Potential problems with re-lifting the Laskik FLap?

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Potential problems with re-lifting the Laskik FLap?

Postby Patient13 » Sun Jun 25, 2006 2:02 pm

I went in to have the Custom Lasik procedure done on both eyes last week. I was nearsighted in both eyes with a moderate astigmatism in my left. I am a 31 year old male.

My right eye was completed without any complications. My doctor cut the flap on my left eye but did not start the procedure as the Laser "was not calibrating correctly?" He sent me home and said I have to wait to see if my prescription changes as cutting the flap can affect the astigmatism.

Do I now have a greater risk of complications in my left eye? Should I be real concerned about epithelial ingrowth? Is there now a less risky procedure for my left eye.

Thank you.
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Postby LasikExpert » Sun Jun 25, 2006 9:42 pm

Nobody wants to have surgery aborted before completion, but your doctor did exactly the right thing. Whenever there is any indication of a problem it is almost always best to stop the surgery, reposition the flap, wait a few weeks to months as necessary, reevaluate the situation, inform the patient of the new circumstances, and then proceed as agreed is appropriate.

The doctor is correct that creation of the flap and repositioning the flap can change refractive error even without the laser ablation. This is especially true with astigmatism. When the flap is lifted for enhancement surgery the cornea will not experience the same dramatic changes in internal biomechanical stresses. There have been studies to determine if there is an advantage to flap creation with laser ablation weeks or months later. Thus far the studies have been inconclusive, however there is nothing to indicate that your final outcome will be any different.

Epithelial cells comprise the outermost layer of the cornea. They are the fastest reproducing cells and human body. It is possible for an epithelial cell to get underneath the flap in both initial surgery and enhancement surgery. If the epithelial cells get under the flap and grow, it may be necessary for the flap to lifted, the cells removed, and the flap repositioned. This is a relatively benign complication of initial and enhancement surgery that can be managed and resolved successfully. There is a slightly elevated risk of epithelial ingrowth with enhancement Lasik compared to the initial Lasik, but the difference is not dramatic.

For more details you may want to read Lasik Enhancement.
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Postby Patient13 » Mon Jun 26, 2006 4:42 pm

I removed the lense in my glasses for the Lasik corrected eye. However, I am having trouble focusing and feel some eye strain. Will I still have this once my left eye is corrected with Lasik?

Thank you for your advice and information.
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Postby LasikExpert » Mon Jun 26, 2006 5:02 pm

Although glasses will most certainly help with your refractive error, a consequence of having one I corrected with glasses and the other eye without need of correction is an imbalance in the size of the image in each retina. Glasses to correct myopia (nearsighted, shortsighted) vision tend to reduce the size of images. This is necessary to get the entire visual field into the width of the corrective lens. You're right eye was fully corrected by surgery and is not subject to this minification.

The image that reaches the retina in your left eye is undoubtedly smaller than the image that reaches your retina in the right eye. Because the two images are of a different size when combined they create a blur effect. The brain is attempting to focus away the blur, however the blur is not caused by poor focus. This can cause headaches, nausea, photophobia, vertigo, poor depth perception, and poor vision quality when using both eyes. This is known as aniseikonia and you can click on this word for a detailed article about the problem.

If you are able to wear a contact lens in your left eye, the size of the images at the left retina and the right retina will be nearly identical and will reduce or resolve this problem until you have enhancement surgery. Discuss this with your surgeon.
Glenn Hagele
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USAEyes

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