Surface ablation can enhance previous LASIK in patients with compromised corneas

WAILEA, Hawaii — Surface ablation techniques can be used to enhance the results of previous LASIK, particularly when the condition of the cornea complicates lifting the flap, according to a speaker here.

At Hawaiian Eye 2006, William B. Trattler, MD, said that PRK or laser epithelial keratomileusis may be indicated as enhancement techniques for post-LASIK patients with certain corneal conditions. These conditions can include an insufficient residual stromal bed; consecutive hyperopia after primary myopic LASIK; intraoperative or postoperative flap problems; flaps that are difficult to lift because too much time has gone by since the LASIK procedure; and severe dry eye.

Dr. Trattler reported on a retrospective study of 89 eyes treated with either PRK or LASEK to enhance previous LASIK. He and colleagues found that “there was a strong trend toward improvement in [best corrected visual acuity]” following the surface ablation procedures. Nearly 100% of the eyes attained 20/40 or better uncorrected visual acuity. And there were no cases of postoperative corneal haze, which can be a major concern after surface ablation, Dr. Trattler said.

He said he believes that there are three keys to success with surface ablation: promoting rapid visual recovery, preventing corneal haze, and minimizing postoperative pain and discomfort.

Surgeons can reduce the risk of postop haze by applying mitomycin C 0.02% to the cornea after the ablation, Dr. Trattler said. To minimize pain and maximize patient comfort, a careful preoperative dry eye test is essential to determine if the patient should be treated prophylactically with Restasis (cyclosporine, Allergan) and punctal plugs, he said.

Other methods of reducing postop pain include prescribing oral and/or topical nonsteroidal anti-inflammatory drugs, chilling the cornea and using bandage contact lenses, Dr. Trattler said.