LASIK NIGHTMARE - INCOMPLETE AND LOST FLAP
Published 2022 - 26th ESCRS Winter Meeting
Reference: CR14 | Type: Cornea Day Case Presentations | DOI: 10.82333/2kf4-rw64
Authors: Celso Cabral Costa* 1 , Andreia Rosa 1 , João Gil 1 , Cristina Tavares 1 , Esmeralda Costa 1 , Maria João Quadrado 2 , Joaquim Murta 3
1Department of Ophthalmology,Centro Hospitalar e Universitário de Coimbra (CHUC),Coimbra,Portugal, 2Clinical Academic Center of Coimbra,Clinical Academic Center of Coimbra,Coimbra,Portugal, 3Faculty of Medicine,University of Coimbra,Coimbra,Portugal
A 43-year-old female was referenced to our department after a history of incomplete and lost flap, when attempting to perform microkeratome LASIK on her right eye.
Her pre-operative right eye refraction was -1.75 D and her best-corrected visual acuity was 0.0 logMAR. Topography showed a regular with-the-rule astigmatism with normal keratometry readings.
According to the referral letter, there was a suction loss during the microkeratome excursion. The result was a partial temporal free cap, which was lost and consequently not repositioned.
Her post-operative refraction was -0,50 -7,00 x 80º and her best-corrected visual acuity was 0.8 logMAR. Topography showed two half-divided cornea regions, one very steep with high K values and another one very flat with low K values. The AS-OCT showed a localized loss of epithelium and stroma.
We performed phototherapeutic keratectomy and topography-guided photorefractive keratectomy. We chose to regularize the corneal surface instead of attempting to correct the refractive error, due to the great difference in the curvature and pachymetry in the two cornea halves. Her refraction 3 months post-op with -3.00 -1,50 x 80º was 0.18 logMAR.
Incomplete flap due to loss of suction is a rare LASIK complication. It has a very low incidence and is more likely to occur in flat corneas, deep orbits, inadequate suction and decentered ring placement.
If an incomplete flap is created, the surgeon should reposition the shredded flap as best as possible and do not proceed with the excimer laser. If the flap is lost, then topoguided PRK is a viable option with good results from the therapeutic point of view.