Indications

Surgical correction of natural myopia, hyperopia, and astigmatism

Select cases of postsurgical myopia, hyperopia, and astigmatism

Select cases of presbyopia management with a monovision goal

Contraindications

Keratoconus and forme fruste keratoconus

Collagen vascular diseases and inflammatory ocular diseases

Herpes keratitis

Epithelial basement membrane dystrophy

Pregnancy

Preoperative Procedure

1. Discontinue soft contact lens wear at least 1–2 weeks and rigid contact lens wear 2–4 weeks preoperatively. Confirm stability and regularity of corneal topography.

2. Patient should not wear eye makeup on day of procedure.

3. Treat preexisting dry eye and blepharitis. Consider non-preserved lubricants, lid hygiene, punctual plugs, topical cyclosporine, and oral doxycycline for blepharitis.

4. Ensure appropriate corneal thickness with ultrasonic pachymeter.

Note: Corneal thickness minus flap thickness minus ablation depth should be > 250 μm to minimize risk of corneal ectasia.

Instrumentation

Lid speculum

Gentian violet marking pen (± 3 mm optical zone marker or Sinskey hook)

Cellulose sponges

Microkeratome or femtosecond laser

LASIK or cyclodialysis spatula

LASIK irrigating cannula

Operative Procedure

1. For lasers requiring pupil dilation, administer tropicamide 1% ± phenylephrine 2.5%. Otherwise, no dilation.

2. Prep and drape operative eye.

3. Place lid speculum.

4. Create LASIK flap.

a. For mechanical microkeratomes:

  i. Choose proper ring size and nominal thickness of microkeratome head, depending on corneal thickness, keratometric steepness, corneal width, and expected ablation depth.