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Welding


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Welding, Craig - Aurora, CO, 10/16/2005
Never heard of risk of welding, Eye, 10/17/2005, (#1)
Response, Glenn - Sacramento, CA, 10/20/2005, (#2)

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"Welding"
Posted by Craig - Aurora, CO on 22:21:10 10/16/2005
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Can welding iron (with protective mask)cause complications to my surgery?
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1. "Never heard of risk of welding"
Posted by Eye on 21:35:54 10/17/2005
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Hi. Supposedly you'd be wearing a mask and nothing could fly in your eye. Your mask should also protect you from the bright light. There are enough complications from refractive surgery to worry about without throwing in the welding angle, which doesn't sound like a problem. Read these recent studies and THEN decide if you want to have your eyes cut and burned:
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Recent articles from Emory University and the Mayo Clinic make a clear case for withdrawal of FDA approval for the LASIK procedure

Permanent Disease Changes Present in all Post-LASIK Corneas!

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retri...=15604873&query_hl=1

Cornea. 2005 Jan;24(1):92-102.

Pathologic findings in postmortem corneas after successful laser in situ keratomileusis.

Kramer TR, Chuckpaiwong V, Dawson DG, L'Hernault N, Grossniklaus HE, Edelhauser HF.

Emory Eye Center, Emory University, Atlanta, GA 30322, USA.

PURPOSE: To examine the histologic and ultrastructural features of human corneas after successful laser in situ keratomileusis (LASIK).

METHODS: Corneas from 48 eyes of 25 postmortem patients were processed for histology and transmission electron microscopy (TEM). The 25 patients had LASIK between 3 months and 7 years prior to death. Evaluation of all 5 layers of the cornea and the LASIK flap interface region was done using routine histology, periodic acid-Schiff (PAS)-stained specimens, toluidine blue-stained thick sections, and TEM.

RESULTS: In patients for whom visual acuity was known, the first postoperative day uncorrected visual acuity was 20/15 to 20/30. In patients for whom clinical records were available, the postoperative corneal topography was normal and clinical examination showed a semicircular ring of haze at the wound margin of the LASIK flap. Histologically, the LASIK flap measured, on average, 142.7 microm (range, 100-200). A spectrum of abnormal histopathologic and ultrastructural findings was present in all corneas. Findings at the flap surface included elongated basal epithelial cells, epithelial hyperplasia, thickening and undulations of the epithelial basement membrane (EBM), and undulations of Bowman's layer. Findings in or adjacent to the wound included collagen lamellar disarray; activated keratocytes; quiescent keratocytes with small vacuoles; epithelial ingrowth; eosinophilic deposits; PAS-positive, electron-dense granular material interspersed with randomly ordered collagen fibrils; increased spacing between collagen fibrils; and widely spaced banded collagen. There was no observable correlation between postoperative intervals and the severity or type of pathologic change except for the accumulation the electron-dense granular material.

CONCLUSIONS: Permanent pathologic changes were present in all post-LASIK corneas. These changes were most prevalent in the lamellar interface wound. These changes along with other pathologic alterations in post-LASIK corneas may change the functionality of the cornea after LASIK.

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Corneal Nerve Damage Continues to Increase years 2-3 after LASIK
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retri...=15505047&query_hl=2

Invest Ophthalmol Vis Sci. 2004 Nov;45(11):3991-6.

Corneal reinnervation after LASIK: prospective 3-year longitudinal study.

Calvillo MP, McLaren JW, Hodge DO, Bourne WM.

Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.

PURPOSE: To measure the return of innervation to the cornea during 3 years after LASIK.

METHODS: Seventeen corneas of 11 patients who had undergone LASIK to correct myopia from -2.0 D to -11.0 D were examined by confocal microscopy before surgery, and at 1, 3, 6, 12, 24, and 36 months after surgery. In all available scans, the number of nerve fiber bundles and their density (visible length of nerve per frame area), orientation (mean angle), and depth in the cornea were measured.

RESULTS: The number and density of subbasal nerves decreased >90% in the first month after LASIK. By 6 months these nerves began to recover, and by 2 years they reached densities not significantly different from those before LASIK. Between 2 and 3 years they decreased again, so that at 3 years the numbers remained <60% of the pre-LASIK numbers (P <0.001). In the stromal flap most nerve fiber bundles were also lost after LASIK, and these began recovering by the third month, but by the third year they did not reach their original numbers (P <0.001). In the stromal bed (posterior to the LASIK flap interface), there were no significant changes in nerve number or density. As the subbasal nerves returned, their mean orientation did not change from the predominantly vertical orientation before LASIK. Nerve orientation in the stromal flap and the stromal bed also did not change.

CONCLUSIONS: Both subbasal and stromal corneal nerves in LASIK flaps recover slowly and do not return to preoperative densities by 3 years after LASIK. The numbers of subbasal nerves appear to decrease between 2 and 3 years after LASIK. The orientation of the regenerated subbasal nerves remains predominantly vertical.

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LASIK Flap Only 2.4% as strong as Normal Cornea
http://www.journalofrefractivesurgery.com/showAbst.asp?thing=11320

Cohesive Tensile Strength of Human LASIK Wounds With Histologic, Ultrastructural, and Clinical Correlations

Journal of Refractive Surgery Vol. 21 No. 5 September/October 2005

Ingo Schmack, MD; Daniel G. Dawson, MD; Bernard E. McCarey, PhD; George O. Waring III, MD, FACS, FRCOphth; Hans E. Grossniklaus, MD; Henry F. Edelhauser, PhD

PURPOSE
To measure the cohesive tensile strength of human LASIK corneal wounds.

METHODS
Twenty-five human eye bank corneas from 13 donors that had LASIK were cut into 4-mm corneoscleral strips and dissected to expose the interface wound. Using a motorized pulling device, the force required to separate the wound was recorded. Intact and separated specimens were processed for light and electron microscopy. Five normal human eye bank corneas from 5 donors served as controls. A retrospective clinical study was done on 144 eyes that had LASIK flap-lift retreatments, providing clinical correlation.

RESULTS
The mean tensile strength of the central and paracentral LASIK wounds showed minimal change in strength over time after surgery, averaging 2.4% (0.72 ± 0.33 g/mm) of controls (30.06 ± 2.93 g/mm). In contrast, the mean peak tensile strength of the flap wound margin gradually increased over time after surgery, reaching maximum values by 3.5 years when the average was 28.1% (8.46 ± 4.56 g/mm) of controls. Histologic and ultrastructural correlative studies found that the plane of separation always occurred in the lamellar wound, which consisted of a hypocellular primitive stromal scar centrally and paracentrally and a hypercellular fibrotic stromal scar at the flap wound margin. The pathologic correlations demonstrated that the strongest wound margin scars had no epithelial cell ingrowth—the strongest typically being wider or more peripherally located. In contrast, the weakest wound margin scars had epithelial cell ingrowth. The clinical series demonstrated the ability to lift LASIK flaps without complications during retreatments up to 8.4 years after initial surgery, correlating well with the laboratory results.

CONCLUSIONS
The human corneal stroma typically heals after LASIK in a limited and incomplete fashion; this results in a weak, central and paracentral hypocellular primitive stromal scar that averages 2.4% as strong as normal corneal stroma. Conversely, the LASIK flap wound margin heals by producing a 10-fold stronger, peripheral hypercellular fibrotic stromal scar that averages 28.1% as strong as normal corneal stromal, but displays marked variability. [J Refract Surg. 2005;21:433-445.]

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2. "Response"
Posted by Glenn - Sacramento, CA on 16:02:26 10/20/2005
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Welding with proper eye protection should have no effect on the efficacy of LASIK or similar surgery to reduce your need for glasses, however welding can have a negative effect on your eye's health.

Even with proper protection, studies have found that welders have different rates of cataracts and other compromising eye responses. In addition to your goggles, you may want to investigate vitamin and mineral supplements that are designed specifically for ocular health.

Be sure to discuss your occupation and vision requirements with your potential refractive surgeon.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

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