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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

Intraocular straylight after thin-flap LASIK with a femtosecond laser versus a mechanical microkeratome.

J Refract Surg. 2013 Aug;29(8):534-9

Authors: Wang Y, Li J, Liu Y, Xie L

Abstract
PURPOSE: To investigate characteristics of straylight before and after thin-flap LASIK performed with femtosecond laser versus with mechanical microkeratome and assess changes at 1 day, 1 week, 1 month, 6 months, and 1 year postoperatively.
METHODS: One hundred twenty-eight consecutive eyes from 66 patients were included in this prospective study. Sixty-one eyes of 31 patients had thin-flap LASIK with femtosecond laser. In addition, 67 eyes from 35 patients underwent thin-flap LASIK with mechanical microkeratome were included for comparison. Following flap creation, all eyes were ablated using the VIXS S4 excimer laser system (Visx USA, Inc., Santa Clara, CA). Straylight values were measured using the C-Quant straylight meter (Oculus Optikgeräte GmbH, Wetzlar, Germany) preoperatively and 1 day, 1 week, 1 month, 6 months and 1 year postoperatively.
RESULTS: Preoperatively, the mean straylight values were 0.93 ± 0.11. After femtosecond laser-assisted thin-flap LASIK, the values were 1.00 ± 0.11, 0.98 ± 0.10, and 0.99 ± 0.12 at 1 day, 1 week, and 1 month, respectively, and significantly increased (F = 7.62, P > .0001) compared to preoperative values. However, these values decreased and returned to preoperative levels at 6 months and 1 year postoperatively (0.92 ± 0.09 and 0.89 ± 0.13, respectively; P > .05). The postoperative-preoperative increases in straylight were reduced in the femtosecond laser group compared to the mechanical microkeratome group (0.05 ± 0.13 vs 0.10 ± 0.13 at 1 month postoperatively; P < .05). This difference was statistically significant at 1 month postoperatively (P = .04). A negative significant correlation was also found between preoperative straylight values and postoperative-preoperative increases.
CONCLUSIONS: Straylight increased significantly in the early stages after femtosecond laser-assisted thin-flap LASIK. However, these values improved over time and gradually returned to preoperative levels, which may be related to the progression of corneal healing. [J Refract Surg. 2013;29(8):534-539.].

PMID: 23909780 [PubMed - in process]

 


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