Partially Inverted Corneal Flap After Microkeratome Assisted Lasik

To report an unusual case of inadvertent inversion of a corneal flap after microkeratome-assisted LASIK surgery.

Clinica Baviera Gandía (Valencia, Spain)

We describe a case report managed in our clinic.

A 25-year-old female patient with stable compound myopic astigmatism in OU and normal preoperative topography was treated with apparently uneventful microkeratome-assisted LASIK. The following day after the surgery the patient presented with pain in the right eye and an inferior epithelial defect was adverted in the slit-lamp examination. At the 4-day post-op appointment, the slit-lamp biomicroscopy revealed a horizontal line in OD with adjacent epithelial ingrowth superior to the line and mixed astigmatism. The flap was folded inferiorly on itself. The flap was lifted inferiorly, the epithelium between the fold and the margin of the flap was removed and the flap was repositioned  At 3 weeks the patient achieved 20/20 UDVA in OD.

This is a rare complication of LASIK surgery that may be prevented and resolved in the early post-op examination with a meticulous examination in the slit-lamp. In our case, most probably, this complication happened either due to squeezing during speculum removal or due to eyelids folding the flap margin that was not well adhered. Inadvertent flap inversion should be considered an emergency and early management is crucial to prevent persistent folds and epithelial ingrowth.