Lasik Flap Retraction After Successful Post-Traumatic Flap Repositioning In A 12-Year-Old Lasik Flap.

To report a case of an accidental trauma in an eye with a 12-year-old LASIK flap that received proper surgical management and demonstrated an unusual complication. The patient was operated 4 days after the insult with flap lifting, stretching, debridement, irrigation and flap repositioning. During the following three months, a progressive retraction of the LASIK flap borders was noted.

The patient was initially seen at the emergency department of the Jules Gonin Eye Hospital in Lausanne, Switzerland and was subsequently managed by the cornea service of the hospital.

A 34-year-old male presented to the emergency department one day after an accidental trauma with a drinking straw in his right eye. His past ocular history was significant for LASIK vision correction 12 years prior to presentation. The patient described difficulty to open his eye, photosensitivity, a foreign body sensation, mild secretions and a subjective visual decline. His best corrected visual acuity was 0.63 on the affected eye. On slit lamp examination, a flap dislocation with an internal fold was visible in the inferotemporal quadrant, an epithelial defect in the same area was noted along with anterior stromal thickening with several macrostriae on the temporal half of the cornea.

 The patient was operated under topical anesthesia.  The surgical management included hydration of the flap with BSS, epithelial debridement of the exposed stroma, lifting of the flap, unfolding the fold, flap stretching and flap repositioning. The patient was subsequently followed in the cornea department. During the following three months, a progressive contraction of the LASIK flap borders was noted. Three months after the procedure, the uncorrected visual acuity was 0.8, the refraction was +0.50 -0.50x160 and the cornea presented a mild central haze.

This case serves as another example of a late traumatic LASIK flap dislocation.  Surgical treatment with meticulous attention to debridement and repositioning and proper postoperative monitoring is necessary to diagnose and manage this rare postoperative complication. It can also serve as a reminder that LASIK flap retraction can appear even after a successful LASIK flap repositioning.