Exposing the LASIK Scam

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PostPosted: Sun Jun 24, 2007 11:33 pm 
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Prophylactic Mitomycin C to Inhibit Corneal Haze After Photorefractive Keratectomy for Residual Myopia Following Radial Keratotomy

Journal of Refractive Surgery Vol. 23 No. 3 March 2007

Belquiz A. Nassaralla, MD, PhD; Stephen D. McLeod, MD; Jo?o J. Nassaralla Jr, MD, PhD

Quote:
It is well documented that RK incisions never completely heal,

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PostPosted: Wed Jul 04, 2007 2:02 am 
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Laser Epithelial Keratomileusis for the Correction of Hyperopia Using a 7.0-mm Optical Zone With the Schwind ESIRIS Laser

Journal of Refractive Surgery Vol. 23 No. 4 April 2007

David P.S. O?Brart, MD, FRCS, FRCOphth; Faye Mellington, MBBS; Sophie Jones, MRCOphth; John Marshall, PhD

Quote:
For LASIK, long-term published data are somewhat limited and the refractive and biomechanical stability remains uncertain.13-16 By its very nature LASIK must be regarded as more invasive in terms of corneal biomechanical stability than surface ablation procedures. The LASIK flap once cut may contribute little to the mechanical stability of the cornea and probably never completely adheres to the underlying stromal bed, with late traumatic fl ap displacement being reported as an infrequent complication.9

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PostPosted: Sun Aug 19, 2007 12:21 am 
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Am J Ophthalmol. 2006 May;141(5):799-809. Epub 2006 Mar 20.

Corneal keratocyte deficits after photorefractive keratectomy and laser in situ keratomileusis.

Erie JC, Patel SV, McLaren JW, Hodge DO, Bourne WM.
Department of Ophthalmology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA. erie.jay@mayo.edu

PURPOSE: To measure changes in keratocyte density up to five years after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

DESIGN: Prospective, nonrandomized clinical trial.

METHODS: Eighteen eyes of 12 patients received PRK to correct a mean refractive error of -3.73 +/- 1.30 diopters, and 17 eyes of 11 patients received LASIK to correct a mean refractive error of -6.56 +/- 2.44 diopters. Corneas were examined by using confocal microscopy before and six months, one year, two years, three years, and five years after the procedures. Keratocyte densities were determined in five stromal layers in PRK patients and in six stromal layers in LASIK patients. Differences between preoperative and postoperative cell densities were compared by using paired t tests with Bonferroni correction for five comparisons.

RESULTS: After PRK, keratocyte density in the anterior stroma decreased by 40%, 42%, 45%, and 47% at six months, two years, three years, and five years, respectively (P < .001). At five years, keratocyte density decreased by 20% to 24% in the posterior stroma (P < .05). After LASIK, keratocyte density in the stromal flap decreased by 22% at six months (P < .02) and 37% at five years (P < .001). Keratocyte density in the anterior retroablation zone decreased by 18% (P < .001) at one year and 42% (P < .001) at five years. At five years, keratocyte density decreased by 19% to 22% (P < .05) in the posterior stroma.

CONCLUSIONS: Keratocyte density decreases for at least five years in the anterior stroma after PRK and in the stromal flap and the retroablation zone after LASIK.

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PostPosted: Mon Sep 03, 2007 3:26 pm 
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J Cataract Refract Surg. 2004 Sep;30(9):1989-92.

Role of the endothelial pump in flap adhesion after laser in situ keratomileusis.

Bissen-Miyajima H, Nakamura K, Kaido M, Shimmura S, Tsubota K.

Quote:
The mechanism of flap adhesion immediately after surgery is strongly affected by the pump function. In the long term, flap adhesion is more dependent on the epithelium. Pathologic studies of rabbit eyes reveal epithelial hyperplasia at the flap edge.5, 6 Clinically, there have been reports of flap dislocation; however, these cases had evidence of injuries.7, 8 During LASIK enhancement procedures, the edge of the flap is observed to be tightly adhered to the epithelium. Once this tight junction is compromised, the flap can be easily peeled, which underscores the importance of the endothelial pump even in the long term following LASIK.

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PostPosted: Thu Oct 04, 2007 12:35 am 
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Ophthalmology. 2007 Oct;114(10):1848-59.

Interface fluid syndrome in human eye bank corneas after LASIK: causes and pathogenesis.

Dawson DG, Schmack I, Holley GP, Waring GO 3rd, Grossniklaus HE, Edelhauser HF.
Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA.

PURPOSE: To evaluate the effects of corneal edema on human donor corneas that had previous LASIK using a laboratory model with histologic and ultrastructural correlations.

DESIGN: Experimental study.

PARTICIPANTS: Thirty human eye bank corneas from 15 donors (mean age +/- standard deviation, 49.9+/-8.9 years) who had had previous LASIK surgery (2-8 years before death).

METHODS: The corneas were mounted in an artificial anterior chamber and the corneal endothelium was perfused for up to 5.0 hours with 0.9% saline solution (endothelial cell damage group) or BSS Plus at a pressure of 15 mmHg (control group), or BSS Plus at a pressure of 55 mmHg (high-pressure group). The corneas were evaluated by confocal and specular microscopy before, during, and at the end of the experimental period. Subsequently, the specimens were evaluated by light and electron microscopy.

MAIN OUTCOME MEASURES: Corneal thickness, reflectivity, histology, and ultrastructure.

RESULTS: Endothelial cell damage resulted in an increased (141.5+/-38.8 microm) total corneal thickness relative to controls (52.3+/-33.7 microm), whereas high pressure resulted in a decreased thickness (24.8+/-14.1 microm) relative to controls. This ultimately was due to swelling of the LASIK interface in both groups and swelling of the residual stromal bed (RSB) in the endothelial cell damage group or compression of the RSB and, possibly, the flap in the high-pressure group. A significant increase in corneal reflectivity at the LASIK interface occurred in both groups, primarily due to varying degrees of fluid accumulation and associated hydropic keratocyte degeneration, as well as increased corneal reflectivity in the RSB only in the endothelial cell damage group.

CONCLUSIONS: After LASIK surgery, edematous corneas preferentially hydrate and swell in the paracentral and central interface wound, commonly resulting in a hazy corneal appearance primarily due to keratocyte hydropic degeneration. More severe corneal edema is characterized by the formation of an optically empty space corresponding to an interface fluid pocket. The spectrum of interface fluid syndrome can be described in 3 stages.

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PostPosted: Mon Oct 15, 2007 7:32 pm 
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J Refract Surg. 2007 Sep;23(7):729-30.

Traumatic flap dislocation 4 years after LASIK due to air bag injury.

Ram?rez M, Quiroz-Mercado H, Hernandez-Quintela E, Naranjo-Tackman R.

Department of Cornea and Refractive Surgery, Asociaci?n Para Evitar la Ceguera en M?xico, Hospital Luis S?nchez Bulnes, Universidad Nacional Aut?noma de M?xico, Mexico City, Mexico. mramirezfdz@igo.com.mx

PURPOSE: To report a patient who developed corneal flap dislocation following air bag injury 48 months after LASIK.

METHODS: Evaluation by slit-lamp microscopy and fluorescein angiography.

RESULTS: A 29-year-old man was treated after air bag injury that occurred 48 months after LASIK. Examination revealed corneal flap dislocation, with severe folds and flap edema. Preoperative visual acuity was finger counting at 1 m. Visual acuity was 20/400 24 hours after repositioning the corneal flap. Retinal angiography revealed Berlin macular edema, which was injected with periocular steroids. Five days after injection, visual acuity remained 20/400, but improved to 20/40 1 month after injection.

CONCLUSIONS: Significant trauma can dislocate a corneal flap many months after surgery.

From the full text:

Quote:
The corneal flap can be easily displaced following trauma many months after LASIK.


Quote:
The healing process at the corneal flap wound interface persists for several months after LASIK, which consists of disorganized collagen fibers that can be seen along the interface of the corneal flap creating a hypocellular primitive stromal scar.9,10 The risk of trauma, such as that associated with some occupations or participation in sports, should be discussed with the patient preoperatively and during follow-up to LASIK surgery.

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PostPosted: Thu Oct 25, 2007 2:22 am 
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Trans Am Ophthalmol Soc. 2005 December; 103: 56?68.

LONG-TERM CORNEAL KERATOCTYE DEFICITS AFTER PHOTOREFRACTIVE KERATECTOMY AND LASER IN SITU KERATOMILEUSIS

Jay C Erie, MD,*? Jay W McLaren, PhD, David O Hodge, MS, and William M Bourne, MD?

Full Text:
http://www.pubmedcentral.nih.gov/articl ... id=1447559

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PostPosted: Thu Nov 08, 2007 1:28 pm 
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J Refract Surg. 2007 Oct;23(8):830-2.

Shewanella putrefaciens keratitis in the lamellar bed 6 years after LASIK.

Park HJ, Tuli SS, Downer DM, Gohari AR, Shah M.
Department of Ophthalmology, University of Florida, Gainesville, Fla, USA.

PURPOSE: To present a case of infectious keratitis occurring 6 years after LASIK due to the rare human pathogen Shewanella putrefaciens.

METHODS: A 58-year-old man presented with redness and pain in the right eye 6 years following LASIK retreatment. Examination revealed a corneal infiltrate at the flap interface. Corneal scraping of stroma beneath the flap was submitted for histopathologic and microbiologic evaluation.

RESULTS: An infiltrate located at the LASIK flap interface originated from an epithelial defect at the flap-corneal junction. Corneal stroma cultures demonstrated Shewanella putrefaciens. The infection resolved with antibiotic treatment.

CONCLUSIONS: LASIK-related complications, such as infections, can occur many years following the procedure. The potential space created under the LASIK flap may predispose patients to infection by opportunistic organisms.

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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PostPosted: Sat Nov 24, 2007 8:44 pm 
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Ophthalmology. 2007 Oct;114(10):1848-59.
Interface fluid syndrome in human eye bank corneas after LASIK: causes and pathogenesis.Dawson DG, Schmack I, Holley GP, Waring GO 3rd, Grossniklaus HE, Edelhauser HF.
Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA.

PURPOSE: To evaluate the effects of corneal edema on human donor corneas that had previous LASIK using a laboratory model with histologic and ultrastructural correlations. DESIGN: Experimental study.

PARTICIPANTS: Thirty human eye bank corneas from 15 donors (mean age +/- standard deviation, 49.9+/-8.9 years) who had had previous LASIK surgery (2-8 years before death).

METHODS: The corneas were mounted in an artificial anterior chamber and the corneal endothelium was perfused for up to 5.0 hours with 0.9% saline solution (endothelial cell damage group) or BSS Plus at a pressure of 15 mmHg (control group), or BSS Plus at a pressure of 55 mmHg (high-pressure group). The corneas were evaluated by confocal and specular microscopy before, during, and at the end of the experimental period. Subsequently, the specimens were evaluated by light and electron microscopy.

MAIN OUTCOME MEASURES: Corneal thickness, reflectivity, histology, and ultrastructure.

RESULTS: Endothelial cell damage resulted in an increased (141.5+/-38.8 microm) total corneal thickness relative to controls (52.3+/-33.7 microm), whereas high pressure resulted in a decreased thickness (24.8+/-14.1 microm) relative to controls. This ultimately was due to swelling of the LASIK interface in both groups and swelling of the residual stromal bed (RSB) in the endothelial cell damage group or compression of the RSB and, possibly, the flap in the high-pressure group. A significant increase in corneal reflectivity at the LASIK interface occurred in both groups, primarily due to varying degrees of fluid accumulation and associated hydropic keratocyte degeneration, as well as increased corneal reflectivity in the RSB only in the endothelial cell damage group.

CONCLUSIONS: After LASIK surgery, edematous corneas preferentially hydrate and swell in the paracentral and central interface wound, commonly resulting in a hazy corneal appearance primarily due to keratocyte hydropic degeneration. More severe corneal edema is characterized by the formation of an optically empty space corresponding to an interface fluid pocket. The spectrum of interface fluid syndrome can be described in 3 stages.

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"What concerns me is that if the person informing the patient is themselves poorly or inaccurately informed then how on earth can consent ever be truly informed?" Dr. Sarah Smith


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 Post subject: Check out Lasikdisaster.com for information on the flap
PostPosted: Mon Feb 04, 2008 2:21 am 
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Check out this link:

http://www.lasikdisaster.com/flapdislocation.htm

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PostPosted: Sat Mar 01, 2008 4:11 am 
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The flap never heals.

J Cataract Refract Surg. 2008 Mar;34(3):383-8.
Visual rehabilitation and outcomes for ectasia after corneal refractive surgery.
Woodward MA, Randleman JB, Russell B, Lynn MJ, Ward MA, Stulting RD.
From the Department of Ophthalmology (Woodward, Randleman, Russell, Ward, Stulting) and Rollins School of Public Health (Lynn), Emory University, Atlanta, Georgia, USA.

Collagen crosslinking procedures may prove to be effective for postoperative ectasia; however, most of the crosslinking effect occurs in the anterior stroma, a region of the cornea that is functionally decoupled from the posterior stroma after creation of the LASIK flap. Thus, the full potential effect of collagen crosslinking for postoperative ectasia remains to be determined. Collagen crosslinking is currently not approved by the U.S. Food and Drug Administration.

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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PostPosted: Thu Jun 05, 2008 3:13 pm 
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Nippon Ganka Gakkai Zasshi. 2008 May;112(5):465-71.

[Traumatic flap dislocation after laser in situ keratomileusis][Article in Japanese]

Hori-Komai Y, Toda I, Yamamoto T, Sakatani K, Asano-Kato N, Fukumoto T, Arai H, Tsubota K.
Minamiaoyama Eye Clinic Tokyo, Japan. hori@minamiaoyama.or.jp

PURPOSE: To report our experience in treating cases of flap dislocation caused by trauma after laser in situ keratomileusis (LASIK).

PATIENTS AND METHODS: We did a retrospective review of the case records of 16,319 patients (31,655 eyes) who underwent LASIK in Minamiaoyama Eye Clinic. Ten eyes of 9 patients were treated for flap dislocation. Conditions of the trauma occurrence, main findings of the eyes, treatments and clinical results are described.

RESULTS: Dislocation occurred during a period of 5 days to 4 years after LASIK. Accidents happened when working, when playing with children or pets, or when fighting. The main findings were folds or microstriae, diffuse lamellar keratitis (DLK), and epithelial ingrowth, including partial splitting of the flap (1 eye) and only a crack in the epithelium of the flap edge (1 eye). Seven flaps were lifted, irrigated and repositioned, and observed after fitting the patients with soft contact lenses. Three flaps were treated with eye drops of hyaluronic acid only, or with systemic steroids, topical steroids, and antibiotics. Uncorrected visual acuity recovered to more than 1.0 in 7 eyes, and best corrected visual acuity (BCVA) was more than 1.0 in all eyes. However, 3 eyes lost one line and 1 eye lost two lines of BCVA.

CONCLUSION: Many cases of flap dislocation showed recovery of good visual acuity with adequate and prompt treatment. However, it is possible to leave irregular astigmatism untreated which has a bad effect on visual acuity, depending on the affected part and the seriousness of the injury. The connection between patient and clinic is important for proper and prompt treatment.

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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