Results of phototherapeutic keratectomy in the management of flap striae after LASIK*1

We present a patient with severe visual symptoms following multiple corneal refractive procedures including automated lamellar keratoplasty, arcuate keratotomy, laser in situ keratomileusis (LASIK), LASIK enhancement by cutting another flap, followed by a further LASIK enhancement by flap lifting. Topography was irregularly irregular, and the best spectacle-corrected visual acuity (BSCVA) was 20/25. Artemis very high-frequency digital ultrasound (US) analysis of the anatomical irregularities of the epithelium and stroma was used in conjunction with the topography to determine the cause of the visual symptoms. Very high-frequency digital US-assisted transepithelial phototherapeutic keratectomy together with a wavefront-guided treatment was used to reduce the stromal surface irregularities and the higher-order aberrations (HOAs), respectively. The treatment successfully regularized the stromal surface, dramatically reduced the HOAs, improved the contrast sensitivity to the high normal range, and improved the BSCVA to 20/20.

mentioning

confidence: 99%

Combined Artemis very high-frequency digital ultrasound-assisted transepithelial phototherapeutic keratectomy and wavefront-guided treatment following multiple corneal refractive procedures

Reinstein¹,

Archer²

2006

“…Others simply designate large full-thickness folds as macrostriae and finer, less visually significant wrinkles as microstriae. 2 While the macrostriae are visible with direct illumination, microstriae are best detected with retroillumination or fluorescein. 5 Although confocal microscopy of post-LASIK corneas has revealed microstriae in the Bowman layer in 97% of cases, 6 visually significant folds and striae requiring intervention are thought to range from 0.2% to 1.5%.…”

Section: Discussionmentioning

confidence: 99%

“…Phototherapeutic keratectomy (PTK) was performed to treat the striae in the right eye, as described by Steinert et al 2 The procedure consisted of applying 200 pulses with a diameter of 6.5 mm as a first stage. This was immediately followed by a further ablation of 100 pulses interrupted 5 times to wet the cornea with a microsponge soaked with artificial tears (Blink, Abbott Medical Optics, Inc.) to act as a masking agent.…”

Section: Techniquementioning

confidence: 99%

Maddox rod effect to confirm the visual significance of laser in situ keratomileusis flap striae

Choi

Melki

2011

“…The first patient presented with macrostriae more than 17 months after LASIK. We attempted the technique described by Steinert et al, 14 but the patient's visual complaints persisted. The second patient's macrostriae remained despite 8 months of intensive treatment, including debridement of the epithelium over the striae, stretching the flap, use of hypotonic saline, and suturing the flap.…”

Section: Discussionmentioning

confidence: 99%

“…Because much of the laser energy is absorbed by the masking fluid in PTK, the depth of stromal ablation in Case 1 was undoubtedly much less than the 40 mm that was programmed, perhaps closer to less than 10 mm. 14 Epithelial remodeling (hyperplasia between ridges and hypoplasia atop the ridges) can reduce the optical effects of striae. 17 While this process is occurring, attention to the ocular surfacedfor example, lubrication and/or contact lens weardcan help.…”

Section: Discussionmentioning

confidence: 99%

Photorefractive keratectomy for refractory laser in situ keratomileusis flap striae

Kuo¹,

Jabbur²,

O’Brien³

2008

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.