Buttonhole Flap

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Buttonhole Flap

Postby GeneralPatientInquiry » Mon Jun 05, 2006 6:31 am

my left eye had a button hole in the center. my doctor stopped immediately and replaced the flap. The right eye was done first with no problems. At this point my doctor is recommending at 3 months we re-evaluate any further surgery. Currently he feels that PRK with eye drops etc... would be the best way to go. Is PRK the best way to go or are there any other better or safer options?
So far my corneas are healing well.

Thank you for your time and help.
This post is a reprint of a previously requested inquiry received by USAEyes.org via email.
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Postby LasikExpert » Mon Jun 05, 2006 6:33 am


Your doctor did exactly the right thing by stopping the procedure, replacing the flap, and planning to wait three months to decide what to do. Your doctor will also be watching the healing of the flap to be sure that all is okay.

Depending upon exactly how thick is your flap, how it is shaped, and how it heals, PRK may be a better option, but there are additional concerns with PRK.

Advanced Surface Ablation (ASA) is a simplified way to describe PRK, LASEK, or Epi-LASIK with today's laser equipment. There is no ASA surgical procedure. ASA means one of the three surgical techniques that do not use a flap of stromal corneal tissue. That has both advantages and disadvantages.

In PRK the entire outer layer of corneal cells - epithelial layer - is removed and the laser treatment is performed where the cells were located. After a few days the cells regenerate and cover the treatment area.

For patients with over 6.00 diopters of correction, PRK tends to cause late-onset corneal haze. It is possible for the doctor to apply Mitomycin C intraoperatively to help prevent haze, but Mitomycin C is very strong medicine that may be appropriate when needed, but should be avoided if possible.

With LASIK, a flap of stromal tissue is created. This stromal flap tends to "fool" the eye into not knowing it has had surgery. The healing response is different and haze is rare with LASIK.

To help reduce the probability of corneal haze but use a surface ablation technique, LASEK was developed. In LASEK the epithelial cells are not destroyed and removed, but are weakened with an alcohol mixture, moved aside, then returned over the treatment area.

Epi-LASIK uses a microkeratome with a special blunt blade that scrapes the epithelial layer off in one sheet, very much like a LASIK flap, which is moved aside and then repositioned after laser treatment. It is LASEK with a more intact epithelium.

PRK, LASEK, and Epi-LASIK all do not require the deeper stromal tissue flap that LASIK needs. Without this flap, there is no possibility of any LASIK flap related problem during surgery or at any time in the patient's life. Remember that once you have had LASIK, you have always had LASIK.

If your prescription were less than 6.00 diopters, then PRK, LASEK, or Epi-LASIK may be an obviously appropriate choice. Since you are slightly more than 6.00, then Mitomycin C may be required.

If you do opt for a surface ablation technique, take 500mg of vitamin C twice a day for one week before surgery and at least two weeks after. Plus, use 100% UV blocking sunglasses when you even think of going out of doors. Studies have shown this treatment tends to reduce the probability of corneal haze.

Discuss your concerns and options with your doctor.
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