Fuchs corneal endothelial dystrophy, keratoconus, pellucid marginal degeneration, epithelial basement membrane dystrophy (EBMD), peripheral retinal tears (especially in highly myopic eyes), systemic autoimmune disease, pregnancy, lactation, severe dry eyes, and significant blepharitis are contraindications. Refraction should be stable within 0.5 D for 1 year or more before LASIK surgery. When glasses or contacts become too troublesome and inconvenient, many people turn to laser eye surgery. J Refract Surg 2004; 20:S718S722. The most common complication or side effect following LASIK is dry eyes. [5] Flap thickness Mechanical microkeratomes may have a wide variance from the intended actual flap thickness, with the average To help ensure an acceptable final postoperative residual stromal thickness, flap thickness can be measured by intraoperative ultrasound pachymetry. Our mission is to provide the best possible comanagement services to the profession of Optometry. Marcony R Santhiago. Corneal ectasia induced by laser in situ keratomileusis. The power calculation is based on several variables in the formula including preoperative manifest spherical and cycloplegic refractive error, keratometric power, corneal thickness, horizontal visible iris dimension 2014;40(6):918-928. Accessed Aug. 16, 2019. [25][26] Most of the cross-linking effect occurs in the anterior 200 microns of cornea that is weakened by flap creation. Some studies have indicated that PTA is one of the most predictive factors of the risk for corneal ectasia, even in eyes with a normal pre-operative corneal topography. Kymionis GD, Diakonis VF, Kalyvianaki M, et al. Treatment strategies for corneal ectasia. You may have difficulty seeing at night after surgery, which usually lasts a few days to a few weeks. The flap usually heals without stitches. The lower numbers represent flap thickness and residual stromal bed thickness in microns, respectively. Privacy Policy, Serving Anchorage, Boise, Lewiston, Great Falls, Albuquerque, Femto lasik laser; It is one of the eyes treatment techniques used in the treatment of hyperopia, myopia and astigmatism.In this treatment, valve preparation is done with a laser called "Femtosecond laser". Cataract surgery with a smartphone / tablet. Flap thicknesses can deviate significantly from the nominal setting and routine measurement can help the surgeon evaluate the range of actual thickness obtained. WebAblation Depth vs. Diopters & Diameter of Optical Zone for Myopia. LASIK often offers improved vision without the hassle of glasses or contact lenses. Talk with your doctor about any vision changes. Intracorneal rings are placed symmetrically or asymmetrically on the steep meridian or about the cone. After its development, the excimer (excited dimer) laser was used to reshape the cornea in a technique called photorefractive keratectomy (PRK). Preoperative evaluation should include a complete eye examination, a full medical and ophthalmologic history, and informed consent. If possible, they should be evaluated at one of our Corneal thickness can be measured with a corneal pachymetry test. Your eye doctor might also ask you to wear a shield over your eye at night until your eye heals. Cornea. Clin Ophthalmol. If you wear contact lenses, which can change the shape of your cornea, you'll need to completely stop wearing them and wear only your glasses for at least a few weeks before your evaluation and surgery. Well, not really. The Ectasia Risk Score System scale may help to identify high-risk patients preoperatively. Corneal flap thickness was set at 120 m (all flap pedicles were located in the upper portion of the eyes), excimer laser cutting energy at the corneal stromal bed at 1.0 J, femtosecond laser scanning line distance at 8 m, spot pitch at 8 m, and flap edge cutting energy at 1.3 J. Accessed Aug. 15, 2019. Ophthalmology 2009; 116:16651674. Corneal thickness, degree of myopia and RSB are related and RSB thickness is the most significant predictor of ectasia among them. Glasses or contact lenses can correct vision, but reshaping the cornea itself also will provide the necessary refraction. Kannellopoulos et al showed that pregnancy did not induce significant changes in refractive error, corneal stability, and total corneal and epithelial thickness in women after LASIK up to 1 year postop. In the U.S.A. the approved indications can be found on the Food and Drug Administration (FDA) labeling. Infectious keratitis in contact lens users and after LASIK. These microkeratomes produce a meniscus flap architecture [that is] thicker in the periphery, where the biomechanical properties of the cornea may be more adversely affected, he said. During LASIK surgery, a special type of cutting laser is used to precisely change the shape of the dome-shaped clear tissue at the front of your eye (cornea) to improve vision. [1]Ectatic changes can occur as early as 1 week[2] or can be delayed for years after LASIK. The surgeon adds the expected flap thickness (FT) to the planned ablation depth (AD), and then divides the sum by the eyes central corneal thickness (CCT). The Ectasia Risk Score System designed by Randleman and colleagues[8], is a controversial screening tool carefully developed by an evidence-based review of a large series of LASIK ectasia cases. J Refract Surg2009; 25:S8112S8818. Webnea that will be impacted by LASIK. 2022 Excel Laser Vision Institute. This service is free of charge if patients proceed with surgery. Dr. Santhiago cautioned that PTA is not a replacement for other well-established risk assessment tools, such as the ERSS. Thus, percent tissue altered is derived from (FT + AD) CCT. Measurement of corneal topography is essential, and is used to screen for irregular astigmatism, keratoconus and forme fruste keratoconus which are associated with unpredictable refractive outcomes and progressive ectasia after LASIK. Including an intraocular lens power calculator for cataract surgery for virgin eyes, and eyes that have had corneal refractive surgery, thanks to the n Tissue Consumption (TC) should not be more than 25% of Central Corneal Pachymetry (CCT) or more than 150m. J Cataract Refract Surg2007; 33:7580. J Refract Surg 2005;2:494496. Doctors generally use wavefront-guided technology to evaluate your eye in detail before LASIK surgery. LASIK is also a better option than PRK for correcting more severe nearsightedness (myopia). To assess the posterior corneal power and asphericity changes after myopic laser in situ keratomileusis (LASIK) and to correlate these changes with the amount of correction and the residual stromal bed thickness. Here are some of the qualifications and facts that LASIK specialists consider: After measuring the thickness of your cornea, LASIK specialists will need to do some mathematical reasoning in order to determine if you are a safe candidate for the procedure. Then depending on your prescription you may still be a LASIK candidate, however PRK may still be the safer option to make sure you have enough residual corneal bed left over after the procedure. You might be given pain medication or eyedrops to keep you comfortable for several hours after the procedure. 5th ed. Serving Optometric Physicians in the Sprit of True WebThe IOL Calculator is meant to serve as an adjunct tool to assist physicians in selecting the appropriate IOL for a particular patient. (JavaScript must be enabled to view this email address). 3 Moshirfar M et al. Use this tool to estimate if myopic patients have enough corneal thickness to proceed with laser vision correction. Investigative Ophthalmology & Visual ScienceNovember 2010, Vol.51, 5546-5555. This means that after the flap has been made and the prescription is applied, you should have that much left. Chehalis, Kennewick, Olympia, Silverdale, Tacoma, and Vancouver, Serving Optometric Physicians in the Sprit of True Folding back the flap allows your doctor to access the part of your cornea to be reshaped. In 2014, Moshirfar et al. Amoils SP, Deist MB, Gous P, Amoils PM. J Refract Surg 2009; 22:112. No direct measurement of corneal strength. If possible, they should be evaluated at one of our offices before the day of surgery. The flap allows access to the deeper layers of your eye. It receives millions of pieces of information about the outside world, which are quickly processed by the brain. The Ectasia Risk Score System is a cumulative score system. Compared to conventional mechanical microkeratomes, femtosecond lasers create LASIK flaps with more predictable and uniform thickness, and fewer complications. You'll probably have blurred vision. Download Panacea IOL & Toric Calculator and enjoy it on your iPhone, iPad and iPod touch. Pallikaris IG,Kymionis GD,Astyrakakis NI. A residual posterior stromal thickness of at least 250 m is recommended to reduce the risk of post-LASIK ectasia. 2. Adding PTA [to your preoperative protocol] will increase the chances that you will identify the patients with normal topography who have high risk for ectasia., For example, Dr. Santhiagos study found that PTA and younger age were the top two factors associated with ectasia development in seemingly normal corneas. WebLASIK in Pregnant Patients. For every diopter corrected, around 12 to 14 microns are removed. Schallhorn SC, Farjo AA, Huang D, Boxer Wachler BS, Trattler WB, Tanzer DJ, Majmudar PA, Sugar A. Wavefront-Guided LASIK for the Correction of Primary Myopia and Astigmatism. The more detailed the measurements, the more accurate your eye doctor can be in removing corneal tissue. A Report by the American Academy of Ophthalmology. Am J Ophthalmol. [20], Various types of contact lenses such as rigid gas permeable (RGP), custom wavefront-guided soft contact lenses, hybrid lenses and tandem soft contact lens-rigid gas permeable lenses can be used for visual rehabilitation. Comparison of sequential vs same-day simultaneous collagen cross-linking and topography-guided PRK for treatment of keratoconus. 2014 Jul;158(1):87-95. This is a particularly important requirement for a few reasons. All rights reserved. However, in comparison to conventional LASIK, WFG surgery did not result in improved outcomes. A few eyes do not develop ectasia despite having PTA values greater than 40 percent, Dr. Miller said. The SMILE procedure is faster than LASIKon average, the laser portion of SMILE takes around 30 The PTA equation accounts for the biomechanical effects of a combination of risk factors, unlike a potentially oversimplified approach of looking at risk factors individually, Dr. Waring said. Some surgeons believe corneal thickness less than 500 microns is an independent risk factor for ectasia. Corneal refractive procedures for hyperopia comprised of techniques that failed to gain popularity such as intracorneal inlays, conductive keratoplasty, and automated lamellar keratoplasty due to poor predictability and possible loss of corrected distance visual acuity (CDVA) [1,2,3].Femtosecond laser-assisted laser in situ keratomileusis (FS PTA is an additional significant risk factor for post-LASIK ectasia and may be considered in addition to residual stromal bed when determining the safety of an excimer laser treatment. RSB thickness is especially important after LASIK because both stress-strain analysis[11] and tensile strength analysis[12] indicate greater strength in the anterior 40% relative to posterior 60% of stroma and LASIK reduces anterior corneal structural integrity. To begin, your doctor uses a special blade or laser to cut a flap on the top layer of your cornea, about the size of a contact lens. Rao SN, Epstein RJ. Do I think this is going to be a big metric 10 years from now? J Refract Surg2009; 25:S807S811. Wavefront-guided LASIK, also called custom LASIK, is a variation of LASIK where the excimer laser ablates a sophisticated pattern based on measurements from a wavefront aberrometer (Figure 4). Alain Saad, Damien Gatinel. WebFor a flap procedure, such as LASIK or IntraLASIK, the standard of care in the United States is to leave at least 250m behind after subtracting out the flap thickness and ablation depth. There is a trend to cut thinner flaps with the newer microkeratome models, which are more precise. After the flap has been created, it is reflected away from the cut surface. Kymionis GD, Kontadakis GA, Kounis GA, et al. Ophthalmology 2008;115:1249 1261. WebFor example, pre-treatment refractive power, as well as thickness and curvature changes following corneal incisions, are used to perform post-operative calculation of the total corneal refractive power (TCRP) after LASIK treatment. Corneal thickness is one of the eye conditions that LASIK specialists will check for before qualifying a patient for LASIK. Post-LASIK ectasia may occur when the biomechanical stability of the cornea is altered. When a patients cornea is too thin or too weak, this increases their chances of experiencing complications or jeopardizing their healing process. Despite its advantages, PTA does have certain drawbacks. Facts about myopia. Thus, percent tissue altered is derived from (FT + AD) CCT. J Refract Surg 2002;18:177184. Typically, well say that we want to leave a 250-m residual stromal bed and then the patient will be safe. These usually clear up after a few weeks or months, and very few people consider them to be a long-term problem. Rigid contact lenses should be removed for several weeks and soft lenses for several days to weeks before examination. 1. Visit our LASIK page for more information. As this is a multifactorial risk-benefit analysis, Dr. Waring said, he would also ask the following questions: What does the topography look like? However, after a healing period, a secondary LASIK or PRK procedure may be performed in some cases. This might happen due to certain conditions, such as abnormal wound healing, hormonal imbalances or pregnancy. Your eye doctor will evaluate which areas of your cornea need reshaping and determine the precise amount of tissue to remove from your cornea. This form of measurement gives the doctors an overall view of your corneal thickness across the entire cornea. Dr. Santhiagos research group is currently working on a mathematical equation intended to screen for ectasia by combining the PTA formula and the ERSS. Kohlhaas M, Spoerl E, Schilde T, Unger G, Wittig C, Pillunat LE. Although few patients with normal corneal topography develop post-LASIK ectasia, this surprise complication remains one of the most feared in laser refractive surgery, thanks to its potential to cause visual catastrophe. [17], Light microscopy and hematoxylin-eosin staining of post-LASIK ectasia corneas demonstrated RSB thinning, hypocellular stromal scar, larger than normal artifacteous interlamellar cleft in RSB and fewer areas of Bowmans layer disruption than keratoconus. The normal cornea is about 540 microns thick (a little more than half a millimeter), measured in the center. Corneal thickness can be measured with a corneal pachymetry test. We dont want to oversimplify. Am J Ophthalmol. Clin Ophthalmol. This totals 196 to 202 microns of corneal tissue. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. Paying For Your DipCompSci(Cantab); Tariq A. Lewis, MSci, ARCS, OMT; Marine Gobbe, MSTOptom, PhD; Johnny Moore, FRCOphth, PhD, MD; Tara Moore, BSc, PhD Long-term Visual and Refractive Outcomes After (JavaScript must be enabled to view this email address), Corneal Cross-linking Comanagement Resources, Patient Education Video Library for use in Your Pactice, Direct Messaging with PCLI Details and addresses. They really go hand in hand. Then the surgeon uses a laser (B) to reshape the cornea, which corrects the refraction problems in the eye (C). In Results will be sent to you without interpretation. The upper numbers represent the transverse distance from the corneal vertex in millimetres. 2014;158(1):87-95. Disclaimer: The calculations provided are an estimate and may vary from the numbers provided by the manufacturer. The correction for hyperopia is peripheral (leaving the central cornea untouched), and Accurate measurement of the corneal thickness (CT) has become mandatory for several reasons during the past several years. Fortunately, LASIK is more affordable than ever with available financing options. Computer-assisted corneal topography in keratoconus. Thus, if both those factors were marginal in a prospective LASIK patient, caution might be in order, Dr. Waring advised. 3. LASIK involves creating a corneal flap using a microkeratome (Figure 1) or a femtosecond laser, reshaping the cornea using an excimer laser to remove tissue from the underlying stromal bed and then replacing the flap. Kim TI, et al. Illustration of a femtosecond laser cutting a LASIK flap. WebObjective. In the Randleman et al score system, the most common risk factors, in order of significance include: Abnormal topography compromises of keratoconus, pellucid marginal corneal degeneration, or forme fruste keratoconus with an I-S value of 1.4 or more[9] and is the most significant factor with highest relative risk. While surgical complications are rare, good postoperative care is important. You'll have a follow-up appointment with your eye doctor one to two days after surgery. LASIK removes about 12-14 microns per diopter of vision for correction. Staring at this light helps you keep your eye fixed while the laser reshapes your cornea. This page has been accessed 188,314 times. 2012;6:1801-1813. In the past, risk factors have been largely considered independently and with equal weight. Many of the patients in the study who developed ectasia would have been considered at low risk if other measurements (notably RSB or CCT) had provided the sole guidance, said principal investigator Marcony R. Santhiago, MD, PhD. One significant criticism of the Risk Score System is that any individual less than 22 years old is automatically classified as at least 'Moderate Risk', despite the low incidence of ectasia in this age group. One-year follow-up of corneal confocal microscopy after corneal cross-linking in patients with post laser in situ keratosmileusis ectasia and keratoconus. Residual Bed Stroma (RBS) should not be less than 60% of Central Corneal Pachymetry (CCT). (function(d, t) {var g = d.createElement(t);var s = d.getElementsByTagName(t)[0];g.id = "yelp-biz-badge-script-rrc-Vd2b4xX5LCoLpV6fMup81Q";g.src = "//yelp.com/biz_badge_js/en_US/rrc/Vd2b4xX5LCoLpV6fMup81Q.js";s.parentNode.insertBefore(g, s);}(document, 'script')); 10 Pointe Drive. WebIOL Calculator for Eyes with Prior Myopic LASIK/PRK Please enter all data available and press "Calculate" Pre-LASIK/PRK Data: Post-LASIK/PRK Data: Optical/Ultrasound Biometric Data: *If entering "Sph (D)", you must enter a value for "Cyl (D)", even if it is zero. With each pulse of the laser beam, a tiny amount of corneal tissue is removed. Iatrogenic keratectasia after laser in situ keratomileusis for less than -4.0 to -7.0 diopters of myopia. Femtosecond laser aided LASIK has been shown to provide better predictability of refractive outcomes and lower enhancement rates than LASIK performed using a 2006;25(4):388-403. This is an application that allows the ophthalmology surgeon to perform multiple IOL (Intraocular lens) Power, and Toric (Astigmatic) calculations. LASIK surgeons in Los Angeles correct this issue by removing excess tissue and reshaping the cornea to better reflect light. The correction of high myopia may present a greater risk of post-LASIK ectasia and decreased quality of vision in some patients. LASIK removes about 160 microns of tissue to create the corneal flap. We wont be making flaps in the future. After inserting the refraction intended to treat, you will see the Tissue Consumption (TC) for the different Optical Zones (OZ). Rarely, some people's eyes slowly return to the level of vision they had before surgery. Laser refractive surgery. Figure 2. These patients have a high rate of conversion to PRK. All rights Reserved. The association is more robust than all the variables isolated, and I use the formula with my patients every day, said Dr. Santhiago, at the Federal University of Rio de Janeiro. The app can be used by entering patients personal data, refraction of each eyes, keratectomy values, pachymetry of the cornea and type of refractive surgery. Biomechanical evidence of the distribution of cross-links in corneas treated with riboavin and ultraviolet A light. The surgeon adds the expected flap thickness (FT) to the planned ablation depth (AD), and then divides the sum by the eyes central corneal thickness (CCT). Elsevier; 2019. https://www.clinicalkey.com. Less serious side effects such as dry eyes, night time starbursts, and/or reduced contrast sensitivity occur relatively frequently. Ophthalmology. Sometimes this change in vision is due to another eye problem, such as a cataract. [CDATA[*/var l=new Array();var output = '';l[0]='>';l[1]='a';l[2]='/';l[3]='<';l[4]=' 109';l[5]=' 111';l[6]=' 99';l[7]=' 46';l[8]=' 105';l[9]=' 108';l[10]=' 99';l[11]=' 112';l[12]=' 64';l[13]=' 108';l[14]=' 101';l[15]=' 98';l[16]=' 109';l[17]=' 105';l[18]=' 103';l[19]=' 46';l[20]=' 110';l[21]=' 105';l[22]=' 108';l[23]=' 114';l[24]=' 97';l[25]=' 109';l[26]='>';l[27]='\"';l[28]=' 109';l[29]=' 111';l[30]=' 99';l[31]=' 46';l[32]=' 105';l[33]=' 108';l[34]=' 99';l[35]=' 112';l[36]=' 64';l[37]=' 108';l[38]=' 101';l[39]=' 98';l[40]=' 109';l[41]=' 105';l[42]=' 103';l[43]=' 46';l[44]=' 110';l[45]=' 105';l[46]=' 108';l[47]=' 114';l[48]=' 97';l[49]=' 109';l[50]=':';l[51]='o';l[52]='t';l[53]='l';l[54]='i';l[55]='a';l[56]='m';l[57]='\"';l[58]='=';l[59]='f';l[60]='e';l[61]='r';l[62]='h';l[63]='a ';l[64]='<';for (var i = l.length-1; i >= 0; i=i-1){ if (l[i].substring(0, 1) == ' ') output += "&#"+unescape(l[i].substring(1))+";"; else output += unescape(l[i]);}document.getElementById('eeEncEmail_aOqrpfADDW').innerHTML = output;/*]]>*/, Copyright 2023 Pacific Custom wavefront-guided soft contact lenses have been used in keratoconus with similar visual acuity compared to RGP and decreased aberrations.[21][22]. WebThis is an application that allows the ophthalmology surgeon to perform multiple IOL (Intraocular lens) Power, and Toric (Astigmatic) calculations. Cataract and Laser Institute. No, because were going to completely change things. Comanagement, . This laser eye surgery alternative uses a slightly different method to correct vision in which a corneal flap is not needed. Post-LASIK ectasia is considered in patients who developed increasing myopia, with or without increasing astigmatism, loss of uncorrected visual acuity, often loss of best-corrected visual acuity, During LASIK eye surgery, an eye surgeon creates a flap in the cornea (A) the transparent, dome-shaped surface of the eye that accounts for a large part of the eye's bending or refracting power. Advertising revenue supports our not-for-profit mission. Simultaneous topography- guided PRK followed by corneal collagen cross-linking for keratoconus. WebAt Flaum Eye Institute Refractive Surgery Center, your corneal thickness will be measured first by the Orbscan IIz Corneal Analysis System. Maguen E, Maguen B, Regev L, Ljubimov AV. LASIK surgery causes a temporary decrease in tear production. This will likely be a long-term treatment, especially if your cornea becomes stable with time or from cross-linking. Its not a direct measurement. Meanwhile, he and other researchers are helping to validate diagnostic technology to directly measure corneal strength. J Cataract Refract Surg 1999;25:582586. The typical pedestal thickness for PRK and LASIK is approximately 5 m, but this value may vary depending on the specific medical excimer laser device and even the profile type. Before surgery, your doctor will discuss the risks and benefits of LASIK surgery, what to expect before and after surgery, and any questions you may have. [CDATA[*/var l=new Array();var output = '';l[0]='>';l[1]='a';l[2]='/';l[3]='<';l[4]=' 109';l[5]=' 111';l[6]=' 99';l[7]=' 46';l[8]=' 105';l[9]=' 108';l[10]=' 99';l[11]=' 112';l[12]=' 64';l[13]=' 108';l[14]=' 101';l[15]=' 98';l[16]=' 109';l[17]=' 105';l[18]=' 103';l[19]=' 46';l[20]=' 110';l[21]=' 105';l[22]=' 108';l[23]=' 114';l[24]=' 97';l[25]=' 109';l[26]='>';l[27]='\"';l[28]=' 109';l[29]=' 111';l[30]=' 99';l[31]=' 46';l[32]=' 105';l[33]=' 108';l[34]=' 99';l[35]=' 112';l[36]=' 64';l[37]=' 108';l[38]=' 101';l[39]=' 98';l[40]=' 109';l[41]=' 105';l[42]=' 103';l[43]=' 46';l[44]=' 110';l[45]=' 105';l[46]=' 108';l[47]=' 114';l[48]=' 97';l[49]=' 109';l[50]=':';l[51]='o';l[52]='t';l[53]='l';l[54]='i';l[55]='a';l[56]='m';l[57]='\"';l[58]='=';l[59]='f';l[60]='e';l[61]='r';l[62]='h';l[63]='a ';l[64]='<';for (var i = l.length-1; i >= 0; i=i-1){ if (l[i].substring(0, 1) == ' ') output += "&#"+unescape(l[i].substring(1))+";"; else output += unescape(l[i]);}document.getElementById('eeEncEmail_CrgqwYqeOQ').innerHTML = output;/*]]>*/, Copyright 2023 Pacific J Refract Surg. Low residual stromal bed (RSB) thickness, Histopathology and Immunohistochemical characteristics, Binder PS, Lindstrom RL, Stulting RD, et al. Ophthalmology 2008;115:3750. https://nei.nih.gov/health/errors/myopia. Critical variable. But if a patient has two borderline findingssay a PTA of 30 percent and an age of 18he or she would likely not be a suitable LASIK candidate. All we need from you is their refraction. Normal corneal thickness is approximately 555 microns and the ideal pre-procedure In farsightedness (hyperopia), your cornea doesn't refract light properly, so the point of focus falls behind the retina. WebBecause a small incision (2-3 mm) is used in place of an entire flap, corneal nerve severance is minimal in comparison to LASIK. When you calculate the total cost of LASIK and compare that to the lifetime use of glasses or contacts, you will see that this procedure is a worthwhile investment. Randleman JB, Banning CS, Stulting RD. Mayo Clinic does not endorse companies or products. Privacy Policy, Serving Anchorage, Boise, Lewiston, Great Falls, Albuquerque, The ideal approach to preventing post-LASIK ectasia would be to directly measure the structural integrity of the preoperative cornea, which PTA does not do, Dr. Waring said. Other tests which should be performed include measuring pupil size and eye movements and corneal aberrometry. https://www.fda.gov/medical-devices/lasik/what-should-i-expect-during-and-after-surgery#top. Before surgery the excimer laser, suction ring, microkeratome and blade (or femtosecond laser settings), are checked by the technician and the surgeon. Figure 3. This page was last edited on January 8, 2023, at 17:15. 2010;21:255-8. If the flap created during the LASIK procedure is irregular, incomplete, or buttonholed, laser treatment cannot safely be performed in the same session.
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