Incomplete Femto Lasik Corneal Flap Management

How to proceed for excimer after incomplete femtosecond corneal flap

Femto second has been in practice now worldwide in making corneal flap instead of microkeratome to correct refrative errors through excimer.Femto second steps like docking and adjustment is critical and sometimes can give surprises to the surgeon on table.

I was proceeding for a case of moderate degree myopia in a thirty year old lady.Her palpebral aperture was relatively small and she was continuously forcing the eyes in speculum to close while docking.In her right eye where i proceeded first for femto second laser to create flap, i adjusted and suction applied and laser done but to my surprise when i tried to lift the flap i was unable to lift and then i realised that continuous flap is not created instead small portions or pockets of airbubble created.That was a night mare and on table i had to decide how to proceed further.That time I used phaco keratome and digged the edge of flap and then through small corneal scissoris created part of flap and then digged with flap hook and made all pockets joined and rest was done like any other flap procedure.After applying excimer i ended it with bandage contact lens so that irregular edges of flap would not hurt patient and i removed it one day post operative and patient was 20/20 OU.

It is necessary to hold on and rethink whenever surprises happen during any surgical procedure.Thinking and holding on your confidence can help you come out of the dramatic situation and thats how you get experience of different kind of cases with time.Also get ready woth any case to give you a new surprise wach time you are on surgical table.