Exposing the LASIK Scam

The cornea does not heal after LASIK
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Author:  Bill [ Fri Nov 25, 2005 2:23 pm ]
Post subject:  The cornea does not heal after LASIK

http://www.ncbi.nlm.nih.gov/entrez/quer ... uery_hl=11

J Refract Surg. 2005 Sep-Oct;21(5):433-45. Related Articles, Links

Cohesive tensile strength of human LASIK wounds with histologic, ultrastructural, and clinical correlations.

Schmack I, Dawson DG, McCarey BE, Waring GO 3rd, Grossniklaus HE, Edelhauser HF.

Emory Eye Center, Emory University School of Medicine, Atlanta, GA 30322, USA.

PURPOSE: To measure the cohesive tensile strength of human LASIK corneal wounds.

METHODS: Twenty-five human eye bank corneas from 13 donors that had LASIK were cut into 4-mm corneoscleral strips and dissected to expose the interface wound. Using a motorized pulling device, the force required to separate the wound was recorded. Intact and separated specimens were processed for light and electron microscopy. Five normal human eye bank corneas from 5 donors served as controls. A retrospective clinical study was done on 144 eyes that had LASIK flap-lift retreatments, providing clinical correlation.

RESULTS: The mean tensile strength of the central and paracentral LASIK wounds showed minimal change in strength over time after surgery, averaging 2.4% (0.72 +/- 0.33 g/mm) of controls (30.06 +/- 2.93 g/mm). In contrast, the mean peak tensile strength of the flap wound margin gradually increased over time after surgery, reaching maximum values by 3.5 years when the average was 28.1% (8.46 +/- 4.56 g/mm) of controls. Histologic and ultrastructural correlative studies found that the plane of separation always occurred in the lamellar wound, which consisted of a hypocellular primitive stromal scar centrally and paracentrally and a hypercellular fibrotic stromal scar at the flap wound margin. The pathologic correlations demonstrated that the strongest wound margin scars had no epithelial cell ingrowth-the strongest typically being wider or more peripherally located. In contrast, the weakest wound margin scars had epithelial cell ingrowth. The clinical series demonstrated the ability to lift LASIK flaps without complications during retreatments up to 8.4 years after initial surgery, correlating well with the laboratory results.

CONCLUSIONS: The human comeal stroma typically heals after LASIK in a limited and incomplete fashion; this results in a weak, central and paracentral hypocellular primitive stromal scar that averages 2.4% as strong as normal comeal stroma. Conversely, the LASIK flap wound margin heals by producing a 10-fold stronger, peripheral hypercellular fibrotic stromal scar that averages 28.1% as strong as normal comeal stromal, but displays marked variability.

Author:  Scientist [ Sat Nov 26, 2005 9:12 pm ]
Post subject:  Late traumatic displacement of LASIK flaps

Once you've had LASIK you have fragile eyes. Post-LASIK eyes are like wounds that never heal.



Cornea. 2003 Jan;22(1):66-9. Related Articles, Links

Late traumatic displacement of laser in situ keratomileusis flaps.

Tumbocon JA, Paul R, Slomovic A, Rootman DS.

Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.

PURPOSE: To report the occurrence, management, and outcome of late-onset traumatic dehiscence and dislocation of laser in situ keratomileusis (LASIK) flaps. METHODS: Two interventional case reports of patients with late-onset LASIK corneal flap dislocation after ocular trauma occurring at 7 and 26 months after surgery, respectively. RESULTS: The flaps were lifted, stretched, and repositioned after irrigation and scraping of the stromal bed and the underside of the flap. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. The dislocated corneal flaps were successfully repositioned in both cases. The patient whose dislocated flap was repositioned 4 hours after the trauma recovered his uncorrected visual acuity (UCVA) of 20/20 1 week after the procedure and had a well-positioned flap with a clear interface. The patient who was managed 48 hours after the injury required repeat flap repositioning at 10 and 24 days after the initial procedure for treatment of persistent folds and striae in the visual axis. His uncorrected visual acuity 2 weeks after the third flap repositioning was 20/40 + 2. Diffuse lamellar keratitis developed in both patients that resolved with the use of topical corticosteroids. CONCLUSION: Laser in situ keratomileusis corneal flaps are vulnerable to traumatic dehiscence and dislocation, which can occur more than 2 years after the procedure.

Author:  Bill [ Fri Dec 16, 2005 12:50 pm ]
Post subject: 

A new article in Retina. Too bad it doesn't even provide an abstract online.

http://www.ncbi.nlm.nih.gov/entrez/quer ... query_hl=1

Retina. 2005 Dec;25(8):1101-1103.


Tosi GM, Tilanus MA, Eggink C, Mittica V.

Author:  Eye [ Mon Dec 19, 2005 1:20 am ]
Post subject:  WebMDHealth on flap never healing

?The LASIK flap never heals? the LASIK flap can be easily dislodged from simple contact with the eye such as a finger poke.?

WebMDHealth http://my.webmd.com/content/article/61/68084.htm .

Author:  Eye [ Mon Dec 19, 2005 1:22 am ]
Post subject:  Traumatic flap displacement and DLK after LASIK

J Cataract Refract Surg. 2001 May;27(5):781-3.

Traumatic flap displacement and subsequent diffuse lamellar keratitis after laser in situ keratomileusis.

Schwartz GS, Park DH, Schloff S, Lane SS.
Associated Eye Care, Lake Elmo, Minnesota 55042, USA. gschwartz@associatedeyecare.com

A 45-year-old man was struck in the left eye by the edge of a paper shopping bag 3 weeks after having laser in situ keratomileusis (LASIK). The injury resulted in partial displacement of the LASIK flap. The patient developed diffuse lamellar keratitis (DLK) the day after the flap was repositioned. By day 4, visual acuity diminished to 20/60. By day 9, the clinical evidence of the DLK had resolved, and by day 15, uncorrected visual acuity was 20/20. Eye trauma 3 weeks after LASIK can result in displacement of the LASIK flap, and DLK can develop following flap replacement. Long-term anatomic and visual results are usually good.

Author:  Eye [ Mon Dec 19, 2005 1:24 am ]
Post subject:  Traumatic flap dislocation 4 years after LASIK

J Cataract Refract Surg. 2005 Aug; 31 8 :1664-5.

Traumatic flap dislocation 4 years after laser in situ keratomileusis.

Nilforoushan MR, Speaker MG, Latkany R.
Laser and Corneal Surgery Associates and New York Eye and Ear Infirmary, New York, New York 10003, USA. mreza04@yahoo.com

We present a case of late traumatic flap dislocation 47 months after laser in situ keratomileusis (LASIK). This is the latest reported case of traumatic LASIK flap dislocation to date. The patient was examined 5 days after being struck in the face and found to have a flap dislocation.

Check out this link:


Author:  Eye [ Mon Dec 19, 2005 1:26 am ]
Post subject:  Late-onset flap folds and partial dehiscence of flap

J Cataract Refract Surg. 2005 Mar;31(3):633-5.

Late-onset repetitive traumatic flap folds and partial dehiscence of flap edge after laser in situ keratomileusis.
Miyai T, Miyata K, Nejima R, Shimizu K, Oshima Y, Amano S.
Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan. t-miyai@miyata-med.ne.jp

A 25-year-old woman had traumatic flap folds and partial dehiscence of the flap edge in the right eye 5 and 30 months after laser in situ keratomileusis. The period from injury to treatment was 4 hours and 9 days, respectively. With the first injury, the flap was lifted and stretched with moistened sponges to clear the folds. With the second injury, the folds were hard so the flap was lifted and sutured to stretch the folds.

Author:  Eye [ Mon Dec 19, 2005 1:28 am ]
Post subject:  Late traumatic dislocation of LASIK flap

Indian J Ophthalmol. 2004 Dec;52(4):327-8. Related Articles, Links

Late dislocation of LASIK flap following fingernail injury.
Srinivasan M, Prasad S, Prajna NV.
Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Madurai, India.

A case of traumatic flap displacement with a fingernail injury four years after LASIK is reported.

Author:  Eye [ Mon Dec 19, 2005 1:29 am ]
Post subject:  Late traumatic dislocation of LASIK flaps

J Cataract Refract Surg. 2004 Jan;30(1):253-6. Related Articles, Links

Late traumatic dislocation of laser in situ keratomileusis flaps.
Heickell AG, Vesaluoma MH, Tervo TM, Vannas A, Krootila K.
Helsinki University Eye Hospital, Helsinki, Finland.

We present 2 patients with late traumatic laser in situ keratomileusis flap dislocation 8 months and 17 months after surgery. One patient had a sharp trauma that caused a partial laceration and the second patient had a blunt trauma that caused a dislocation of the flap. The corneas were examined with slitlamp microscopy, computed corneal topography, and confocal microscopy. One flap was repositioned surgically; the other was treated conservatively with an eye patch.

Author:  Eye [ Thu Dec 22, 2005 1:53 am ]
Post subject:  Flap can be lifted indefinitely

Non-peer reviewed but we already had this thread started here....

Flap can be lifted indefinitely

Author:  Bill [ Mon Jan 09, 2006 2:49 am ]
Post subject: 

Am J Ophthalmol. 2001 Apr;131(4):505-6.

Late-onset traumatic laser in situ keratomileusis (LASIK) flap dehiscence.

Geggel HS, Coday MP.

Virginia Mason Medical Center, Section of Ophthalmology, Seattle, Washington 98101, USA. ophhsg@vmmc.org

PURPOSE: To report a case of laser in situ keratomileusis (LASIK) flap dehiscence following focal trauma six months after uneventful refractive surgery. METHODS: Case report. A 37 year old man was seen one day after a tree branch snapped tangentially against his left cornea causing a dehiscence of his LASIK flap. RESULTS: The flap was repositioned after treating the exposed flap stroma with a 50:50 mixture of distilled water and balanced salt solution. The patient regained 20/20 uncorrected visual acuity. CONCLUSIONS: Patients should be informed about the potential for traumatic flap dehiscence following LASIK surgery and advised to wear eye protection when appropriate. Due to minimal wound healing except at the edges of the flap, corneal flap dehiscence may occur months or years after uneventful LASIK.

Author:  Broken Eyes [ Wed Jan 11, 2006 12:17 am ]
Post subject: 

An OD that I know once said that the LASIK flap is like a Tupperware lid -- the edge seals but the lid doesn't attach to anything.

Author:  WonderWhy [ Sat Jan 14, 2006 7:03 pm ]
Post subject: 

I guess that is why they lift the same flap to do enhancements. What about the patient that has had two flaps cut to repair/enhance? Have you any information on this?

Author:  Truly [ Sat Jan 14, 2006 7:50 pm ]
Post subject:  I have only heard anecdotal information

I have seen discussions of cutting a 2nd flap vs. relifting and believe the consensus is that relifting is better. Of course your corneal nerves will be ripped apart again.

With two flaps, two very thin parallel slices must be cut very accurately. Microkeratomes are notoriously innacurate - they cut within a 'range' of thicknesses and sometimes produce a wavy, irregular slice.

Two flaps mean two interfaces that most likely won't refract light normally, two regions that have collected junk, two regions that wrinkle, and two flaps that can become dislodged. It would seem logical that a cornea with two flaps would be especially vulnerable to trauma.

I think the consensus on this bulletin board would be that having the first flap cut is a huge mistake. A 2nd flap... well... I wouldn't hold out hope for terrific vision out of that eye.

But the surgeon is only attempting to 'reduce your dependency on glasses', not to improve your visual quality... so perhaps the SURGEON's goals would be met by such a procedure.

Author:  Broken Eyes [ Sun Jan 15, 2006 1:25 am ]
Post subject: 

You definitely want to avoid a 2nd flap if at all possible.

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_DocSum

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