Moran CORE

Laser-Assisted In-Situ Keratomileusis (LASIK)

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Title: Laser-Assisted In-Situ Keratomileusis (LASIK)
Author (s): Russell Swan, MD; Mark Mifflin, MD
Date: 01/30/2016
Keywords/Main Subjects: refractive surgery, myopia, hyperopia, astigmatism, Laser-Assisted In-Situ Keratomileusis, LASIK
Diagnosis: Myopia, astigmatism
Description: This video demonstrates a standard surgical technique for LASIK at the University of Utah Moran Eye Center with Dr. Mark Mifflin. Below is our standard protocol:

1. Calibrate and program the femtosecond and excimer lasers
2. Prepare the operative cart with the instruments and supplies necessary to perform the procedure
3. Prepare the patient with the proper sedation
4. Instill topical anesthesia, antibiotics and NSAID drops into the operative eye(s)
5. Clean the eyelashes and fornices
6. Position the patient on the laser table
7. +/- use of eyelid holder for femtosecond flap creation
8. Align red dots of femtosecond laser on limbus
9. Using gentle pressure engage the suction ring (centered over the limbus) by pressing on the right side of the foot pedal
10. Lower applanation cone into suction ring and engage second automatic suction (securing applanation cone in suction ring)
11. Align flap as desired on computer monitor
12. Engage femtosecond laser: first a tunnel will be created at the hinge of the flap to decrease formation of opaque bubble layer (OBL) by allowing for escape of gas during creation of the flap. Next the flap is created followed by the side cut
13. Disengage applanation cone and suction ring
14. Shift patient from FS200 (femtosecond) laser to EX500 (excimer) laser
15. Drape the eye, being sure to isolate the eyelashes and meibomian glands
16. Place a locking eyelid speculum to obtain adequate exposure
17. Center the eye in the operative field by adjusting the microscope and/or head position
18. Place the alignment markings
19. Irrigate the cornea with BSS
20. Dry the fornices of excess fluid with a microsurgical sponge
21. Lift the corneal flap with a Lasik flap lifter (create small opening in gutter and then use hook to pass all the way across the flap near the hinge. Next, back out to 50% width and free 50% of the flap moving gently away from the hinge. Finally free the remaining 50% of the flap
22. Flip the LASIK flap over placing it on the superior conjunctiva
23. Remove any OBL with gentle pressure from the LASIK flap lifter
24. Use a microsurgical sponge to remove excess fluid from the bed to obtain uniform hydration
25. Ablate the stromal bed with programmed refraction in the laser while covering the flap with a wet microsurgical sponge
26. Place BSS on the stromal bed and re-approximate the flap with the irrigating cannula
27. Irrigate beneath the flap to remove debris and float the flap into position
28. Dry the keratectomy gutter with a moistened surgical sponge
29. Check corneal alignment markings and symmetry of the keratectomy gutter space to ensure correct positioning of the flap
30. Wipe the corneal flap with a moistened microsurgical sponge to smooth any wrinkles
31. Wait 1-2 minutes for flap adhesion
32. Place a viscous lubricant on the eye and carefully remove the eyelid speculum without touching the cornea. Also remove the eyelid drapes.
33. Instill antibiotic and steroid drops
34. Recheck the flap alignment at the slit lamp prior to discharge to assure correct flap alignment
35. Place protective shields over the eye(s) and discharge the patient.

Format: video
Identifier: Moran_CORE_20263
Faculty Approval by: Mark Mifflin, MD

Russell Swan, MD, ©2015. For further information regarding the rights to this collection, please visit: http://morancore.utah.edu/terms-of-use/

Photorefractive Keratectomy (PRK)

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Title: Photorefractive Keratectomy (PRK)
Author (s): Russell Swan, MD; Mark Mifflin, MD
Date: 01/30/2016
Keywords/Main Subjects: Photorefractive keratectomy; PRK, Refractive surgery; Myopia; Hyperopia; Mitomycin C; Astigmatism
Diagnosis: Myopia, astigmatism
Description: This video demonstrates a standard surgical technique for photorefractive keratectomy at the University of Utah Moran Eye Center with Dr. Mark Mifflin. Below is our standard protocol:

1. Calibrate and program the excimer laser
2. Prepare the operative cart with the instruments and supplies necessary to perform the procedure
3. Prepare the patient with the proper sedation
4. Instill topical anesthesia, antibiotics and NSAID drops into the operative eye(s) and clean the eyelashes and fornices
5. Position the patient on the laser table
6. Drape the eye, being sure to isolate the eyelashes and meibomian glands
7. Place a locking eyelid speculum to obtain adequate exposure
8. Center the eye in the operative field by adjusting the microscope and/or head position
9. Use 8.0mm alcohol well to place 20% alcohol on the epithelium for 40 seconds to loosen it
10. Rinse the eye with 3cc of BSS
11. Dry the fornices of excess fluid with a microsurgical sponge
12. Use Sloane micro-hoe and Mahoney hockey stick to remove epithelium and smooth Bowmans
13. Use a microsurgical sponge to remove excess fluid from the bed to obtain uniform hydration
14. Ablate the stromal bed with programmed refraction in the laser
15. For hyperopic ablations or myopic ablations >-6.0D use MMC (typically 12 seconds).
16. Copiously flush surface with BSS, particularly if MMC is used
17. Instill antibiotic and steroid drops
18. Place bandage contact lens in eye

Format: video
Identifier: Moran_CORE_20259
Faculty Approval by: Mark Mifflin, MD

Russell Swan, MD, ©2015. For further information regarding the rights to this collection, please visit: http://morancore.utah.edu/terms-of-use/

Refractive Surgical Complications

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