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 outcome

Select cases of thinner corneas in which LASIK contraindicated

Select cases of epithelial basement membrane dystrophy

Vocational needs (occupations in which LASIK flap not allowed)

Contraindications

Keratoconus and forme fruste keratoconus

Collagen vascular diseases and inflammatory ocular diseases

Herpes keratitis

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

4. Optional: Administer oral corticosteroid on day of procedure and taper thereafter to decrease postoperative discomfort.

5. Ensure appropriate corneal thickness with ultrasonic pachymeter.

Note: The corneal thickness minus the ablation depth should leave > 350 μm to minimize risk of corneal ectasia. This number is a suggestion and has not been validated.

Instrumentation

Lid speculum