision Complaints With Wavefront Technology - To evaluate the accuracy of the diagnostic capabilities of optical metrics generated from wavefront measurements in relationship to post–laser assisted in situ keratomileusis (LASIK) visual complaints as expressed and drawn by patients.

Maximum permissible lateral decentration in aberration-sensing and wavefront-guided corneal ablation - To investigate the lateral alignment accuracy needed in wavefront-guided refractive surgery to improve the ocular optics to a desired level in a percentage of normally aberrated eyes.

Surgeons Opinions on Wavefront: The Demise of Conventional LASIK? - Will customized LASIK procedures replace standard treatments?

Measurement of Contrast Sensitivity and Glare Under Mesopic and Photopic Conditions Following Wavefront-guided and Conventional LASIK Surgery - To compare contrast and glare vision in a prospective study of eyes treated using conventional and wavefront-guided LASIK surgery. The reproducibility of a glaremeter device used to quantitatively measure glare and halo was also determined.

Spot size and quality of scanning laser correction of higher-order wavefront aberrations - To investigate the effect of laser spot size on the outcome of aberration correction with scanning laser corneal ablation.

 
Retinal Studies & Articles PDF Print E-mail

Full-thickness macular hole after LASIK for the correction of myopia - To describe 19 patients (20 eyes) who developed a macular hole (MH) after undergoing bilateral LASIK for the correction of myopia.

Lattice Degeneration With And Without Atrophic Holes - Illustrates an important point that lattice degeneration is quite common, occuring in 8-11 percent of the population.

Retinal phlebitis after LASIK - To report a case of retinal phlebitis with cystoid macular edema in both eyes 8 weeks after LASIK.

Two cases of retinal detachment - Following laser in Situ keratomileusis repaired by scleral buckling surgery.

Bilateral retinal detachment after laser in situ keratomileusis - Another case of retinal detachment after LASIK.

Early rhegmatogenous retinal detachment following LASIK for high myopia - Four eyes had early rhegmatogenous retinal detachment within 3 months of LASIK for correction of high myopia using the microkeratome, Clear Corneal Molder.

Retinal detachment after Excimer laser (myopic LASIK or PRK) - A retrospective multicentric study: 15 cases.

Proposed mechanism for retinal tears after LASIK: an experimental model - To demonstrate axial length changes associated with anterior shift of the lens/iris diaphragm and anterior vitreous base in human cadaver eyes during suction ring application preceding Moria LASIK, and to propose that these changes may be associated with anterior retinal tears.

Vitreoretinal alterations following laser in situ keratomileusis: clinical and experimental studies - The presence of vitreoretinal changes following laser in situ keratomileusis in myopia is evaluated.

Diffuse lamellar keratitis - Several studies related to Diffuse lamellar keratitis, with (submitted) commentary.

Late Onset Lamellar Keratitis and Epithelial Ingrowth Following Orbital Cellulitis - To report a case of late onset lamellar keratitis and epithelial ingrowth associated with orbital cellulitis 1 month after LASIK surgery.

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.

Retinal nerve fiber layer thickness changes after an acute increase in intraocular pressure - To determine whether the increase in intraocular pressure (IOP) for 45 seconds during laser in situ keratomileusis (LASIK) suction can induce a decrease in retinal nerve fiber layer thickness (RNFLT) assessed by a confocal scanning laser polarimeter.

Retinal Nerve Fiber Layer Thickness Change after Photorefractive Surgery - To analyze the retinal nerve fiber layer (RNFL) change after photorefractive surgery.

Read more...
 
Contacts, Implants, etc. Related Articles & Studies PDF Print E-mail

Contact Wearers, Beware! - "Many patients in the United States go blind every day from the use of contact lenses (especially when patients sleep in them)." - Dr. William Trattler: July 1999 asklasikdocs forum posting.

Contact lens overrefraction variability in corneal power estimation after refractive surgery - To evaluate the accuracy and precision of the contact lens overrefraction (CLO) method in determining corneal refractive power in post-refractive-surgery eyes.

Contact lens fitting post-refractive surgery - A number of patients who had undergone refractive surgery still required contact lens fitting.

Intrastromal corneal ring implantation for the correction of myopia: 12-month follow-up - To evaluate the efficacy, predictability, and stability of refraction obtained after intrastromal corneal ring segment (ICRS) implantation for low to moderate myopia.

 

 
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