this invention describes a method , the devices , and the materials used for altering corneal shape which does not involve removing corneal tissue , which is reversible , and which may be adjusted at a later date . although the present invention may be most useful for procedures where net tissue addition is desirable , such as treatment of hyperopia , it is also likely that it will be effective for treating myopia , astigmatism , and irregular astigmatism . this is shown in fig1 - 5 and described hereinbelow . first , a lamellar flap 10 of corneal tissue in the anterior corneal cap 12 is made . this flap thickness is usually to a depth of approximately 130 to 160 microns , and comprises a corneal diameter of approximately 8 . 0 to 9 . 5 mm . such a corneal flap is made easily with presently available microkeratomes ( not shown ), such as the corneal shaper microkeratome manufactured by chiron corporation ( irvine , calif .). following creation of the corneal flap , the flap is temporarily reflected to the side exactly as it is in the lasik procedure . a discrete quantity of gel material 14 is placed on the bed 16 of the flap , as shown in fig2 . the volume of the gel material may be predetermined by the intended refractive change . in a preferred embodiment of the invention , the gel material will polymerize , that is &# 34 ; set up &# 34 ;, after a predetermined period of time . thus , the gel material 14 , as one of its characteristics , will have the property of polymerizing or becoming more solid with a short passage of time after it is placed in the corneal bed 16 . other appropriate materials , such as a solid lenticule , may also be employed . after placing the gel material , the surgeon replaces the flap into position over the gel , as shown in fig3 . using a suction device which may be operatively associated with the commonly employed microkeratome , a suction mold 20 is affixed to the corneal surface for a predetermined period of time , as illustrated in fig4 . when suction is activated , the suction ring 22 drives the cornea into the mold which has a shape and curvature matching the desired dimension of the cornea following treatment . the viscous nature of the gel allows the anterior corneal cap to assume the shape of the posterior surface 24 of the mold 20 . as alternatives for conforming the corneal cap and gel , pressure may be applied thereto without utilizing suction , the gel may be configured to the appropriate dimensions prior to placement , the gel can be expandable , or other appropriate means may be employed to achieve the desired result . because the gel allows the corneal flap to be lifted into a new position , the anterior corneal cap 12 is free to &# 34 ; float &# 34 ; into a new shape and curvature that matches the posterior curvature of the mold . the suction pressure is released and the gel polymerizes into position . once the gel is polymerized , the anterior flap is held into its new position . epithelial cells at the margin of the flap quickly heal , exactly as they do following the standard lasik procedure . postoperative care of the patient is exactly the same as performed with the present lasik procedure . little postoperative attention is needed , and routine antibiotic drops for 3 - 4 days are prescribed . because the gel polymerizes and holds the flap into its new position , and the cornea has not been structurally destabilized as it has following rk and other procedures , the structural integrity of the cornea is maintained . wound healing is not invoked and there are no significant epithelial stromal interactions . the outcome of surgery is expected to be stable and will not be influenced by the effects of epithelialstromal wound healing as it is , for example , following excimer laser photorefractive keratectomy and radial keratotomy . because no corneal tissue is removed , it is possible to surgically open the flap and peel out the gel , making polymerizing gel intrakeratophakia ( pgi ) a reversible technique . by using a number of different mold profiles available for attachment and use with the suction ring , and by varying the diameter of the flap , the surgeon can treat a wide variety of refractive errors when the desired radius of curvature of the anterior corneal cap is determined .
a method , materials , and medical devices are disclosed for providing an intralamellar insert between opposing layers formed in the cornea . upon preparing the cornea by partially separating a flap of tissue , a gel or similar material is placed thereon and conformed to desired dimensions to correct refractive errors of the cornea .