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The Normal LASIK Procedure

A Step-By-Step Surgical Approach

LASIK STEPS

Preparing Instruments

LASIK instrument trays can be divided into the following 2 different areas: used instruments area and sterile instruments area.

• Used instruments area
  
  
  
  • Sterile gloves
    
  • Interface pack (one for each eye)
  
  
• Sterile instruments area
  
  
  
  • 2 small piles of 4 × 4 gauze
    
  • Eye patch (one 4 × 4 gauze folded with tape)
    
  • Drape: Tegaderm (3M Company; one for each eye or adhesive plastic)
    
  • 2 balanced salt solution (BSS) tubes per eye
    
  • 2 packs of Weck-Cel sponges (Beaver Visitec)
    
  • Syringe filled with BSS (3 cubic centimeters with 25 grams cannula)
    
  • 2 flap lifters
    
  • Curved forceps
    
  • Skin marker

We advise hanging a photo of the LASIK and photorefractive keratectomy trays in the surgical suite to guide the staff in preparing complete trays (Figure 1-1). This is especially useful in high-volume environments.

Preparing Patient

• Place the head cover (cover hair and ears).
  
• Place the gauzes between the head cover and the ears (Figures 1-2 and 1-3).
  
• Apply anesthetic drops (one drop is instilled in each eye).
  
• Apply Betadine 5% (Alcon Labs) on the patient’s skin (mainly on eyebrows, upper eyelid, and lower eyelid).
  
• Close the contralateral eye.
  
• Ask the patient to maintain a chin-up position.
  
  
  
  • The patient’s hands may rest on his or her chest or he or she may be given a teddy bear to hold and squeeze instead of squeezing his or her eyelids.

• Preoperative checklist
  
  
  
  • Recheck the patient’s name, date of birth, eye being treated, and refractive correction (Table 1-1).
  
  
• Explain to the patient that the part of the surgery involving a femtosecond laser will probably be the most uncomfortable for him or her, as he or she may feel pressure and/or black out.
  
• Initiate the laser platform (Figures 1-4 and 1-5).
  
  
  
  • Enter the patient’s name, the patient’s date of birth, and the surgeon’s name.
    
  • Choose the procedure: Flap (with the IntraLase [Abbott Medical Optics]).
    
  • Choose the following flap parameters:
    
    
    
    • Pattern of ablation: Raster cut vs spiral cut (variable; depends on the laser platform and factory recommendation)
      
    • Hinge position: Usually superior
      
    • Depth: Between 100 microns (µm) and 110 µm (depends on ablation and residual stromal bed)
      
    • Flap diameter: Our default preference is 9.1 mm; we prefer a diameter of 8.8 mm in small eyes to avoid air bubbles in the anterior chamber and a minimum of 9.1 mm for hyperopic ablations.
      
    • Bed energy and spot separation (depends on the laser platform and factory recommendation)
      
    • Side cuts: Between 60 and 90 degrees (variable; depends on the laser platform and factory recommendation)
      
    • Side cut energy: Variable (depends on the laser platform and factory recommendation)
      
    • Pocket
      

      ◆ Parameters as set by factory.

      
      

      ◆ ON decreases the risk of opaque bubble layer (OBL).

      
      

      ◆ OFF increases the flap diameter when needed.

      
      

      ◆ Initiate the laser.

    
    
  • Verify glass cone integrity (Figures 1-6 and 1-7).

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