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Interface blood as a new indication for flap lift after LASIK using the WaveLight FS200 femtosecond laser

Poster Details

First Author: R.Krueger USA

Co Author(s):    J. Au              

Abstract Details


To report the indications for flap lift, including a new indication of interface blood after using the FS200 laser for flap creation in LASIK at a single center over a 33 month period.


Cleveland Clinic Cole Eye Institute in Cleveland, OH U.S.A.


We reviewed the medical records of all eyes having LASIK by a single surgeon (RRK) using the WaveLight FS200 femtosecond laser in conjunction with the WaveLight Allegretto Wave Eye-Q excimer laser at the Cole Eye Institute during months of 3/2011 to 11/2013. We then recorded the number of eyes requiring flap lift, and the reason for this intervention during the same period. Based on a new indication of interface blood, an additional set of eyes were examined during the subsequent months of 12/2013 to 2/2014 to determine the incidence of blood in the evacuation canal of the FS200 created flap. Care was then taken not to fully dissect the interface to the canal edge when lifting these flaps during the primary LASIK procedure.


A total of 1597 eyes received FS200 femto-LASIK during this first interval (33 months), with 11 eyes (0.7%) requiring a flap lift. Visually significant interface blood was noted in 3 eyes (0.2%), diffuse lamellar keratitis of grade 3 or more in 3 eyes (0.2%), visually significant interface debris in 2 eyes (0.1%) and flap striae with a vision of 20/25 or worse in 3 eyes (0.2%). No eyes were noted to have epithelial ingrowth requiring a flap lift. In the second interval (2-3 months) 95 eyes had LASIK with the FS200 laser, and 20 eyes (21%) had some amount of blood in the canal extending from the limbal vessels. In none of these eyes, did the blood progress to the flap interface.


The indications and incidence of flap lift is acceptably low when using the WaveLight FS200 femtosecond laser, and in no eyes was the flap lifted for epithelial ingrowth, indicating a good quality to the edge of the laser's inverted side cut. The unique design of the evacuation canal of the FS200, however, extends to the edge of the limbal vasculature, and blood is frequently noted extending into the canal, and can rarely deposit into the flap interface, requiring a flap lift. Incomplete dissection of the flap to the canal edge, when blood is noted, seems to prevent the progression of blood into the interface. FINANCIAL INTEREST: One of more of the authors... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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