Routine Lasik Surgery - Nebraska Laser Eye Associates

Routine Lasik Surgery
Mark E Johnston MD FRCSC : Jones Eye Clinic
Cover lashes with Tegaderm
Wire speculum with short ends
Introduce under the superior lid
Introduce speculum inferior-nasal
and slide under the lid
Center and Focus
Three radial marks: IMPORTANT!
Use 9.5 ring if WTW over 11.7 mm
Apply pressure to post,watch pupil
Apply alcaine
Alcaine; pupil dilated
Dry Alcaine
With second micro-sponge dry
plate and along lids
Lift and Tip Inferior Ring Forward
Push back inf. lid with 4th and 5th Fingers
Dry Fornix
Use damp sponge to dry cornea
and gutters
Cut end of moist sponge (wedgie)
to superior fornix
Note width of gutter when dry
Lift with Kelman forceps
Note absence of excess fluid
Note bed has no excess fluid
Note texture and hydration of bed
Laser: Note absence of central fluid
(Visx S2- no drying or wetting the bed)
Control small drop at hinge. Optisol has
pinkish tint and is slightly cohesive
Controlled drop starting to spread
Apply drop over the bed
Avoid excessive fluid
Use canula and fluid to replace
flap
Note limited fluid under the flap
Limited irrigation under the flap
Slide canula out inferior
Sweep canula over the hinge area
first
Sweep canula lighty down over
the central cornea
Sweep very lightly over the
inferior flap
Note the alignment of the marks
and the narrow gutter
Sweep lightly with a overhydrated sponge
Note alignment marks and
narrow gutter !STOP!
The size of the bubbles gives an indication of
the depth of fluid under the flap
Bubbles and fluid are removed with
gentle sweep with a curved canula
Enhancements: Find edge with pressure over
flap;open epithelium and lift with Sinskey
Open epithelium with K-Spatula
Reposition for each quadrant
When the epithelium is open; introduce a
Long Kelman under the superior flap
Slide the Kelman inferior: the
wedge shape is used to advantage
At 18 months there is moderate
adhesion to the stromal bed