HOW TO MANGE OLD FOLDED LASIK FLAP

Published 2023 - 27th ESCRS Winter Meeting

Reference: CR14 | Type: Case Report (Cornea Day) | DOI: 10.82333/kmpc-fp15

Authors: Hazem El-Nashar* ¹

¹consultant of ophthalmology,The Memorial Institute For Ophthalmic Resarch,Giza,Egypt

Purpose

to show how to improve vision in such complicated situation using femto lasik. how to creat new flap and the too much challenges i faced to elevate this flap (as shown in video of this case) and the resurfacing of the cornea with marked improvement in its topography and refraction

Setting

the memorial institute for ophthalmic research (MIOR)

Report of case

a 30 years old male came to my clinic complaining of left drop of vision after lasik 2 years ago by another doctor with history of deterioration of vision in this eye directly after lasik. his 1st follow up was after lasik by 10 days with another surgery was done in the same day with no improvement in vision . the patient consult many doctors and all told him to do keratoplasty but he refused.when i examined him i see that the temporal 1/4 of the flap folded under the flap with elevation at this area and depression in the temporal part of flap with unaided VA 3/60 and refraction +6.00/-10.00 x 170 and best corrected 6/36 by +5.00/-8.00 x 170 and other eye 6/6 without glasses.

As the patient refuse to do keratoplasty, the Choices For Treatment are:

PRK ( very high refraction lead to dense haze).

Reposition of flap (epithelium removing and unfolding the flap then reposition it in its original place ) without doing excimer laser.

Create a new deep flap ( at a level deeper to the folded part of flap ) .

i offered the patient to give the eye a chance with femto lasik to try to resurface cornea to correct vision in this eye as much as i can and he accepted the idea. my plan was to create new flap more deep to 1st flap and use the following refraction +3.00/-6.00 x 170 (-6.00 cylinder was the max number accepted by laser machine) to resurface cornea to improve vision. but i change the plan during surgery due to the too much challenges i faced during elevation of flap as i found two planes one for old flap and other for new one and i found sever adhesions at multiple points (as shown in video) but finally i elevate flap and apply laser .post operative there was marked improvement in corneal topography and refraction as the refraction of this eye become +2.50/-4.50x 155 (after 2 months) with uncorrected VA 0.4 which correct by +1.00 /-3.00 x 155 to 0.7

Conclusion / Take home message

•Early follow up after surgery is very important as it allows early intervention for post operative complications and prevents further deterioration .

•In such challenging cases with irregular cornea , we can give a chance to Femto-lasik before we rush to keratoplasty .

•Although Femto-lasik is a valuable tool in these cases , as the idea of creating a deeper flap at this level cannot be done except with Femto-lasik ,but sometimes - as in this case – it can't cut all adhesions which make the surgery extremely difficult.