Managing Lasik Keratome Complications

State of the art LASIK technology avoids the following problems during

quality laser eye surgery

The Sliding Suction Ring

Application of adequate suction is essential

for intraocular pressure

upsurge and dissection of good quality corneal

flaps. On occasion, the suction ring slides prior to the buildup of

adequate vacuum and the flap is decentered from the pupillary axis.

This is reported to happen more frequently with the Hansatome

microkeratome due to a slower rise in vacuum. Applying equal downwards

pressure on the ring through its handle and at the base knob for about

3 seconds prior to initiating vacuum has minimized this problem.

On occasion, the initial vacuum results in a

decentered ring with a large slant requiring the surgeon to release the

vacuum to reposition the ring. It is not uncommon to see the ring

sliding back in the conjunctival groove created by the initial suction.

Decentering the ring in the opposite direction prior to activating

suction may achieve good centration as the vacuum level may be high

enough by the time the ring slides close to the center to prevent

further slide towards the initial groove.

Another approach is to change the ring size (e.g. from 8.5 to 9.5 mm),

hence avoiding the chemotic conjunctiva. Some surgeons advocate

applying Vasocon-A (Alcon Laboratories, Fort Worth TX) allowing a

decrease in conjunctival swelling prior to reattempting the procedure

30 minutes later. If this does not resolve the conjunctival chemosis,

further difficulties might be encountered and it is best delaying the

surgery for another day

The Mid-Cut Jam

The suction ring has fit well, the keratome slides easily in place and

the cut is proceeding smoothly until....it stops half-way and does not

respond to either forward or backwards pedal commands. This unpleasant

situation can occur secondary to a mechanical or electrical failure of

the keratome. The main goal of the surgeon in that situation is to

protect the flap and the bed from the keratome blade. Although resuming

forward movement may result in an uneven cut, we have not encountered

this in our experience.

A quick check of electrical wiring may reveal a loose connection

especially at the connection with the keratome motor. Every keratome

should be handled differently in this situation and the surgeon should

inquire about the best approach to handle such a situation. For the

Hansatome, if no movement can be initiated, careful release of suction

and sliding the keratome-suction ring as one unit backwards will ensure

that the flap is not incarcerated under the blade. The keratome head

cannot be reversed along the track manually. On the other hand, with

the Automated Corneal Shaper (ACS), releasing suction might trap the

flap under the footplate. It is therefore preferable to disassemble the

keratome head from its base without releasing suction.

Author Bio:

Adapted from: "101 Pearls in Refractive, Cataract and Corneal Surgery"

Samir Melki MD PhD and Dimitri T. Azar MD editors, Slack inc.

www.slackinc.com Dr. Melki is a experienced Boston affordable LASIK surgeon, Laser Eye Surgery,

Vision Correction and Cosmetic Surgery

http://bostonlaser.com/ See All articles From Author Tags:

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Word Count Appx. : 467 | Article Views 197 Published 11-06-2007