New York Eye and Ear Infirmary Flap Lift and Repair of Post-operative LASIK Complications at the Slit Lamp Richard S. Koplin, MD David C. Ritterband, MD John A. Seedor, MD New York Eye and Ear Infirmary

The authors have no financial interest in any materials or devices associated with this presentation.

Repair of the Lasik Flap Lasik surgeons habitually return their post–op complications to an operating room environment for repair using an operating microscope We do this because we: are more ergonomically in tune with the supine patient find comfort in what is seemingly a successful technique and a community norm

Repair of the Lasik Flap There is an opportunity for improved outcomes right under our noses The operating microscope is an inferior optical system when compared to the slit lamp which is ubiquitous and readily available in every surgeon’s office

Practical Advantages of Slit Lamp Preferential optical system with distance from optics to object of desire advantageous for magnification and resolution Variable beam aperture, and lighting options provide textural variation unavailable with present day operating microscopes Working

Practical Advantages of Slit Lamp Immediate servicing of the patient‘s needs with minimal physician cost Avoid disruption to physician’s schedule to travel outside the office Slit lamp prone position less threatening to the patient Working

Slit lamp repair of Lasik Flap Disadvantages Ergonomics at the slit lamp requires a modest learning curve May require assistant to hold forehead across headband in slit lamp May require elbow rest to support operating hand

Materials and Methods Cellulose sponges: 6 wet/6 dry Topical anesthetic and BSS with irrigating tip Machat or other flap lifter Wire lid speculum Small toothed forceps Corneal Rake© (IMPEX) or small chalazion curette

Repair at the Slit Lamp In growth Fistula

Repair at the Slit Lamp Machat Flap Lifter

Standard Flap Lift Technique Repair at the Slit Lamp Standard Flap Lift Technique

If flap becomes desiccated apply a wet sponge Repair at the Slit Lamp If flap becomes desiccated apply a wet sponge

Repair at the Slit Lamp Corneal Rake©

A new tool Corneal Rake©

Debris along edge of “Rake” Repair at the Slit Lamp Debris along edge of “Rake”

Back surface of flap “Raked” Repair at the Slit Lamp Back surface of flap “Raked”

Repair at the Slit Lamp RESULT: Surfaces free of cells RESULT:

Flap after re-setting with wet and dry sponges Repair at the Slit Lamp Flap after re-setting with wet and dry sponges

OUTCOMES Summary of clinical histories and surgical outcomes following slit lamp repair of post-Lasik complications (six patients/seven eyes)

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