Enhancement Surgery Flap
and Lasik, Bladeless Lasik, Epi-Lasik
During initial conventional
Bladeless Lasik, a flap of corneal
stromal tissue is created. The
excimer laser energy is applied under this flap to remove tissue
and effect a change in
error. Lasik flaps are made with a mechanical
microkeratome using a metal blade. Bladeless Lasik flaps are made
surgery is required, it is almost universally preferred to lift
the existing flap. Flaps made with a mechanical microkeratome have been
lifted as much as 12 years after surgery. "Lifted" is probably not the
correct term for a flap after this amount of healing time. It is more
like separating the cornea at the location of the original flap.
The Bladeless Lasik
flap tends to heal tighter at the edges. This makes it more difficult
for the doctor to start the flap lift, however once started, the Bladeless
Lasik flap can be lifted as well as a flap made with a mechanical microkeratome.
On rare occasion it
is necessary to create a new flap. This is usually because the original
flap is too thin or is otherwise less than perfect. To be able to create
a second flap, the incision must be made significantly under or over
the previous flap. If the new flap dissects through the first flap,
and poor vision quality is likely to occur.
A flap made during
Epi-Lasik consists only of
epithelium. Although the epithelial flap will be repositioned after
the laser energy is applied, it is not possible to have a second Epi-Lasik
flap created because to create the Epi-Lasik flap with the special
layer must be intact. The laser ablation during the initial surgery
will have removed the Bowman's layer. If an epithelial flap is desired,
LASEK would be appropriate.
PRK could be used, however the epithelium is not saved during PRK
and saving the epithelium may be necessary for other reasons. Lasik
and Bladeless Lasik can be performed after successful Epi-Lasik, using
a stromal flap.
Everyone's situation will
be unique. Talk to your doctor about what s/he feels is appropriate.