Tamponade

Occasionally during the keratotomy, small blood vessels (limbal ciliary vessels) located in the very periphery of the cornea are cut resulting in bleeding at the margins of the stromal bed.

The normal cornea is avascular (without blood vessels). Occasionally during the keratotomy, small blood vessels (limbal ciliary vessels) located in the very periphery of the cornea are cut, resulting in bleeding at the margins of the stromal bed (Illustration 10). This is a normal occurrence and is seen more frequently as larger flaps are being made to accommodate the larger treatment zones delivered by the latest generation lasers. Although the resultant bleeding is minimal in amount, it can cause several direct and indirect problems. One of these problems is the direct masking of the laser beam from bleeding onto the target stromal surface. Other potential indirect problems occur as a consequence of the increased manipulation to stop the bleeding. Several of these include inadvertently creating micro-abrasions at the margins of the flap bed, possibly increasing the risk of epithelial in-growth, and changed hydration status of the target tissue from prolongation of the procedure thereby altering the laser's effectiveness.

Conventional LASIK - Several techniques and methods are currently utilized to control and stop the limbal ciliary vessel bleeding. The most common method is to apply direct pressure to the bleeding vessels utilizing a surgical sponge. A less common method utilizes a combination of direct pressure and application of a topical vasoconstrictor. Because the surgeon's hands are "tied up" while holding pressure to stop the bleeding (which may becoming from multiple sites), the procedure may be delayed. In addition, the direct application of a sponge to the margins of the flap bed (where the source of the bleeding is) may create small micro-abrasions, which have been implicated in contributing to epithelial in-growth (Illustration 11).

LAHayeSIK™ Surgical System - The LAHayeSIK™ Handpiece is designed to provide 360° of non-traumatic tamponade of the limbal ciliary vessels thereby facilitating hemostasis (stoppage of bleeding) (Illustration 12). LAHayeSIK™ efficient means of hemostasis allows the surgeon to minimize direct manipulation to the bleeding vessels and flap/bed margins and facilitates with no delay of the procedure. In addition, LAHayeSIK™ Surgical System is designed to pre-wash blood from the surgical field prior to the next step, corneal flap reflection and placement.

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