Archive for the ‘Cataracts’ Category

Lasik flap folds can induce irregular astigmatism with optical
aberrations and loss of BCVA especially if they involve the visual
axis. ‘Macrofolds’ are easily seen by slitlamp exam and represent full
thickness flap tenting in a linear fashion. On the other hand,
‘microfolds’ 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.

Management ranges from simple lifting and refloating of the flap to
placement of sutures to stretch the flap in position. Probst et al.
described a technique using the red reflex as a way to better detect
flap wrinkles during flattening procedures. Smoothing of the flap
should aim towards an even distribution of forces applied to the
surface. This can be performed with methylcellulose sponges or their
equivalent. Instruments such as the Pineda corneal LASIK iron can also
be used to flatten isolated flaps at the slit lamp or under the
operating microscope by gently pressing on them. Other reported
strategies include hydrating the flap with hypotonic saline (60-80%)
which may facilitate leveling of the flap surface.

Fixed folds are sometimes encountered and probably occur when
epithelial hyperplasia has time to form in the crevices formed by the
folds. Superficial epithelial incisions or frank epithelial debridement
over the wrinkled area may relieve contractures that occur secondary to
the presumed epithelial hyperplasia in these longer standing folds.
Recalcitrant wrinkling is reported to respond well to placement of
running torque-antitorque 10-0 or 11-0 nylon sutures.

Epithelial Ingrowth after Lasik

Epithelium in growth under the corneal flap can cause irregular astigmatism
and induced hyperopia secondary to stromal melting. A swift
intervention is sometimes needed to prevent these complications.

Once the epithelium is noted to progress towards the visual axis or
once a significant hyperopic shift or loss of BCVA is encountered,
lifting of the flap and scraping of the epithelium should be performed
promptly. This can be performed with a #69 blade or the equivalent. It
is important to remember to scrape both the stromal bed as well as the
stromal aspect of the flap. Flap folds connected to the peripheral
epithelial ring are a special source of concern as they provide a
conduit for epithelial cells infiltration. Similarly, an epithelial
defect adjacent to the edge of the flap should be followed closely due
to the presence of high epithelial mitotic activity.

Which epithelium is safe to leave? Small epithelial pearls are usually
self-limited and do not progress. Epithelial tongues connected to the
flap edge are more worrisome, they do not need to be scraped unless
they exhibit a quick rate of progression or if they already
involving/threatening the visual axis.

Author Bio:
Adapted from: 101 Pearls in Refractive, Cataract and Corneal Surgery Samir Melki MD PhD and Dimitri T. Azar MD editors, Slack inc. http://www.slackinc.com Dr. Melki is a experienced Boston affordable LASIK surgeon, Laser Eye Surgery, Vision Correction and Cosmetic Surgery

Implantable contact lenses are another surgical option for vision correction, especially if the patient isn’t a good candidate for LASIK surgery. They are exactly what the name implies, contact lenses that are surgically implanted in the eye to correct vision.

There are 2 are contact lenses that are available in the United States, Verisyse and Visian ICL. Both are approved for correcting moderate to severe nearsightedness, the Verisyse in ranges of -5.00 to -20.00 diopters and the Visian ICL in ranges of -3.00 to -20.00. Patients receiving these lenses must be 21 years or older.

Both procedures start out with numbing drops to the eye, an instrument placed to hold open the eyelid and an incision being made in the eye. The lenses are implanted differently.

The Verisye is inserted and attached to the iris (the colored portion of the eye and held in place with dissolvable stitches. The procedure lasts about 15-30 minutes. The patient will need to wear an eye shield until the followup appointment the next day. If you look closely in the mirror you may be able to see the lens.

The Visian is inserted just behind the iris and in front of the natural lens. It is folded and inserted through a microincision. When in place it unfolds to it’s full width. No stitches are needed to hold it in place. Because of it’s position behind the iris, the lens can only be seen with a microscope.

Immediately following the procedure you may have some irritation or scratchiness. This is temporary and should resolve on it’s own. Most patients have immediate improvement of vision following the implantation.

The patient returns for a followup visit the following day and can usually resume normal activities, such as driving, at that time.

As with any type of surgery there’s no 100% guarantee and there are risks of complications with the procedure. Possible complications include increased chance of a detached retina, loss of cells in the thin layer inside the cornea (endothelium), inflammation, infection and cataracts. Generally, the implantable lenses have been found to be safe, but good followup is essential. One advantage the implantable contact lenses have over LASIK surgery is that they are removable. If severe complications arise or the eye changes, they can be taken out.

I recently underwent corrective eye surgery myself. There are a lot of options out there for correcting vision defects these days. I did a lot of research before making up my mind and would love to share that research with you on my website http://eyesurgerys.com/eyesurgery so you can make the best, informed decision for your own corrective vision needs.

Our eyes are a very sensitive organ that can only take limited amount of stress. Eye stress can happen to anyone and it is important that we perform the effective ways of relieving it and maintain good eyesight.

Eye stress happens when the nerves and tissues in our eyes are subjected to tension and get strained. It can happen to every member of the population as our eyes are constantly working. Some of the things that we do can be stressful to our eyes such as reading for too long, working on the computer for hours, watching the TV and even by exposing our eyes to harsh lighting. However, there are simple remedies that you can do to relieve your eyes of stress:

1. Try simple exercise like looking at objects at far distances to work the different muscles in the eyes. Then look at something near you. Look far and look near. This exercise will strengthen the muscles in your eyes. Blink for a couple of times and repeat this exercise as often as necessary.
2. Try different distance exercises such as following your finger like how the doctors do it. This is very effective in relieving the stress out of your eyes and at the same time strengthens the muscles in them.
3. Look at things that are refreshing to the eyes. Cool colors such as blue and green are very effective in relieving the stress out of your eyes. Look at things or areas that are refreshing for a couple of minutes to reduce the strain and tension in your eyes.
4. Have a head massage. Reflexology can do wonders for the strained parts of your body. Give your head a massage on the scalp and temples and relieve your eyes of strain and stress.
5. Dim the lights that you use. One of the factors that add strain and stress to the eyes is harsh lighting. If too much light is unnecessary and is hurting your eyes, dim your lights at a level that your eyes are most comfortable with.
6. The most effective way of relieving stress off your eyes is by having a cat nap. By resting your eyes for about 10-15 minutes, your eyes will be refreshed and stress-free.

Eye stress may lead to other serious eyesight problems such as blurred vision and cataract. It is important that we maintain good eyesight. The mentioned tips and exercises above are effective in relieving the stress off your eyes and help you see the world much better!

Is this article not enough for you? If you’re interested in getting access to ALL the Powerhouse Techniques that I uncovered through my months of research, download my FREE Report called “10 Secrets To Fix Your Eyesight Problems Naturally” HERE.

Lasik flap folds can induce irregular astigmatism with optical
aberrations and loss of BCVA especially if they involve the visual
axis. ‘Macrofolds’ are easily seen by slitlamp exam and represent full
thickness flap tenting in a linear fashion. On the other hand,
‘microfolds’ 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.

Management ranges from simple lifting and refloating of the flap to
placement of sutures to stretch the flap in position. Probst et al.
described a technique using the red reflex as a way to better detect
flap wrinkles during flattening procedures. Smoothing of the flap
should aim towards an even distribution of forces applied to the
surface. This can be performed with methylcellulose sponges or their
equivalent. Instruments such as the Pineda corneal LASIK iron can also
be used to flatten isolated flaps at the slit lamp or under the
operating microscope by gently pressing on them. Other reported
strategies include hydrating the flap with hypotonic saline (60-80%)
which may facilitate leveling of the flap surface.

Fixed folds are sometimes encountered and probably occur when
epithelial hyperplasia has time to form in the crevices formed by the
folds. Superficial epithelial incisions or frank epithelial debridement
over the wrinkled area may relieve contractures that occur secondary to
the presumed epithelial hyperplasia in these longer standing folds.
Recalcitrant wrinkling is reported to respond well to placement of
running torque-antitorque 10-0 or 11-0 nylon sutures.

Epithelial Ingrowth after Lasik

Epithelium in growth under the corneal flap can cause irregular astigmatism
and induced hyperopia secondary to stromal melting. A swift
intervention is sometimes needed to prevent these complications.

Once the epithelium is noted to progress towards the visual axis or
once a significant hyperopic shift or loss of BCVA is encountered,
lifting of the flap and scraping of the epithelium should be performed
promptly. This can be performed with a #69 blade or the equivalent. It
is important to remember to scrape both the stromal bed as well as the
stromal aspect of the flap. Flap folds connected to the peripheral
epithelial ring are a special source of concern as they provide a
conduit for epithelial cells infiltration. Similarly, an epithelial
defect adjacent to the edge of the flap should be followed closely due
to the presence of high epithelial mitotic activity.

Which epithelium is safe to leave? Small epithelial pearls are usually
self-limited and do not progress. Epithelial tongues connected to the
flap edge are more worrisome, they do not need to be scraped unless
they exhibit a quick rate of progression or if they already
involving/threatening the visual axis.

Author Bio:
Adapted from: 101 Pearls in Refractive, Cataract and Corneal Surgery Samir Melki MD PhD and Dimitri T. Azar MD editors, Slack inc. http://www.slackinc.com Dr. Melki is a experienced Boston affordable LASIK surgeon, Laser Eye Surgery, Vision Correction and Cosmetic Surgery

The eyeball is basically a sphere, filled with a jelly-like substance to hold up its shape. Due to a number of causes, this substance, known as the vitreous humor in medical terminology, change in texture towards a more liquid form. A common problem encountered is the formation of foreign materials or eye floaters within the eyeball. We see specks of dust or shadows in our vision. No amount of eye rubbing, swiping or swatting at these irritants will remove them from sight as they are inside the eyeball. This is obviously not a laughing matter as we suffer defective vision in varying degrees.

Eye floaters’ causes are most commonly due to age. In our youth, the vitreous gel within our eyeballs is of the same density. As we get older, it sometimes turns into a more liquid state which then causes pockets of gel and liquid to co-mingle. As such, images of these differences in form are mixed with our standard vision and cast onto the retina. Our eyes and brain then translates this amalgamation of images into a picture speckled with dots. As a consequence of the vitreous gel changing in form, it sometimes collapses away from the back of the eyeball. Hence, parts of it which used to be attached to the optic nerve are detached and drift within the eyeball as eye floaters.

Other factors which contribute towards eye floaters’ causes are occurrences of cellular materials within the eyeball. Sometimes our eyes suffer from hemorrhage due to various reasons. Abnormal growth of blood vessels can result in bleeding inside the eye which releases red blood cells into the vitreous area and become eye floaters. Direct trauma onto eyes and head areas is also a common cause of bleeding in the eyes. Sufferers of certain conditions such as myopia, diabetes and auto-immune deficiencies have a higher risk of defective vision. Eye corrective surgeries to address cataract problems as well as vision improvement contribute somewhat to formation of eye floaters. As is commonly known, medication can bring about side effects in varying degrees to different people. Not surprisingly, these drugs are sometimes the culprits which add to the problem.

Dennis enjoys writing on wide range of topics such as Eye Floaters Causes. You can visit for more details.

Lasik flap folds can induce irregular astigmatism with optical
aberrations and loss of BCVA especially if they involve the visual
axis. ‘Macrofolds’ are easily seen by slitlamp exam and represent full
thickness flap tenting in a linear fashion. On the other hand,
‘microfolds’ 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.

Management ranges from simple lifting and refloating of the flap to
placement of sutures to stretch the flap in position. Probst et al.
described a technique using the red reflex as a way to better detect
flap wrinkles during flattening procedures. Smoothing of the flap
should aim towards an even distribution of forces applied to the
surface. This can be performed with methylcellulose sponges or their
equivalent. Instruments such as the Pineda corneal LASIK iron can also
be used to flatten isolated flaps at the slit lamp or under the
operating microscope by gently pressing on them. Other reported
strategies include hydrating the flap with hypotonic saline (60-80%)
which may facilitate leveling of the flap surface.

Fixed folds are sometimes encountered and probably occur when
epithelial hyperplasia has time to form in the crevices formed by the
folds. Superficial epithelial incisions or frank epithelial debridement
over the wrinkled area may relieve contractures that occur secondary to
the presumed epithelial hyperplasia in these longer standing folds.
Recalcitrant wrinkling is reported to respond well to placement of
running torque-antitorque 10-0 or 11-0 nylon sutures.

Epithelial Ingrowth after Lasik

Epithelium in growth under the corneal flap can cause irregular astigmatism
and induced hyperopia secondary to stromal melting. A swift
intervention is sometimes needed to prevent these complications.

Once the epithelium is noted to progress towards the visual axis or
once a significant hyperopic shift or loss of BCVA is encountered,
lifting of the flap and scraping of the epithelium should be performed
promptly. This can be performed with a #69 blade or the equivalent. It
is important to remember to scrape both the stromal bed as well as the
stromal aspect of the flap. Flap folds connected to the peripheral
epithelial ring are a special source of concern as they provide a
conduit for epithelial cells infiltration. Similarly, an epithelial
defect adjacent to the edge of the flap should be followed closely due
to the presence of high epithelial mitotic activity.

Which epithelium is safe to leave? Small epithelial pearls are usually
self-limited and do not progress. Epithelial tongues connected to the
flap edge are more worrisome, they do not need to be scraped unless
they exhibit a quick rate of progression or if they already
involving/threatening the visual axis.

Author Bio:
Adapted from: 101 Pearls in Refractive, Cataract and Corneal Surgery Samir Melki MD PhD and Dimitri T. Azar MD editors, Slack inc. http://www.slackinc.com Dr. Melki is a experienced Boston affordable LASIK surgeon, Laser Eye Surgery, Vision Correction and Cosmetic Surgery

Lasik flap folds can induce irregular astigmatism with optical
aberrations and loss of BCVA especially if they involve the visual
axis. ‘Macrofolds’ are easily seen by slitlamp exam and represent full
thickness flap tenting in a linear fashion. On the other hand,
‘microfolds’ 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.

Management ranges from simple lifting and refloating of the flap to
placement of sutures to stretch the flap in position. Probst et al.
described a technique using the red reflex as a way to better detect
flap wrinkles during flattening procedures. Smoothing of the flap
should aim towards an even distribution of forces applied to the
surface. This can be performed with methylcellulose sponges or their
equivalent. Instruments such as the Pineda corneal LASIK iron can also
be used to flatten isolated flaps at the slit lamp or under the
operating microscope by gently pressing on them. Other reported
strategies include hydrating the flap with hypotonic saline (60-80%)
which may facilitate leveling of the flap surface.

Fixed folds are sometimes encountered and probably occur when
epithelial hyperplasia has time to form in the crevices formed by the
folds. Superficial epithelial incisions or frank epithelial debridement
over the wrinkled area may relieve contractures that occur secondary to
the presumed epithelial hyperplasia in these longer standing folds.
Recalcitrant wrinkling is reported to respond well to placement of
running torque-antitorque 10-0 or 11-0 nylon sutures.

Epithelial Ingrowth after Lasik

Epithelium in growth under the corneal flap can cause irregular astigmatism
and induced hyperopia secondary to stromal melting. A swift
intervention is sometimes needed to prevent these complications.

Once the epithelium is noted to progress towards the visual axis or
once a significant hyperopic shift or loss of BCVA is encountered,
lifting of the flap and scraping of the epithelium should be performed
promptly. This can be performed with a #69 blade or the equivalent. It
is important to remember to scrape both the stromal bed as well as the
stromal aspect of the flap. Flap folds connected to the peripheral
epithelial ring are a special source of concern as they provide a
conduit for epithelial cells infiltration. Similarly, an epithelial
defect adjacent to the edge of the flap should be followed closely due
to the presence of high epithelial mitotic activity.

Which epithelium is safe to leave? Small epithelial pearls are usually
self-limited and do not progress. Epithelial tongues connected to the
flap edge are more worrisome, they do not need to be scraped unless
they exhibit a quick rate of progression or if they already
involving/threatening the visual axis.

Author Bio:
Adapted from: 101 Pearls in Refractive, Cataract and Corneal Surgery Samir Melki MD PhD and Dimitri T. Azar MD editors, Slack inc. http://www.slackinc.com Dr. Melki is a experienced Boston affordable LASIK surgeon, Laser Eye Surgery, Vision Correction and Cosmetic Surgery

Lasik flap folds can induce irregular astigmatism with optical
aberrations and loss of BCVA especially if they involve the visual
axis. ‘Macrofolds’ are easily seen by slitlamp exam and represent full
thickness flap tenting in a linear fashion. On the other hand,
‘microfolds’ 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.

Management ranges from simple lifting and refloating of the flap to
placement of sutures to stretch the flap in position. Probst et al.
described a technique using the red reflex as a way to better detect
flap wrinkles during flattening procedures. Smoothing of the flap
should aim towards an even distribution of forces applied to the
surface. This can be performed with methylcellulose sponges or their
equivalent. Instruments such as the Pineda corneal LASIK iron can also
be used to flatten isolated flaps at the slit lamp or under the
operating microscope by gently pressing on them. Other reported
strategies include hydrating the flap with hypotonic saline (60-80%)
which may facilitate leveling of the flap surface.

Fixed folds are sometimes encountered and probably occur when
epithelial hyperplasia has time to form in the crevices formed by the
folds. Superficial epithelial incisions or frank epithelial debridement
over the wrinkled area may relieve contractures that occur secondary to
the presumed epithelial hyperplasia in these longer standing folds.
Recalcitrant wrinkling is reported to respond well to placement of
running torque-antitorque 10-0 or 11-0 nylon sutures.

Epithelial Ingrowth after Lasik

Epithelium in growth under the corneal flap can cause irregular astigmatism
and induced hyperopia secondary to stromal melting. A swift
intervention is sometimes needed to prevent these complications.

Once the epithelium is noted to progress towards the visual axis or
once a significant hyperopic shift or loss of BCVA is encountered,
lifting of the flap and scraping of the epithelium should be performed
promptly. This can be performed with a #69 blade or the equivalent. It
is important to remember to scrape both the stromal bed as well as the
stromal aspect of the flap. Flap folds connected to the peripheral
epithelial ring are a special source of concern as they provide a
conduit for epithelial cells infiltration. Similarly, an epithelial
defect adjacent to the edge of the flap should be followed closely due
to the presence of high epithelial mitotic activity.

Which epithelium is safe to leave? Small epithelial pearls are usually
self-limited and do not progress. Epithelial tongues connected to the
flap edge are more worrisome, they do not need to be scraped unless
they exhibit a quick rate of progression or if they already
involving/threatening the visual axis.

Author Bio:
Adapted from: 101 Pearls in Refractive, Cataract and Corneal Surgery Samir Melki MD PhD and Dimitri T. Azar MD editors, Slack inc. http://www.slackinc.com Dr. Melki is a experienced Boston affordable LASIK surgeon, Laser Eye Surgery, Vision Correction and Cosmetic Surgery

Lasik flap folds can induce irregular astigmatism with optical
aberrations and loss of BCVA especially if they involve the visual
axis. ‘Macrofolds’ are easily seen by slitlamp exam and represent full
thickness flap tenting in a linear fashion. On the other hand,
‘microfolds’ 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.

Management ranges from simple lifting and refloating of the flap to
placement of sutures to stretch the flap in position. Probst et al.
described a technique using the red reflex as a way to better detect
flap wrinkles during flattening procedures. Smoothing of the flap
should aim towards an even distribution of forces applied to the
surface. This can be performed with methylcellulose sponges or their
equivalent. Instruments such as the Pineda corneal LASIK iron can also
be used to flatten isolated flaps at the slit lamp or under the
operating microscope by gently pressing on them. Other reported
strategies include hydrating the flap with hypotonic saline (60-80%)
which may facilitate leveling of the flap surface.

Fixed folds are sometimes encountered and probably occur when
epithelial hyperplasia has time to form in the crevices formed by the
folds. Superficial epithelial incisions or frank epithelial debridement
over the wrinkled area may relieve contractures that occur secondary to
the presumed epithelial hyperplasia in these longer standing folds.
Recalcitrant wrinkling is reported to respond well to placement of
running torque-antitorque 10-0 or 11-0 nylon sutures.

Epithelial Ingrowth after Lasik

Epithelium in growth under the corneal flap can cause irregular astigmatism
and induced hyperopia secondary to stromal melting. A swift
intervention is sometimes needed to prevent these complications.

Once the epithelium is noted to progress towards the visual axis or
once a significant hyperopic shift or loss of BCVA is encountered,
lifting of the flap and scraping of the epithelium should be performed
promptly. This can be performed with a #69 blade or the equivalent. It
is important to remember to scrape both the stromal bed as well as the
stromal aspect of the flap. Flap folds connected to the peripheral
epithelial ring are a special source of concern as they provide a
conduit for epithelial cells infiltration. Similarly, an epithelial
defect adjacent to the edge of the flap should be followed closely due
to the presence of high epithelial mitotic activity.

Which epithelium is safe to leave? Small epithelial pearls are usually
self-limited and do not progress. Epithelial tongues connected to the
flap edge are more worrisome, they do not need to be scraped unless
they exhibit a quick rate of progression or if they already
involving/threatening the visual axis.

Author Bio:
Adapted from: 101 Pearls in Refractive, Cataract and Corneal Surgery Samir Melki MD PhD and Dimitri T. Azar MD editors, Slack inc. http://www.slackinc.com Dr. Melki is a experienced Boston affordable LASIK surgeon, Laser Eye Surgery, Vision Correction and Cosmetic Surgery

Lasik flap folds can induce irregular astigmatism with optical
aberrations and loss of BCVA especially if they involve the visual
axis. ‘Macrofolds’ are easily seen by slitlamp exam and represent full
thickness flap tenting in a linear fashion. On the other hand,
‘microfolds’ 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.

Management ranges from simple lifting and refloating of the flap to
placement of sutures to stretch the flap in position. Probst et al.
described a technique using the red reflex as a way to better detect
flap wrinkles during flattening procedures. Smoothing of the flap
should aim towards an even distribution of forces applied to the
surface. This can be performed with methylcellulose sponges or their
equivalent. Instruments such as the Pineda corneal LASIK iron can also
be used to flatten isolated flaps at the slit lamp or under the
operating microscope by gently pressing on them. Other reported
strategies include hydrating the flap with hypotonic saline (60-80%)
which may facilitate leveling of the flap surface.

Fixed folds are sometimes encountered and probably occur when
epithelial hyperplasia has time to form in the crevices formed by the
folds. Superficial epithelial incisions or frank epithelial debridement
over the wrinkled area may relieve contractures that occur secondary to
the presumed epithelial hyperplasia in these longer standing folds.
Recalcitrant wrinkling is reported to respond well to placement of
running torque-antitorque 10-0 or 11-0 nylon sutures.

Epithelial Ingrowth after Lasik

Epithelium in growth under the corneal flap can cause irregular astigmatism
and induced hyperopia secondary to stromal melting. A swift
intervention is sometimes needed to prevent these complications.

Once the epithelium is noted to progress towards the visual axis or
once a significant hyperopic shift or loss of BCVA is encountered,
lifting of the flap and scraping of the epithelium should be performed
promptly. This can be performed with a #69 blade or the equivalent. It
is important to remember to scrape both the stromal bed as well as the
stromal aspect of the flap. Flap folds connected to the peripheral
epithelial ring are a special source of concern as they provide a
conduit for epithelial cells infiltration. Similarly, an epithelial
defect adjacent to the edge of the flap should be followed closely due
to the presence of high epithelial mitotic activity.

Which epithelium is safe to leave? Small epithelial pearls are usually
self-limited and do not progress. Epithelial tongues connected to the
flap edge are more worrisome, they do not need to be scraped unless
they exhibit a quick rate of progression or if they already
involving/threatening the visual axis.

Author Bio:
Adapted from: 101 Pearls in Refractive, Cataract and Corneal Surgery Samir Melki MD PhD and Dimitri T. Azar MD editors, Slack inc. http://www.slackinc.com Dr. Melki is a experienced Boston affordable LASIK surgeon, Laser Eye Surgery, Vision Correction and Cosmetic Surgery