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
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.
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.
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.
If this article did not fully answer your questions, use our
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