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Lasik and Bladeless Lasik Flap Healing

Lasik and Bladeless Lasik create a thin flap of corneal tissue that heals securely during a complicated healing process.

Illustration of cornea with Lasik flap.  
Lasik flaps heal well enough for US Navy Top Gun pilots and NASA astronauts.  

Many potential and post-conventional or wavefront custom Lasik and Bladeless Lasik patients are concerned about the degree to which the flap ultimately heals and re-bonds to the underlying stromal bed. Here is a synopsis of the Lasik flap healing process. Of course, due to individual healing differences, the time-line below will vary from person to person.

Hopefully this information reassures some of you that the flap eventually does heal quite securely, and does not just lie there flapping in the breeze, indefinitely. If you still have doubt, remember that corneal transplants, despite being much more invasive than Lasik flaps and consisting of imperfectly cross-matched cadaver tissue, ultimately heal so completely that they provide strength and structural integrity for the eye. This is additional evidence that Lasik flaps do heal very securely and eventually contribute at least to some degree to the biomechanical strength of the cornea.

The process of flap healing is similar if the flap is created with a mechanical microkeratome or a laser microkeratome (Bladeless Lasik).

Phase I

Days 1 to 3 post-op Immediately post-op as the flap is re-positioned and the doctor "squeegees" out excess moisture under the flap, a negative osmotic pressure is created that "sucks" the flap onto the stromal bed and holds it there. The flap is held in place fairly well at this time, barring physical trauma such as rubbing the eye or a poke in the eye. Of course, this is a very vulnerable period because any trauma to the flap could easily dislodge it, hence the importance of wearing eye shields at night and similar protections.

Phase II

Days 4 to 14 post-op During this period the epithelium re-generates along the perimeter of the flap, sealing and bonding the flap more securely in place. This is still a vulnerable time, but less so than in Phase I, where only osmotic pressure secured the flap.

Phase III

Days 15 to 60 post-op During this period the re-generated perimeter epithelium lays down a basement membrane that firmly adheres the newly regenerated epithelium to the underlying stromal bed.

Phase IV

Days 61 to 180 post-op During this period the keratocyte cells of the stromal bed and the flap produce an adhesive protein (glycosaminoglycan) that bonds or "glues" the flap to the stromal bed. By the 180th day, these processes have generally rather strongly secured the flap to the stromal bed. Trauma or surgical instruments can still dislodge or lift the flap, but a good deal of healing and re-bonding of the flap to the stromal bed has occurred.

Phase V

Day 181 to 24+ months post-op During this period collagen slowly begins to form at the interface between the flap and the underlying stromal bed. This collagen includes fibril infiltrates that extend from the flap into the stromal bed, in effect suturing the flap to the underlying stromal bed. At the conclusion of this process the flap is both "glued" and "stitched" into place, as well as "sealed" and secured by the surface perimeter epithelium and basement membrane. Although still not as strong as an untouched cornea of the same thickness, the flap and stromal bed are nevertheless now very securely bonded together. At this time, any trauma strong enough to dislodge the flap would also do damage to an eye without Lasik. It is also believed by many researchers that by the 24th month post-op the flap has begun to contribute to some degree to the biomechanical strength of the cornea thus reducing the risk of late-onset ectasia.

Special thanks to Bryce Carlson for this research.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

Personalized Answers

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.

Recent Lasik Flap Healing Medical Journal Articles...

Related Articles

One-Step Transepithelial Photorefractive Keratectomy With Mitomycin C as an Early Treatment for LASIK Flap Buttonhole Formation.

J Refract Surg. 2014 Nov 11;:1-5

Authors: Abdulaal MR, Wehbe HA, Awwad ST

PURPOSE: To assess the efficacy and safety of early one-step transepithelial photorefractive keratectomy (PRK) with mitomycin C as treatment for buttonhole formation during LASIK.
METHODS: Eight patients who developed a buttonhole during LASIK with mechanical or femtosecond flap creation underwent one-step transepithelial PRK a few days after the formation of the buttonhole. The re-treatment procedure was performed after complete epithelial healing and smooth epithelial fluorescein profile were ensured. Postoperative manifest refraction, uncorrected and corrected distance visual acuity, and haze formation were assessed during 6 months of follow-up.
RESULTS: Mean duration of the re-treatment procedure after buttonhole formation was 5 days (range: 4 to 7 days). Mean manifest refractive spherical equivalent and cylinder refraction were -0.05 ± 0.18 and -0.18 ± 0.22 diopters, respectively, at 6 months postoperatively. Uncorrected distance visual acuity was 20/20 in all patients after 3 months of follow-up. No haze formation was detected.
CONCLUSIONS: Early one-step transepithelial PRK with mitomycin C seems to be a safe and effective treatment for LASIK buttonhole complication. [J Refract Surg. 20XX;XX(X):XX-XX.].

PMID: 25380555 [PubMed - as supplied by publisher]


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