Timing of retreatment after a partial flap during laser in situ keratomileusis

Outcomes of Retreatment after Aborted Laser In Situ Keratomileusis due to Flap Complications

Purpose:

To determine the refractive outcomes and complications of retreatment after aborted primary laser in situ keratomileusis (LASIK) due to flap complications.

Materials and Methods:

This retrospective study evaluated 50 retreated eyes that had flap complications during primary LASIK at the Eye Consultants Center in Riyadh, Saudi Arabia. Data were analyzed for patients with at least 3 months follow-up post retreatment.

Results:

Thirty-three eyes of 31 consecutive patients with 3 months follow-up or later post retreatment were included. The primary LASIK was aborted due to incomplete flaps in 22 eyes (66.7%), buttonhole flaps in 7 eyes (21.2%), free partial flaps in 3 eyes (9.1%), and a free complete flap in 1 eye (3.0%). Twenty-two eyes (66.7%) were retreated with LASIK, and 11 eyes (33.3%) were retreated with surface ablation. The mean spherical equivalent (SE) was –0.23 ± 0.72 D, the mean astigmatism was –0.65 ± 0.89 D, and the mean loss of the best corrected visual acuity (BCVA) was 0.78 lines at the final postoperative visit. At the last postoperative visit, 20/30 or better BCVA was achieved in 90.1% of eyes that underwent retreatment with LASIK and in 91% of eyes that were retreated with surface ablation. There was no statistical difference in postoperative SE between eyes retreated with LASIK and eyes retreated with surface ablation (P = 0.610). There was no statistical difference in postoperative BCVA between eyes retreated with LASIK and those retreated with surface ablation (P = 0.756). There were no intraoperative complications and no eyes required a second retreatment.

Conclusion:

Creation of a flap after a previous intraoperative flap complication was not associated with any complications. The refractive outcomes of retreatment with LASIK or surface ablation were comparable and reasonably favorable.

Intraoperative management of partial flap during LASIK: a small case series report

PURPOSE

To report the intraoperative management of incomplete microkeratome LASIK flaps.

DESIGN

Small, retrospective, noncomparative, interventional case series.

PARTICIPANTS

Five outpatients.

METHODS

In 5 eyes of 5 patients, the premature stop of the microkeratome resulting from mechanical obstacles resulted in an incomplete flap that would not allow for the completion of the LASIK procedure. After the careful realignment of the partial flaps and the removal of the identified obstacles, the second pass of the microkeratome resulted in flaps of the intended size.

MAIN OUTCOME MEASURES

Final creation of a flap as intended, completion of the procedure, and visual and refractive outcome of the operative eyes.

RESULTS

The second pass of the microkeratome resulted in flaps as planned. All the procedures were completed, and the operative eyes that were followed up for at least 3 months had excellent visual and refractive results.

CONCLUSIONS

The second pass of the microkeratome can successfully manage incomplete flaps resulting from microkeratome premature stop as a result of mechanical obstacles.

PRK for epithelial ingrowth in buttonhole after LASIK

PURPOSE

To evaluate the efficacy of photorefractive keratectomy (PRK) in progressive central epithelial ingrowth after buttonholes after laser in situ keratomileusis (LASIK).

METHODS

Two eyes of two patients with progressive central epithelial ingrowth and fibrosis in flap buttonholes after LASIK underwent PRK 6 months following primary surgery.

RESULTS

Epithelial ingrowth was treated successfully in both eyes. The uncorrected visual acuities were 20/20, and there was no evidence of recurrent epithelial ingrowth after 6 months.

CONCLUSIONS

Photorefractive keratectomy is a useful modality in the treatment of central epithelial ingrowth in buttonholes following LASIK. As a single-step surgery, it offers both therapeutic and optical advantages by simultaneously clearing the corneal opacity and correcting the refractive error in selected cases.