Laser-Assisted In Situ Keratomileusis

Laser assisted in situ keratomileusis also know as LASIK is a type of refractive surgery,
an improved version PRK or photorefractive keratectomy, it treats myopia (near-sightedness),
hyperopia (far-sightedness) and astigmatism (when the cornea curves or flattens unevenly).
LASIK uses a highly specialized laser-called an excimer laser-to reshape the cornea and
give focused vision. The excimer laser emits pulses of concentrated, cool, invisible ultraviolet
light. That when targeted to specific spots on the cornea, gently and precisely reshapes the
cornea by removing extremely tiny amounts of tissue (25 100,000ths of a millimeter at a time),
without disturbing other tissue.

Indication

 Hyperopia (Far-sightedness)
 Myopia (Near-sightedness)
 Astigmatism (improper curvature of the cornea)

Contraindication

 unstable refractive error

 active collagen vascular disease (especially in the presence of iritis or scleritis)
 pregnancy
 presence of a pacemaker,
 any ongoing active inflammation of the external eye (eg, conjunctivitis, severe dry eye)
 Refractive error outside the range of laser correction (it is common to have patients
treated slightly outside the approved range, but they must understand that it is an off-
label use of the excimer laser).

Other contraindications

 leaving less than a calculated residual bed of 250 µm of untouched cornea, as well as
signs, symptoms, or topographic findings consistent with keratoconus. Residual stromal
bed thickness is calculated by subtracting ablation depth plus flap thickness from the
corneal thickness as measured by pachymetry.

 Patients who are on Accutane (isotretinoin), Cordarone (amiodarone hydrochloride), and

Imitrex (sumatriptan) should be treated with caution, and patient counseling should be
provided because these medications may adversely affect corneal wound healing.
  A history of herpetic keratitis is a relative contraindication. Although patients have been
treated safely with a history of herpes simplex keratitis and the appropriate use of
prophylactic antivirals, reactivation of the virus following treatment remains a concern.

 Patients who cannot cooperate with procedures under a topical anesthetic and cannot
accurately fixate or lay flat without difficulty are poor candidates for refractive surgery.

Procedure

In summary the procedure involves creating a thin flap on the eye, folding it to enable
remodeling of the tissue beneath with a laser. The client is conscious while this operation is
going on, medications such as sedative or anesthetic eye drops are given.

1. Flap is created to the corneal tissue. Corneal suction is applied to the eye, holding the
eye in place. Once it is immobilized, a metal blade or IntraLASIK procedure creates a
series of tiny closely arranged bubbles within the cornea.
2. The laser remodels the corneal stroma by vaporizing tissue in a fine manner without
undue damage.
3. LASIK flap is carefully repositioned over the treatment area. Routine check for proper
placement and absence of bubbles indicates proper placement.

Possible Risks:

 Undercorrections – These are common in people who are nearsighted. If little tissue is
taken off, little effect on the clarity of the vision will happen.
 Overcorrections – This happens when too much tissue is taken off.
 Astigmatism – This happens when there is too much eye movement during the surgery.
It results to uneven tissue and requires another surgery.
 Glare, halos and double vision – There are cases that there is difficulty at seeing at
night, or even halos or double visions. Eyedrops with corticosteriod are used to prevent
further inflammation and better movement of the eyes after surgery.
 Dry eye – This is due to blockage or trauma on the lachrymal glands.

Nursing Management

Preoperative stage:

1. Encourage verbalization of feelings of the unfamiliar procedure.

 2. Assess the level of understanding of the client regarding the upcoming surgery,
the sedation, procedure as well as the responsibility to take of the eye newly
operated.
3. Encourage compliance to prophylactic antibiotics to prevent risk of infection.

Postoperative Stage:

1. Encourage compliance on a course of antibiotic and anti-inflammatory eye drops.

These are continued in the weeks following surgery.
2. Instruct the client to sleep or lie on the unoperated side to prevent increase of
interocular pressure.
3. Instruct the client to avoid overexertion such as straining, lifting and pushing
objects.
4. Frequently reorient the client to the environment and the date and time of the day
to prevent sensory deprivation.
5. Teach the client regarding the signs of complications such as any sharp pain or
feelings of pressure in the eyes which may indicate hemorrhage, increased
intraocular pressure or infection. When this happens, consult the surgeon
immediately to prevent further complications.

Bibliography

 Lusby, F. (2014). LASIK eye surgery. Medlineplus. Retrieved from:

http://www.nlm.nih.gov/medlineplus/ency/article/007018.htm
 Stang, D. (2012). LASIK Eye Surgery. Healthline.Retrieved
From:http://www.healthline.com/health/lasik-eye-surgery#Overview
 ANTIPUESTO, D.J.(2010). LASIK (Laser Eye Surgery). Nursningcrib. Retrieved
from: http://nursingcrib.com/perioperative-nursing/lasik-laser-eye-surgery/
 Taravella, M. (2014). Lasik Myopia. Medscape. Retrieved
from:http://emedicine.medscape.com/article/1221604-overview