Lasik enchancement after PRK

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Lasik enchancement after PRK

Postby Marcco » Fri May 04, 2007 11:56 pm

Here is what has happened. Many years ago, I was 43, now am 52, I had Lasik for myopia of -8.00 or so in left eye. I had 2 further enchancements over the next couple of years. Last year I had another enchancement using PRK......I had regressed to 20/40. I am now 20/25 but with my prescription of -0.25 -1.50 180 8.6 14.2. I developed an astigmatism after this last PRK. I am now in discussion with my surgeon to try to correct the astigmatism by lasik and not PRK. While PRK gave me similar results, it takes several months to heal, while lasik is much faster. The question is, of course, whether after PRK, a surface ablation, is lifting the flap safe. He will be consulting with his peers to find out someone who has some experience in this procedure. The question is, is the cornea now to thin in parts where the PRK surface abalation took place. My cornea has excellent thickness, but when the first flap was cut the thickness was not measured at that time, whereas now they do measure the thickness of the cornea flap. My surgeon is excellent but with reason, being cautious here. Do you have any experience with a procedure such as I described ? I understand that PRK is the preferred option but would really rather have lasik. Many thanks for your input.
Marcco
 
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Postby LasikExpert » Sat May 05, 2007 8:05 pm

I know of no Lasik flap lifts subsequent to PRK after Lasik. I just attended a major medical convention and I did not see any presentations indicating this had occurred. The risk would be the flap would be unstable, tear, wrinkle, or otherwise become distorted.

To do a flap lift after PRK enahncement surgery on the Lasik flap would absolutely require a detailed measurement of the current flap thickness absent the underlying corneal stroma. This can be accomplished with the Visante optical coherence tomography anterior segment imaging or the Artemis very high-frequency digital ultrasound. There are not many of these devices in general use, but I'm sure there is one in or near all major cities. In my opinion a subtraction pachemetry (total cornea minus stromal bed minus assummed PRK tissue removal) would be inadequate. A doctor may reasonably disagree with that opinion, and I am not a doctor.

You may not be the first for this, but you would certainly be one of the first and you would be your surgeon's first. In the overall scheme of things, I think the additional discomfort and delay in healing of an second PRK on Lasik flap would be much more wise than the elevated risk of an attempted flap lift, and I'm leaving wide open the question of whether additional surgery is appropriate at all.

Be sure to keep us informed on your decision and results.
Glenn Hagele
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Lasik Info &
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I am not a doctor.
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Postby LasikExpert » Mon May 07, 2007 8:03 pm

I have contacted four world reknown Lasik doctors about your situation. None recommend attempting to lift the Lasik flap after you have had PRK after Lasik and none know of it having been done.

The concensus is that measurement of the residual Lasik flap must be performed to be sure there is enough tissue so a second PRK on Lasik flap does not go through the flap, lifting the flap would be unwise and could cause a very poor result, it was also pointed out that the continued myopic change may indicate the early stages of cataract development and that Refractive Lens Exchange (RLE) may be more appropriate than more cornea-based surgery. Limbal Relaxing Incision (LRI) or Conductive Keratoplasty (CK) may also be more appropriate than more laser.

If your surgeon would like to contact the doctors who responded to my call for opinion, please have your surgeon email me directly.
Glenn Hagele
Volunteer Executive Director
USAEyes

Lasik Info &
Lasik Doctor Certification

I am not a doctor.
LasikExpert
Site Admin
 
Posts: 3309
Joined: Fri May 12, 2006 6:43 am
Location: California


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