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Use Murocel
sponges to indent the peripheral cornea
("striation test"-striae traverse
into cap)
Use a closed-blade
speculum to help keep the lashes out of
the way, especially if you don't drape or
tape the lids.
Reflect
the cap with a 26G cannula
Decenter
the flap nasally to help ensure the hinge
is not ablated.
Decenter
the flap inferiorly slightly if there is
significant superior corneal neovascularization.
When suction
is applied and the keratome is engaged in
the tracks, apply moderate downward (posterior)
pressure with the suction ring handle, so
that in the rare event suction is lost,
the keratectomy will still be flawless.
If the laser
being used has variable magnification, go
to a less powerful zoom when doing the keratectomy.
Prior to
applying the suction, warn the patient that
the fixation light might go out. Fear of
losing vision ranks high in the patient"
mind, and when the light goes out they will
panic, thinking they've gone blind, unless
they've been appropriately forewarned.
As with
photorefractive keratectomy, continuously
talk to the patient throughout the keratectomy
and the laser ablation. Let them know everything
is going fine, and they will be more relaxed
and cooperative
With the
Visx Star laser, turn down the ring illumination
and turn up the oblique halogen lights to
enable better patient fixation, and better
illumination of the pupil through the stroma
bed. This will improve centration.
Most importantly,
when first starting LASIK, be conservative
with your ablations. Regardless of what
other surgeons tell you about their experience
on their laser, start off by backing down
on your intended amount of correction. It
is very easy to retreat an undercorrection.
With more personal experience on your own
laser, you may begin to "push the envelope"
and get more aggressive with your corrections.
Hopefully these tips will help make LASIK
easier to master. When properly performed,
LASIK will usually create an ecstatic patient
and a proud surgeon.
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