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Buttonhole in 315,625 LASIK procedures: incidence and management

Poster Details

First Author: J.Ortega-Usobiaga SPAIN

Co Author(s):    M. Martinez   F. Llovet           

Abstract Details


We report the largest series to date of buttonholes, with all procedures carried out in the same institution. Cases were retrospectively reviewed to provide information on clinical course, risk factors, and treatment, with the aim of improving our understanding of this entity.


Clķnica Baviera (Spain)


This retrospective case-series review comprised 315,625 eyes who underwent LASIK surgery consecutively at Clķnica Baviera. More than 40,000 refractive procedures are performed each year at the clinic, a private ophthalmologic institution with 19 centers and 84 surgeons throughout Spain, using the same manual microkeratome (Moria One). Patients with a diagnosis of buttonhole were identified by an electronic search of medical histories. Diagnosis of buttonhole was based on slit-lamp findings. The medical histories were reviewed to collect the following data: age, gender, involved eye, preoperative and postoperative distance corrected visual acuity (CDVA), postoperative uncorrected distance visual acuity (UDVA), risk factors, medical and surgical treatment, and complications.


We identified 138 buttonholes. The indicence in our series is 0.044 %. According to preoperative mean keratometry (MK) 11,826 eyes had MK ? 41 D (4 buttonholes; 0.034 %), 287,141 had MK between 41 and 46 D (123 buttonholes; 0.042 %) and 14,258 had MK >46 D (11 buttonholes; 0.077 %); there were not statistically significant differences (p>0.05).


In summary, the occurrence of buttonhole with our microkeratome appeared in 1 out of 2,285 procedures and we did not find that preoperative MK was a risk factor. Buttonhole is a potentially vision-threatening complication, and proper management can enable useful vision to be preserved. FINANCIAL DISCLOSURE?: No

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