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Home > Archive > Lasik Eyes Surgery > October 2004 > PRK after LASIK failed flap
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PRK after LASIK failed flap
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| BuzzLightyear 2004-10-13, 4:55 am |
| How long should I realistically expect to wait to have a PRK op done
after my LASIK failed due to the flap cut having a buttonhole? Or
should I be considering doing another, deeper, flap cut?
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| That's a question for your surgeon, but whatever he says, wait at
least 3 months before you have another surgery.
In fact, since he didn't do the LASIK yet, you might want to try
getting your money back. Tell him you don't want to have surgery
anymore. Then go someplace else.
Just out of curiousity... how much were you paying for the procedure
and where were you having it done?
On 13 Oct 2004 02:32:43 -0700, jgibbs@imailds.com (BuzzLightyear)
wrote:
>How long should I realistically expect to wait to have a PRK op done
>after my LASIK failed due to the flap cut having a buttonhole? Or
>should I be considering doing another, deeper, flap cut?
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| Glenn - USAEyes.org 2004-10-13, 11:10 am |
| >How long should I realistically expect to wait to have a PRK op done
>after my LASIK failed due to the flap cut having a buttonhole? Or
>should I be considering doing another, deeper, flap cut?
For those who do not know, a buttonhole is when the microkeratome cuts
a flap that is too thin and breaks through the surface of the cornea,
usually in the center.
Usually, the flap can be replaced and the cornea will heal without
degradation to vision quality. Sometimes the epithelial cells of the
outer cornea will go through the buttonhole and get underneath the
flap. Although removal of the epithelial cells is the common
response, removal of epithelial cells ingrowth at a buttonhole is
somewhat more difficult than if they were under a normal flap.
Most doctors I know will wait three months for the flap to heal and
then create a new, deeper, flap. PRK over a buttonhole may be
problematic because it is unlikely that the PRK tissue removal will
remove the entire flap. At some point, there will be a flap edge that
may or may not interfere with vision.
When something goes wrong, even something that normally has as good of
a final outcome as a buttonhole flap, I recommend seeking a second
opinion before any additional surgery. Wait at least a couple of
months for some healing to occur and for any problems to manifest,
then seek the opinion of a corneal specialist. If you need help with
a referral, feel free to contact me directly.
If you are going to proceed with a second flap, then I most highly
recommend you investigate having the flap created with the Intralase
femtosecond laser
(http://www.usaeyes.org/faq/subjects..._intralasik.htm). This
method is much more accurate than a mechanical microkeratome and is
virtually impossible to cause a buttonhole.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| Rebecca 2004-10-13, 11:10 am |
| jgibbs@imailds.com (BuzzLightyear) wrote in message news:<2c4b9c69.0410130132.8c4fc0e@posting.google.com>...
> How long should I realistically expect to wait to have a PRK op done
> after my LASIK failed due to the flap cut having a buttonhole? Or
> should I be considering doing another, deeper, flap cut?
If you already had a buttonhole, I do not personally think it is a
good idea to re-attempt LASIK. Were the reasons for the buttonhole
explained? This can be related to equipment problems (in which case as
a minimum, you would probably not want to re-attempt it with the same
equipment anyway) or it can be caused by risk factors such as a steep
or toric cornea, or excessively flat cornea, in which case it is just
not a good idea to do it at all. Another cause for concern would be,
if they had to cut a deeper flap they will be penetrating deeper in to
the cornea than originally intended which (depending on other factors
such as your prescription, the width of the ablation zone and the
brand of keratome) may place you at greater risk of ectasia.
I would wait three months, then go get two or three separate opinions.
Try a university setting if there is one near you.
Rebecca Petris
www.lasermyeye.org
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| Glenn - USAEyes.org 2004-10-13, 7:11 pm |
| Buzz,
As a follow-up, I will be attending a large medical convention next
week and there is at least one presentation regarding PRK over a
buttonhole flap. If you are interested in this information, feel free
to email me directly.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| BuzzLightyear 2004-10-13, 7:11 pm |
| As it stands, I've had my right eye done and vision from that is
perfect. So I'm left with fairly unusable vision in the interim. The
initial recommendation was to have PRK in a month, which has me a
little concerned. I like the idea of LASIK which is why I had it, but
I'm concerned about having a double flap and all the potential
complications.
I'm thinking of getting a contact lens to reduce the vision in the
good eye and to wear my old glasses until the next operation so that I
don't distort the eye needing a retreat - any issues with this, and
considerations for contact lens wear/type/max time in, time to wait
before I start etc.
The Intralase certainly came to mind while looking around the net, but
given the infancy of the technique it does concern me a little.
Is there any evidence of problems with PRK after LASIK of any note?
Thanks, Josh
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| BuzzLightyear 2004-10-13, 7:11 pm |
| Just a side note, the buttonhole was seen immediately and the flap
wasn't manually lifted. As far as I can tell, the vision in the
untreated eye is exactly as it was to begin with.
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| BuzzLightyear 2004-10-13, 7:11 pm |
| One further comment, although the recommended secondary treatment is
PRK, it was also referred to as ASA. After reading a little on this,
it seems that ASA is somewhat preferable to what I guess would
commonly be known as PRK - i.e. old style lasers.
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| Glenn - USAEyes.org 2004-10-13, 10:08 pm |
| What about Intralase is concerning you?
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| Glenn - USAEyes.org 2004-10-13, 10:08 pm |
| >Just a side note, the buttonhole was seen immediately and the flap
>wasn't manually lifted. As far as I can tell, the vision in the
>untreated eye is exactly as it was to begin with.
Very good news. If there is no epithelial ingrowth (ingrowth is less
likely thanks to the flap not being lifted), you should heal very
well. Do stay aware of dry eyes as they can exacerbate the situation.
If you use artificial tears, be sure to use preservative free.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| Glenn - USAEyes.org 2004-10-13, 10:08 pm |
| The value of buzz words. ASA is short for Advanced Surface Ablation.
That means PRK, LASEK, or Epi-LASIK with today's advanced technology.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| BuzzLightyear 2004-10-14, 7:13 pm |
| Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<aeirm09phrp72qgsreoj9pbogphul7nl4c@4ax.com>...
> What about Intralase is concerning you?
>
> Glenn Hagele
> Executive Director
> Council for Refractive Surgery Quality Assurance
>
> Email to glenn dot hagele at usaeyes dot org
>
> http://www.USAEyes.org
> http://www.ComplicatedEyes.org
>
> I am not a doctor.
Two things. Firstly the infancy of the technology, and secondly that
I'm from New Zealand so it's going to take a huge block of time and
money. I certainly raised this with my surgeon, and his comments
reflected my readings regarding the maturity of it, and that ASA will
simply work without the potential complications of having 2 flaps.
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| BuzzLightyear 2004-10-14, 7:13 pm |
| Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<1firm09thn6dcj6ujkscoivfade0arhits@4ax.com>...
> Very good news. If there is no epithelial ingrowth (ingrowth is less
> likely thanks to the flap not being lifted), you should heal very
> well. Do stay aware of dry eyes as they can exacerbate the situation.
> If you use artificial tears, be sure to use preservative free.
Thankfully I haven't had a single sign of dry eyes. Unfortunately my
wife is still experiencing this 6 weeks on from her op - although it's
nothing compared to what I'm going through right now.
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| Glenn - USAEyes.org 2004-10-14, 7:13 pm |
| In the unique circumstances of your situation, I believe your
evaluation of Intralase is probably accurate. If you were in the US
or Europe, that would be a different matter. There will be a
presentation at the American Academy of Ophthalmology meeting next
week by Gordon Binder, MD on 1,000 consecutive IntraLASIK procedures.
I believe that these are all virgin eyes, but the accuracy and other
data will be virtually the same on a buttonhole eye. You may want to
take a look, or drop me a line and I'll get a copy of the abstract to
you.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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| Glenn - USAEyes.org 2004-10-14, 7:13 pm |
| On 14 Oct 2004 11:58:57 -0700, jgibbs@imailds.com (BuzzLightyear)
wrote:
>Glenn - USAEyes.org <glenn.hageleSTOPSPAM@USAEyes.org> wrote in message news:<1firm09thn6dcj6ujkscoivfade0arhits@4ax.com>...
>
>Thankfully I haven't had a single sign of dry eyes. Unfortunately my
>wife is still experiencing this 6 weeks on from her op - although it's
>nothing compared to what I'm going through right now.
We have a detailed article on LASIK related dry eye and potential
treatments at http://www.complicatedeyes.org/dry_eye_treatment.htm.
Perhaps the information there will assist her.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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