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The Lasik Procedure: The Two Stages (cont'd.)
Much emphasis and debate in the literature, at refractive meetings, and even physician advertising are still focused on flap creation. An ongoing debate continues over which technology is better at flap creation: a blade keratome or the laser? In reality, the incidence of complications associated with Stage I of the LASIK procedure are minute in comparison to the overall incidence of less than optimal LASIK outcomes.

STAGE II – Stage II of the LASIK operation begins the moment the corneal flap is reflected (opening the incision) and is completed when the corneal flap is returned and sealed in its original position (closure of the incision). (Illustration 2)

The published data confirms that the majority of complications and less-than-optimal outcomes requiring additional medical and surgical management arise from the technically demanding Stage II of the procedure.  At minimum, this incidence is 27 times greater than keratome or excimer laser related complications. This value is calculated by totaling the minimal percentages of each of the complications (not directly associated with keratome or excimer laser technologies), including infectious keratitis (0.3%), DLK (1%), micro-striae and macro-striae (1%), epithelial ingrowth (0.92%), under and over corrections (5%), and dividing this total by the maximum published incidence of keratome-related complications (0.3%).

There are at least nine functions---in addition to laser ablation---associated with Stage II maneuvers. These include: (1) containment of the surgical field; (2) fixation and control of eye movements; (3) corneal flap placement; (4) removal of laser beam masking moisture; (5) plume evacuation; (6) irrigation; (7) aspiration; (8) flap repositioning and realignment; and (9) flap adherence. Each step is predisposed to complications which must be addressed if there is to be consistency, standardization, and strict adherence to basic surgical principles and techniques required to avoid sub-optimal outcomes.

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