Keratomileusis-In-Situ Using Manual Dissection of Corneal Flap for High Myopia

Overcorrection, regression and haze are some side-effects found after excimer laser photorefractive keratectomy (PRK) for high myopia. A new method attempts to avoid photoablation through Bowman's layer, using the stroma to flatten the cornea without use of a microkeratome. Manual surgical instruments such as the diamond blade, spatula, Pierce forceps, and Vannas scissors are used to remove a disc of anterior cornea. Minimal topical corticosteroids are used, avoiding the complications of prolonged corticotherapy. Six eyes underwent manual excimer laser keratomileusis-in-situ. Postoperatively, the epitheliums in these eyes initially were dry and excoriated. By the twentieth day, however, the eyes had re-epithelialized and recovered. The optical effect is the same as when keratomileusis is used. No more than three-fourths of the pre-existing myopia was used in the program as some undercorrection was desired.