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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

Histopathological study of corneal flap striae following laser in situ keratomileusis in rabbits.

Exp Ther Med. 2015 Mar;9(3):895-900

Authors: Liu L, Song FZ, Bao LY

The aim of the present study was to investigate the histopathological changes and wound healing process of rabbit corneas following conventional laser in situ keratomileusis (LASIK) with and without the complication of flap macrostriae. The right eyes of 14 rabbits underwent LASIK with the formation of flap striae (macrostriae group) and the left underwent LASIK alone (control group). Two rabbits were selected at random for sacrifice on days 1, 3, 7 and 14, and at 1, 3 and 6 months postoperatively. The histopathological characters of the corneas were compared by hematoxylin and eosin (H&E), periodic acid-Schiff (PAS) and Masson staining. In the control group, the epithelial basement membrane of the cornea exhibited microstriae and the arrangement of stromal collagen fibers was regular. The width of the microstriae in the flap was 20-40 μm one week after surgery and the microstriae were no longer visible two weeks postoperatively. In the macrostriae group, infiltration of polymorphonuclear cells occurred around the incision and irregular hyperplasia of the epithelium was observed due to undulation of the epithelial basement membrane on the first postoperative day. The collagen fibers and striae of the corneal stroma exhibited irregular undulation one month postoperatively. The area between the corneal flap and stromal bed was distinctly stained by PAS and Masson stains. Macrostriae with a width of 80-120 μm affecting two-thirds of the entire cornea remained visible six months postoperatively. In conclusion, the inflammatory reactions and clinical impact of flap macrostriae were severe. Macrostriae involving two-thirds of the entire cornea remained visible six months postoperatively. Longer-term studies are required to further elucidate the issues associated with corneal flap striae.

PMID: 25667649 [PubMed - as supplied by publisher]


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