I am 3 months post-op and my surgeon wants to suture my rt. cornea to try to eliminate striae. Is it usually sucessful; does it entail a flap-lift? Could it leave scarring that could prevent a fit to an rgp? I must decide right away and I can't find much info on it as it appears to be a rare procedure. Any help would be very much appreciated.
Thanks, Dawnmarie

Flap suturing can work very well at eliminating persistant striae. The procedure takes about 15-25 minutes. Your surgeon will then decide how long to keep the sutures in palce - from days to weeks. This technique is very effective. Having this procedure would not affect one's ability to wear contact lenses after the procedure.

I hope this helps

Bill Trattler, MD
Miami, FL

Flap striae are an uncommon occurrence after LASIK, but when they do occur,
they can cause blurriness of vision. If your MD has determined that the
striae are the source of your visual loss, there are a variety of strategies
to reduce or remove the striae. My technique is usually to lift the flap
under sterile conditions in our minor procedure room, and using hypotonic
saline float the flap and gently stroke the striae. The hypotonic saline
(some MDs use sterile water), causes the flap to swell temporarily and
thereby reduces the striae. Other strategies include creating a small
"scratch" or epithelial defect on the surface of the flap (without lifting
it) and using the hypotonic saline on the surface, if the striae are very
superficial.

Vincent deLuise MD, FACS
Waterbury, CT

Thank you Dr. Trattler and Dr. deLuise for your replies. I have not had a flap re-float, but the surgeon feels that at 3 months, it is too late and my only option is suturing. I am wondering if a re-float could still be effective at 3 months?
Thanks for your help,
dawnmarie

Someitmes striae can be removed with a flap float and hyptonic saline weeks to months out, but the results are less consistant. As I have mentioned, flap suturing does work. The decision as to which technique to use should be made by yourself and your doctor/surgeon. You of course can always get a second opinion.

Best of luck

Bill Trattler, MD
Miami, FL

It is true that the longer one waits, the more difficult it is to
remove visually significant flap striae. Nevertheless, flap lifting and
refloating with hypotonic saline and/or sterile water is a technique that
has worked well for other patients in the past, even several weeks postop. I
have not performed a flap refloat for striae at three months however, but
others have.
To be sure, some surgeons do both the flap refloat with hypotonic
saline and suturing of the flap edges to "stretch" the flap, but there is no
evidence in the peer-reviewed literature that this is necessarily so. An
option, if proper informed consent is obtained, would be to try the refloat
with hypotonic saline/sterile water on the stromal side, consider an
epithelial side irrigation with hypotonic saline and/or sterile water as
well (through a small epithelial defect made during the procedure) and see
how things go. Remember that flap lifts are done occasionally for a variety
of different reasons (retreatments, epithelial ingrowth, striae) and all
flap lifts do carry a small risk of epithelial rests or epithelial ingrowth,
infection or inflammation, and persistent striae. Good luck and please keep
us informed,.

Vincent de Luise MD FACS
Waterbury, CT

I am also considering flap suturing as a solution to my persistent wrinkles which didn't dissapear after two refloats.

I insist with a question I had posted some time ago.

I have been told that this procedure induces a high level of astigmatism due to the traction of the stitches. How much are we talking about? One diopter, ten diopters??

Does the astigmatism dissapear when the stitches are removed??

I would not want to change the adverse effects of the wrinkles for the adverse effects of the astigmatism.

Thanks,

Gabriel.

In my habds, I have seen mild amounts of astigmatism in some but not all patients who underwent flap suturing. It has not been very significant.
Of course - I do not know your surgeon and your surgeon's surgical technique.
I hope this helps.

Best of luck

Bil Trattler,MD
Miami, FL

You might want to ask your surgeon what type of sutures he will be using. Generally you will get less astigmatism with one, continuous running suture (anti-torque) rather than several interrupted sutures. Using this technique, I agree with Dr. Trattler that the astigmatism should not be a big problem.

Steven Corwin, MD
Atlanta, GA