LATE TRAUMATIC LASIK FLAP DISLOCATION: TWO CASE REPORTS

Published 2022 - 26th ESCRS Winter Meeting

Reference: CR15 | Type: Cornea Day Case Presentations | DOI: 10.82333/ex6m-ja30

Authors: Victoria Segura Fernandez - Nogueras* ¹ , Yolanda Fernandez Barrientos ¹ , Juan Marín Nieto ²

¹Ophthalmology,Hospital Universitario Virgen de la Victoria,Malaga,Spain, ²Ophthalmology,Hospital Regional Carlos Haya,Malaga,Spain

Laser-assisted in-situ keratomileusis (LASIK) is one of the most common surgeries performed worldwide. Its efficacy, outcomes predictability, and safety have experienced a great development over the years but it is not exempt of intraoperative and postoperative risks. We aim to report two cases of late LASIK flap traumatic dislocation, and so review the management of this ocular emergency.

Department Of Ophthalmology of Universitary Hospital Virgen de la Victoria, Málaga (Spain).

Case 1: a 39 years-old female with myopic LASIK performed 5 years ago who hit her left eye (LE) with the cover of a book. Eleven days after the traumatism, she complained about intense pain and blurry vision, Snellen uncorrected distance visual acuity (UDVA) was 20/32 and corrected distance visual acuity (CDVA) was 20/25, refraction +1,25 -2,5X140º. The biomicroscopy revealed epithelial ingrowth (EIG) and flap-folds. Surgical management was decided, the procedure consisted of lifting the dislocated flap, debriding the EIG, flattening the flap and repositioning it with 10.0 Nylon sutures. After four months the CDVA was 20/20 in LE, residual refraction was +0 -0,5X 85º and no surface symptoms were reported.

Case 2: a 30 years-old man with myopic LASIK 10 years ago who suffered a blunt work trauma in his right eye (RE) three months before consulting. The Snellen UDVA was 20/400 and CDVA 20/32, the slit lamp examination showed several small foreign bodies (FB) and a central flap tear, with EIG. Surgery was proposed to lift the flap and remove the FB, however, the great friability of the flap made it no longer optically viable, so it was resected. After four months of follow up, UDVA 20/32 and CDVA 20/32, residual refraction -0,75 -1X 10º. Mild haze is still visible in the anterior corneal stroma.

Late flap dislocations are infrequent: from 0.012% to 2,5% according to the literature. An early evaluation by a refractive surgeon guarantees quick and correct surgical management making it possible to achieve good visual acuity and avoid further complications such as EIG and flap-folds.