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Bausch & Lomb's Hansatome microkeratome

In preparation for Lasik, the eyelids are swabbed with an antiseptic solution to reduce the chance of infection. A mild sedative such as Valium is taken orally to relax the patient. The patient needs to be awake and able to follow commands during the procedure.

First, the eyelids are draped to keep the lashes out of the surgical field. A device called a speculum is inserted to keep the lids and the eye in an open position. Anesthetic eyedrops are dripped onto the eye to numb it. A ring is placed onto the eye to secure it. Vacuum is applied to make the eye firm. The vision usually dims or goes dark at this point. A flap-making device called a microkeratome is then attached to the ring and activated, to create a flap of corneal tissue.

This flap of tissue is thin, approximately 160-180 microns (the center of the cornea averages about 550 microns), and remains attached to the rest of the cornea by a hinge. The location of the hinge depends on the type of microkeratome used. The ring and microkeratome are removed from the eye.

The corneal flap is then flipped, opened like the cover of a book. Again, the flap remains attached at the hinge. The patient is directed to look at the red blinking fixation light of the laser. The red light is not the laser but is used for centering the laser treatment. The surgeon then begins the laser treatment by depressing a foot pedal. The total treatment time depends on the amount of prescription, but in most cases is less than a minute. There is no pain during the laser treatment.

Once the laser treatment has been completed, the corneal flap is replaced, closed like the cover of a book. The surgeon then squirts some irrigating fluid under the flap to clean the under- surface of debris. The flap is gently stroked with a tiny sponge to "squeegee" the remaining fluid out from under the flap. The flap is then allowed to dry into place. Proper positioning is verified by looking at inked alignment marks placed before the flap was made. Additional eyedrops, usually an antibiotic and a non-steroidal anti-inflammatory, are dripped onto the eye, before the drapes and speculum are removed.

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