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Management of buttonhole flap during thin flap LASIK

Poster Details

First Author: T.Manoilo UKRAINE

Co Author(s):    G. Parkhomenko              

Abstract Details


To evaluate clinical results of different management of treatment after buttonhole formation during Thin flap Lasik


" Noviy Zir" clinic, Ukraine, Kyiv


24 eyes of 24 patients with buttonholed flap were included in retrospective study. All patients had myopia (5.2±1.4 D) and myopic astigmatism (2.6±0.9 D). Treatment plan was to perform Thin flap Lasik with Carriaso-Pendular microkeratome and topography-optimized ablation by Esiris (Shwind-eye-tech solution, Germany) eximer laser. Patients were divided on 2 groups depending of the area flap were buttonhole was occurred. Group 1: buttonhole occurred in the 4 mm central optic zone – 5 eyes, group 2: buttonhole was placed in the inferior or superior part of flap out of 4mm central optic zone – 19 eyes. In group 1 treatment strategy was to abort ablation and to do careful flap reposition, soft contact lens till next day for flap adaptation. After 3 months Lasek with mytomicin C (MMC) was performed in all cases. In group 2: cornea ablation, 30c applications of MMC 0.02% before putting flap back in place, soft contact lens till next day. Antibiotic and corticosteroid drops were prescribed as usual.


Button hole flap was created on left eyes in 83% (second cut of microkeratome blade), on right eye in 7% cases. In group 1 the final spherical equivalent refraction was -0.42±0.49 D. One eye had loss 1 line of best corrected visual acuity (BCVA). In group 2 all eyes achieved uncorrected visual acuity as preop BCVA. There was no loss of BCVA in group 2. Final spherical equivalent refraction was - 0.33±0.32 D. One flap was lifted and put back because of striae formation. No eyes need retreatment during follow up of 2 years.


Flap with buttonhole occurred more frequently in the second of 2 consecutively treated eyes. Buttonhole located out of 4mm optical zone didn’t influent to achieved BCVA and postop refraction and allow finish ablation in same session. In case of flap with buttonhole in area of 4mm optical zone aborted ablation and postponed treatment allow to heal cornea and to achieve planning postop refraction with minimal influence to visual acuity. Financial disclosure - no FINANCIAL DISCLOSURE?: No

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