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Striae management techniques should be carefully considered, surgeon says
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WAIKOLOA, Hawaii — When confronted with significant flap striae following LASIK, the surgeon should avoid over-hydrating the flap and consider suturing it, advised Stephen D. McLeod, MD.
Dr. McLeod spoke about management of post-LASIK striae here at Hawaii 2005, The Royal Hawaiian Eye Meeting.
He said surgeons can determine whether subtle striae are visually significant by evaluating the quality of the best corrected visual acuity, by performing retinoscopy and by examining the tear breakup pattern using fluorescein.
Once surgeons decide which striae to work on and which can be left alone, Dr. McLeod said a reasonable first step is to simply re-float the flap with repositioning. But in doing this surgeons must be careful not to over-hydrate the flap.
“Hypotonic hydration can lead to excessive hydration, which is itself a source of microstriae,” he said.
Surgeons should also be wary of epithelial debridement, which can lead to over-hydration and can increase the risk for haze, Dr. McLeod said.
Dr. McLeod instead recommends suturing the flap because the technique is effective and does not alter the overall refractive power.
“You can tent the central cornea out, thus reducing striae,” he said, noting that the desired effect can be accomplished with relatively few sutures.