Chapter 8- LASER TREATMENT AFTER PREVIOUS SURGERY AND SPECIAL CASES

• Previous laser surgery as photorefractive keratectomy (PRK) or LASIK- My preference is to treat on the surface rather than dealing with a LASIK flap. Some other surgeons deal with the LASIK flap. I use a wavescan “fingerprint” of the eye to determine the Advanced Surface Ablation custom treatment.
• Previous refractive incisional surgery such as radial keratotomy (RK) or astigmatic keratotomy (AK). I prefer to get a wavescan “fingerprint” and treat as a custom treatment of Advanced Surface Ablation.
• Corneal transplant- I prefer a wavescan to identify all the abnormalities and use this “fingerprint” as the treatment plan. More than one treatment may be needed. Some surgeons prefer to cut a LASIK flap.
• Previous cataract surgery with or without an intraocular lens. I prefer a wavescan to identify all the abnormalities and use this “fingerprint” as the treatment plan. More than one treatment may be needed. Some surgeons prefer to cut a LASIK flap.
• After previous surgery for glaucoma, retinal detachment or other non-refractive conditions. I prefer a wavescan to identify all the abnormalities and use this “fingerprint” as the treatment plan. Some surgeons prefer to cut a LASIK flap.
• Nystagmus is a to and fro movement of the eyes. If the best corrected vision with glasses is 20/100 before surgery with glasses or contact lenses, than the best vision after refractive surgery will be 20/100 but without correction. Because of the constant movement, nystagmus is more difficult to get an accurate wavescan and provide an accurate treatment.
• Dry eyes- with severe dry eyes, the patient needs to be aggressively treated before the refractive laser surgery. Dry eyes are to be expected for several months following surgery.
• Decentered pupils- with the Visx Excimer laser, the surgeon sees a white light where the patient fixates. The automated eye tracker usually does not work well with decentered pupils and is turned off. The surgeon centers the laser on the light directed visual axis.

References

Davis, EA et al (eds): Refractive Surgery. Philadelphia, Lippincott Williams & Wilkins, Int. Ophthalmol Clin. 2000; 40(3): 111-123.

Forseto AS, Francesconi CM, Nose RA, Nose W. Laser in situ keratomileusis to correct refractive errors after keratoplasty. J. Cataract Refract Surg. 1999; 25:479-485. [pubmed]

Guell JL, Gris O, deMuller A, Corcostegui B. LASIK for the correction of residual refractive errors from previous surgical procedures. Ophthalmic Surg lasers. 1999; 30: 341-349. [pubmed]

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