Traumatic Corneal Flap Avulsion And Loss 15 Years After Lasik

To report an interesting case of total corneal flap loss 15 years after Laser-assisted in situ keratomileusis (LASIK) surgery, following minor trauma during routine domestic activities, as well as its management.

 A 40-year-old female visited our emergency department after hitting her right eye (OD) in the corner of the chair.  The patient reported that she found a ‘’small transparent membrane‘’ after this incident and brought it folded in a napkin. She reported pain, blurry vision, foreign body sensation and photophobia. 

Slit-lamp examination revealed total absence of the corneal LASIK flap, as well as severe lacrimation ,eyelid oedema and conjunctival hyperemia. Best corrected visual acquity (BCVA) was 7/10 ( -4.00 sph / -2.00 cyl * 180 ^o ). Fundus examination was normal. Therapeutic contact lens was used and she was prescribed antibiotic drops ( Gatifloxacin 0.3 % ) and artificial tears. Once the epithelial deficit was closed, we administered chloramphenicol 0,5% / dexamethasone 0,1% eye drops that were taped for a year. She was monitored at a regular basis to check the wound healing, the BCVA, and to rule out the possibility of infection.

The patient declined any surgical intervention. During the follow-up, a smooth epithelialization of the cornea was noticed, but also the appearance of haze and irregular astigmatism, which was expected. She was suggested scleral lenses, rigid gas-permeable (RGP) contact lenses or corneal cross-linking in case of corneal ectasia. After 15 months, BCVA was 8/10 ( -2.00 sph / -2.50 cyl * 80^o ).

To our knowledge, this is the longest time reported in such a case in the literature. Conservative measures and medical treatment yielded an acceptable visual result. Ophthalmologists should be aware that there could be a lifelong potential risk of traumatic corneal flap loss or dislocation after LASIK and inform the patients.