The Bird And The Flap - Traumatic Avulsion Of A Femtosecond Lasik Flap Following A Bird-Inflicted Corneal Injury

To describe a rare case of traumatic avulsion of a femtosecond laser–assisted in situ keratomileusis (FS-LASIK) flap following direct corneal trauma caused by a pet bird.

Emergency room at a major medical center.

A 34-year-old woman presented with acute pain and visual loss in her left eye, after a bird-related corneal injury, ten months following uneventful FS-LASIK for myopia. Slit lamp examination revealed complete absence of the LASIK flap with a sharply demarcated circular epithelial defect corresponding to the flap borders. The superior hinge area appeared torn, and the avulsed flap was not identified on the ocular surface or within the fornices. The patient was treated with a bandage contact lens (BCL) and intensive fortified topical antibiotics (vancomycin and ceftazidime). At four-day follow-up, re-epithelialization of the exposed stromal bed was nearly complete with mild stromal haze. Topical corticosteroids (dexamethasone 0.1% q.i.d.) and later topical losartan 0.08% q.2.h were added. Ten weeks following her injury, the patient demonstrated complete re-epithelialization, minimal haze and reported significant improvement in her visual symptoms. Her uncorrected distance visual acuity was 20/20 in both eyes, and the subjective refraction in her left eye was 0.00-0.75@150.

This case demonstrates a rare but visually significant complication of traumatic FS-LASIK flap avulsion. Despite the precision and stability of femtosecond-created flaps, the corneal interface remains biomechanically vulnerable even months postoperatively. Conservative treatment with a BCL, topical antibiotics, topical steroids and topical losartan resulted in an excellent visual outcome. Awareness of this potential injury and prompt, appropriate management are essential to prevent infection, stromal scarring, and permanent visual sequela.