Calzone-Like Traumatic Flap Dislocation Four Years after Laser in situ Keratomileusis

Abstract

A 46-year-old patient presented with a flip-folded partially dislocated flap after trauma caused by a sheet of paper, four years after a reportedly uneventful laser in situ keratomileusis procedure using microkeratome. Flap re-lift, mechanical debridement, and flap stretching were performed in a first interventional approach. Due to epithelial ingrowth two month after the first intervention, a flap re-lift and mechanical removal of epithelial cells from the stroma bed and flap were performed. In addition, triamcinolone was applied subconjunctivally. Thereafter, best corrected visual acuity of 20/20 was regained and no more epithelial ingrowth was observed. Only few cases of flap dislocation with epithelial ingrowth have been described in the literature following trauma, though none of a permanently inward folded flap. The use of subconjunctival triamcinolone is a new approach to prevent recurrent epithelial ingrowth.

Flap amputation for long-standing post-LASIK flap dislocation with epithelial ingrowth

“…Post-LASIK flap dislocation is considered an emergency and immediate refloatation and repositioning of flap is recommended to prevent long-term sequalae such as fixed flap folds and epithelial ingrowth that may lead to significant loss of vision 15. Previous reports have described the use of sutures and extensive epithelial debridement for cases with flap dislocation where repair was delayed for up to 3 months 16.…”