Femto-Smile After Photo-Therapeutic Keratectomy In An Eye With Failed Lasik Flap (Would You Smile After Lasik Nightmare)

The aim of the case report is to present a challenging refractive case who experienced many complications during and after LASIK and how we dealt with such complications. It also describes Femto-SMILE as possible treatment for cornea after phototherapeutic keratectomy for melted thin irregualr flap.

The procedures was carried out at Roaya Vision Correction Center, Alexandria, Egypt.

23 years old medical student female presented requesting refractive surgery. At presentation, UCVA was 3/60 both eyes, manifest refraction for right eye was -3.50 -0.50 x 40º, left eye was -3.50 -0.25 x 160º. Her BCVA was 6/6 for both eyes.  At the time of surgery, starting with the right eye, on removing the suction ring microkeratome assembly, the flap was found to be thin, irregular, button-holed with epithelium covering large part of the bed, there is also free cap. The procedure was aborted.

On follow up of the patient, the flap showed progressive epithelial ingrowth, for which re-lifting of the flap and scrapping was impossible and may be associated with permanent loss of the flap, so conservative treatment was preferred.

Unfortunately, after three months the patient developed progressive melting of part of the flap with scarring of other parts. We decided to treat this cornea with Photo-therapeutic keratectomy (PTK).

After three months of follow up, the patient developed circumferential peripheral scar that was progressively increasing. With intense steroid treatment, the scar decreased significantly.

After three months, the scar was minimal and peripheral, the refraction was stable -5.50 -2.00 x 180º (BCVA 6/6), Corneal thickness was 468 µ. The decision for correction of such error was Femto-SMILE. Femto-SMILE was performed successfully for the patient. Post-operative follow up for one year revealed stable refraction with stable UCVA at 6/6.

In case of complications, you must revise your steps and search for any mistakes & take care of it thereafter. At the time of surgery, the microkeratome must be examined under the microscope to exclude blade imperfections. Suction must be checked all through the procedure of flap creation. Femto-SMILE may be a good option in patients with thin cornea following surface ablation.