1. 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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Repair at the Slit Lamp
In growth
Fistula

10. Repair at the Slit Lamp
Machat Flap Lifter

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

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

13. Repair at the Slit Lamp
Corneal
Rake©

14. A new tool Corneal Rake©

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

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

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

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

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

20. END