Photorefractive keratectomy for refractory laser in situ keratomileusis flap striae

Abstract

Photorefractive keratectomy (PRK) with mitomycin-C (MMC) was performed in 2 patients with visually significant, complicated laser in situ keratomileusis flap striae. These striae had been resistant to multiple treatments, including stretching, suturing, and PRK. The visual symptoms in both patients resolved after PRK with MMC, and both patients were stable 1 year later. Wavefront-guided PRK with MMC may be a viable treatment for patients who have complicated flap striae resistant to standard measures.

Corneal wavefront-guided photorefractive keratectomy in patients with irregular corneas after corneal refractive surgery

“…This shows that corneal wavefront-guided PRK after unsuccessful LASIK can be a useful tool for restoring quality of vision or treating highly aberrated corneas when the stromal residual bed is not thick enough. It can even be successfully used in eyes with flap complications 37 in which flap lifting is not feasible.…”

“…We must consider that the effectiveness of the refractive ablation can be limited by wound healing because the cornea is a complex structural composite material with biomechanical and reparative changes after any damage or injury. 37 Tissue ablation with excimer laser could generate subtle, unexpected modifications that might limit the effect of the ablation. 38 Therefore, we found corneal wavefront-guided PRK enhancements to be an excellent solution for highly aberrated corneas after unsuccessful previous corneal refractive procedures.…”

Femtosecond laser in laser in situ keratomileusis

“…They can be responsible for symptoms such as halos, star bursts, and diplopia as well as decreased visual acuity. 79 Striae are more frequently associated with flap irregularities and extremely thin or thick flaps. 80 Proposed causes include trauma, flap desiccation and contraction, misalignment, and modification in the corneal contour, especially with higher myopic ablations, which may create a disparity in the arc length between the excimer laser–ablated bed and the posterior surface of the flap.…”

Wavefront-guided customized corneal ablation

“…Several studies have evaluated the safety and efficacy of WFG enhancements with LASIK or surface ablations to treat residual refractive errors, postoperative HOAs, and refractory LASIK flap striae in symptomatic patients [41][42][43][44][45][46] after previous keratorefractive procedures, as WFG treatments may be most beneficial in patients with highly aberrated corneas. In addition to good refractive and visual outcomes, WFG enhancements resulted in a reduction of HOAs [41,42] and improvement in low contrast sensitivity and visual symptoms [42].…”