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Striae Lasik Flap Wrinkles

Macrostriae and microstriae ripples in the corneal flap are a complication of Lasik and Bladeless Lasik.

Image of Lasik flap microstriae

Severe macrostriae present at one day after LASIK. The patient inadvertently touched the flap with the tip of the medication bottle. Uncorrected vision was 20/80 and best spectacle-corrected vision was 20/60. The flap was lifted immediately, irrigated, and smoothed. The flap was then returned to its original position and protected with a bandage contact lens for 1 day. No striae were visible the following day and uncorrected and best spectacle-corrected vision were 20/20 after treatment.
Photo: Steven E. Wilson, MD, Courtesy: Review of Refractive Surgery


Striae (pronounced STREE-ah) are wrinkles that  spontaneously develop in the corneal stromal flap after Lasik, or Bladeless Lasik.  Striae may be caused by inappropriate manipulation of the flap, internal stresses of the flap, trauma to the flap, or an otherwise unstable flap. When severe, striae may cause ghosting and poor quality vision.

Striae is normally associated with myopic (nearsighted, shortsighted) correction, but can occur with hyperopic (farsighted, longsighted) correction as well. Striae tend to occur more often with higher corrections and may be exasperated by other maladies, especially Lasik induced dry eyes.

Striae may occur after conventional or wavefront custom Lasik.

Two Kinds of Corneal Striae

There are two types of striae, macrostriae and microstriae. Macrostriae are relatively large folds in the Lasik flap and usually require treatment soon after they develop. Microstriae, also called "Bowman's Crinkles" are caused by internal stresses within the flap and are often best allowed to resolve with healing.

Striae Treatment

Treatment for striae Lasik or Bladeless Lasik flap wrinkles includes smoothing the wrinkled flap or a flap lift with repositioning. Lasik or Bladeless Lasik flap wrinkles can exist entirely outside the visual axis without causing any vision problem and would not need to be removed.

Lasik and Bladeless Lasik Striae

Bladeless Lasik is reportedly less likely to cause striae flap wrinkles because of a more universal flap thickness, however studies have been inconclusive. Thinner flaps tend to be more likely to have problems with striae than thicker flaps.

No Lasik Flap, No Striae

It is impossible to develop striae with techniques that do not require a stromal flap, such as PRK, LASEK, Epi-Lasik, RLE, and P-IOL because these techniques have no flap or have only a flap of quickly reproducing epithelial cells.  Of course, each of these procedures have their own limitations.

Contributing Problems

The most important technique to reduce the probability of striae is to follow doctor's postoperative advice by protecting the eye after surgery and to keep the eyes moist with preservative-free artificial tears. Rubbing your eyes and excessive blinking with very dry eyes can cause striae or similar problems.

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 Striae Medical Journal Articles...

Related Articles

Reproducibility of flap thickness in sub-Bowman keratomileusis using a mechanical microkeratome.

J Cataract Refract Surg. 2014 Nov;40(11):1828-33

Authors: Althomali TA

PURPOSE: To examine the predictability of flap thickness using a mechanical microkeratome (One Use-Plus) and identify factors related to variations in flap thickness in sub-Bowman keratomileusis (SBK).
SETTING: Tadawi Surgical Center, Taif, Saudi Arabia.
DESIGN: Retrospective case series.
METHODS: Patients with a stable refraction for 1 year, corrected distance visual acuity (CDVA) of at least 20/20 in each eye, and minimum central corneal thickness of 480 μm in each eye had microkeratome-assisted SBK. Parameters included manifest refraction, uncorrected distance visual acuity (UDVA), CDVA, pachymetry, and higher-order aberrations (HOAs).
RESULTS: Seventy eyes (36 patients) were enrolled. The mean flap thickness was 88.74 μm ± 15.40 (SD) and the mean change in HOAs, 0.11 ± 0.30 μm(2). There was no correlation between flap thickness and age (r = -0.10), preoperative manifest refraction spherical equivalent (MRSE) (r = -0.08), preoperative cylinder (r = 0.13), postoperative CDVA (r = -0.17), or postoperative change in HOAs (r = -0.07). A strong positive correlation with preoperative pachymetry (r = 0.41) and a weak negative correlation with preoperative sphere (r = -0.21) were observed. There was no or a moderate negative correlation of pachymetry with age (r = -0.14), preoperative sphere (r = -0.36), cylinder (r = -0.04), or MRSE (r = -0.36).
CONCLUSIONS: The microkeratome was reliable with reasonable predictability for SBK flap creation. Extra caution in handling the flaps to avoid flap striae or tears is advised. Flap thickness correlated positively with preoperative pachymetry; however, the variation in flap thickness did not affect visual outcomes.
FINANCIAL DISCLOSURE: The author has no financial or proprietary interest in any material or method mentioned.

PMID: 25261393 [PubMed - indexed for MEDLINE]


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