Rand Eye Institute Cous
Laser Vision Correction
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  • Advanced Surface LASEK
  • PTK

Case #104

Advanced Surface Laser Vision Correction

This is an advanced surface procedure, which we believe has made most LASIK flaps unnecessary whether done by microkeratome or intralase. With the improvement of the advanced surface procedure using mitomycin c and other improvements, we produce consistently clear corneas that have no visible trace of surgical experience, even under high power microscopic examination. This is a case where the right eye is correcting a -4.00 -5.75 x 15. Left eye is correcting -5.00 -4.50 x 161. The procedure is done with our standard Rand-Stein analgesia protocol for patient comfort and done in a Joint Commission accredited sterile surgical facility.

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Case #106

Advanced Surface laser vision correction for a patient who had previous repair of a dislocated LASIK flap 12 years after the original LASIK

This is a patient who had LASIK somewhere in Miami in 1999. In October of 2011 he was hit in the eye with a tennis ball which dislocated the LASIK flap. It is unusual to have flap mobility after 12 years. This was repaired by another doctor in Miami, but the trauma has left him with the need for significant residual spectacle correction.
We performed an advanced surface procedure, preserving the integrity of the flap which is now healed about six months after the repair. With the epithelium removed one can see very substantial striae on the cornea. This is not as visually significant when it is covered over with the epithelium. The procedure was done successfully and a contact lens was placed to allow for epithelialization. Mitomycin was used to prevent scarring in the visual axis.

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Case #088

Excellent example of the Advanced Surface Procedure

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Case #060

This is a patient who had a RK on this eye in 1994 and then had a LASIK procedure with a flap done on the same eye in 2002. We performed cataract surgery for this eye in November of 2009 and there was residual refractive deficit for which we did a surface laser vision correction. We prefer not to make LASIK flaps on previous RK eyes because the flap fragments dislodge and cause the RK segments to open as if they were cut pieces of pizza. The LASEK we performed produced very little difference in the refraction and that is why she was returned to surgery for an additional surface laser treatment. This case shows how irregular the corneal surface is after the previous surgeries. Notice how the areas of superficial cornea from the previous LASIK flap separates and requires them to be replaced in the most exact position. Had we removed any of this tissue or not put it back exactly the way it was, the visual consequences would be potentially catastrophic. For this reason we advise that any laser vision correction on top of previous RKs or old LASIK procedures be done with surface laser procedure with removal of the epithelium with alcohol to avoid trauma to the previously operated tissue.

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Case #043

This a patient that is undergoing advanced surface procedure, laser vision correction, for -3.25, -1.25 x170 in the right eye, -3.50 -0.75 x175 for the left eye. The procedure is routine and required no Mitomycin. An alcohol solution was used to loosen the epithelium on a sponge for approximately forty seconds. Note how easily the epithelium is removed without significant trauma. Custom capture is set prior to the placement of the alcohol so as to assure accurate astigmatism alignment against rotation and custom ablation.

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Case #042

The video shows a hyperopic advanced surface laser procedure with an intended correction of approximately +3.00 in the right eye and +4.00 in the left eye. This is a routine surface procedure. Mitomycin was not necessary but can be used if deeper ablations are done. The pre-cut pledget soaked in alcohol loosens the epithelium and the removal of the epithelium is cleaner and less traumatic. Prior to the epithelial removal the custom capture is locked in on the Visx S4 to link it appropriately for accurate custom ablation.

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Case #007

CASE #1

PTK with gel was used to level the cornea over a Corneal Transplant with DSEK for old surface scars.

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Case # 2

Patient’s seventh corneal surgery.

This patient has had five previous corneal transplants, DSEK on the same eye, and PTK.  This is his only eye. Corneal transplant removes all of the previous surgeries.  A double continuous anti-toric suture is used.  The procedure was done under peribulbar anesthesia. 

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