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OCULAR SURGERY NEWS 6/13/2003

For prevention of microkeratome injuries, new surgeons should avoid difficult cases


MADRID, Spain - Letting corneal wounds heal for 6 months after microkeratome complications is advisable, especially for inexperienced surgeons, said Maria Iradier, MD, here during the Congress of the European Society of Ophthalmology.

Reports of microkeratome complications are decreasing, but surgeons should still be prepared for worst-case scenarios such as large defects, free corneal flaps and corneal flap tears, Dr. Iradier added.

To help prevent LASIK complications, refractive surgeons must assess patient characteristics, which can indicate at-risk factors. For instance, patients with deep, flat corneas, previous surgery or epithelium dystrophy may be at an increased risk of sustaining microkeratome injuries, Dr. Iradier said. With most microkeratome injuries, patients should be given time to heal and the surgery performed later in the year, she said.

For patients with large, epithelial defects, remove the defect and bandage the cornea, Dr. Iradier said. These patients may have an epithelial in-growth and should not have LASIK.

If free cap is sustained, keep the stromal face of the flap dry. Dr. Iradier applies a viscoelastic to the flap for adherence. Observe the patient closely to avoid losing the cap, she advised. For prevention, ensure laser alignment with the surgical markings on the cornea.

An incomplete flap may occur if the microkeratome stops abruptly or if a patient has an irregular stromal condition, Dr. Iradier explained. Surgeons should take measurements to determine if there is enough room for ablation. If not, replace the flap, wait six months for it to heal and redo the flap wider and deeper, she said.

Patients with deep corneas are susceptible to holes in the flap. Again, wait six months for the flap to heal before redoing the flap, she said.

Knowing the microkeratome features is also important when treating injuries from the corneal cut, she said.