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First Author: R.Al-Saady THE NETHERLANDS
Co Author(s): I. van der Meulen C. Nieuwendaal R. Lapid-Gortzak
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To report the results of visual, refractive, topographic, and wavefront aberrometry outcomes after laser in situ keratomileusis (LASIK) flap amputations for flap melt secondary to infection and inflammation.
Ophthalmology department of Academic Medical Center, Amsterdam, The Netherlands.
Case report of 3 eyes of 2 patients, with visual acuity, topography, refractive, and wavefront aberrometry data after amputation of a LASIK flap.
In 1 patient a LASIK flap was amputated after repeated interventions for epithelial ingrowth. After satisfactory resolution of the epithelial ingrowth, the patient developed a herpetic keratitis in this eye, and flap melt ensued. This culminated in a flap amputation and relatively preserved uncorrected distance visual acuity (UDVA) in the right eye of 0.63 and a corrected distance visual acuity (CDVA) of 1.2, with a refraction of S+1.75C-0.50x70. The second patient developed, after a photorefractive keratotomy (PRK) on LASIK flaps, a steroid induced lamellar keratitis (SILK) with melting of the LASIK flaps. The irregular flap remnants were removed. The final outcomes were similar for both UDVA and CDVA in both eyes, OD 1.0 with a refraction of S-1.75 C-3.50x55 and OS 0.7 with a refraction of S +0.25-2.25x104. In terms of topographical changes all three eyes had a highly irregular topography, with no trend towards a definite pattern. The wavefront aberrometry was highly aberrated with a mean root of mean square (ROMS) of 2.42 microns at 6 mm, for the first case. For the second case, aberrometry showed; OD mean ROMS of 1.29 microns at 6mm. OS had a mean ROMS of 0.91 microns at 6 m.
LASIK flap amputation results in relatively preserved uncorrected distance visual acuity, with a residual refraction in which the cylinder component is the most apparent. The topography shows surface irregularity. Higher order aberrations are increased. All three eyes showed an increase in both coma and trefoil changes, but again no definite pathognomonic pattern to be discerned. More study is needed in order to find a definite trend in wavefront patterns after LASIK flap amputations. Based on 3 cases, it seems that the visual impact of flap loss is relatively smaller than expected.