Articles by Sam Melki on ArticleSnatch.com

Flattening the Recalcitrant LASIK Flap Fold & Epithelial Ingrowth after Lasik

Wed, 20 Jun 2007 00:00:00 -0400

Flattening the Recalcitrant LASIK Flap Fold Lasik flap folds can induce irregular astigmatism with optical aberrations and loss of BCVA especially if they involve the visual axis. ËMacrofolds' are easily seen by slitlamp exam and represent full thickness flap tenting in a linear fashion. On the other hand, Ëmicrofolds' within the flap itself may represent wrinkles in Bowman's layer or in the epithelial basement membrane. They are best seen as negative staining lines with sodium fluorescein. The incidence of folds requiring intervention ranges between 0.2% and 1.5%. Flap folds result from uneven alignment of the flap edge and the peripheral epithelial ring. This can occur with unequally hydrated stromal bed prior to flap repositioning. Thinner and larger flaps tend to shift more readily with resultant surface wrinkling. Uneven sponge smoothing can result in radial (with centrifugal movement) or circumferential folds (with centripetal movement). A higher incidence of flap folds is usually found in higher myopes and is sometimes unavoidable. This is due to the reduced central convexity and stromal support resulting in flap redundancy that may be quite difficult to flatten.** End Summary**

About the Author:
'Author Bio: Adapted from: 101 Pearls in Refractive, Cataract and Corneal Surgery"Â Samir Melki MD PhD and Dimitri T. Azar MD editors, Slack inc. www.slackinc.com Dr. Melki is a experienced Boston affordable LASIK surgeon, Laser Eye Surgery , Vision Correction and Cosmetic Surgery

Managing Lasik Flap Buttonholes

Thu, 14 Jun 2007 00:00:00 -0400

From all Lasik flap complication, LASIK flap buttonholes are the ones that lead most often to loss of best-corrected visual acuity (BCVA). Why do they happen? Thin, irregular and perforated flaps seem to result from a common etiology; an inadequate coupling of the blade to the cornea. Steep corneas have been compared to tennis balls that would buckle centrally upon applanating pressure. This results in a central dimple missed by the blade leading to a buttonhole. Another theory is that higher keratometric values offer increased resistance to cutting when applanated, leading to upwards movement of the blade. The latter is probably more applicable to keratomes with lower oscillation rates. Similarly, flat corneas may result in a thin and/or small flap as they could be below the adequate cutting level in certain locations. Inadequate blade to cornea coupling is often due to poor suction (sunken globe/small diameter corneas with inadequate suction ring placement, conjunctival incarceration in the suction portÂ¦). Non-angled blades have equal chances of moving upwards towards the surface or downwards towards the stromal side if faced with resistance. On the other hand, inferiorly angled blades are more likely to be driven towards the stroma.** End Summary**

About the Author:
'Author Bio:' Adapted from: 101 Pearls in Refractive, Cataract and Corneal Surgery"Â Samir Melki MD PhD and Dimitri T. Azar MD editors, Slack inc. www.slackinc.com Dr. Melki is a experienced Boston affordable LASIK surgeon, Laser Eye Surgery , Vision Correction and Cosmetic Surgery

Managing Lasik Keratome Complications

Tue, 12 Jun 2007 00:00:00 -0400

State of the art LASIK technology avoids the following problems during quality laser eye surgery The Sliding Suction Ring Application of adequate suction is essential for intraocular pressure upsurge and dissection of good quality corneal flaps. On occasion, the suction ring slides prior to the buildup of adequate vacuum and the flap is decentered from the pupillary axis. This is reported to happen more frequently with the Hansatome microkeratome due to a slower rise in vacuum. Applying equal downwards pressure on the ring through its handle and at the base knob for about 3 seconds prior to initiating vacuum has minimized this problem. On occasion, the initial vacuum results in a decentered ring with a large slant requiring the surgeon to release the vacuum to reposition the ring. It is not uncommon to see the ring sliding back in the conjunctival groove created by the initial suction. Decentering the ring in the opposite direction prior to activating suction may achieve good centration as the vacuum level may be high enough by the time the ring slides close to the center to prevent further slide towards the initial groove. Another approach is to change the ring size (e.g. from 8.** End Summary**