Results of Phototherapeutic Keratectomy in the Management of Flap Striae after LASIK before and after Developing a Standardized Protocol

Ashrafzadeh, Amin; Steinert, Roger F.

doi:10.1016/j.ophtha.2006.09.023

Cited by 22 publications

(5 citation statements)

References 19 publications

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“…PTK has been effective in treating microstriae with persistent visual symptoms. In a small study of 47 eyes, 81% of eyes achieved 20/33 or better BCVA, and the results remained stable at 24-month follow-up [ 87 ].…”

Section: Reviewmentioning

confidence: 99%

A Literature Review of the Incidence, Management, and Prognosis of Corneal Epithelial-Related Complications After Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE)

Moshirfar,

Santos,

Wang

et al. 2023

Cureus

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Our purpose is to provide a comprehensive investigation into the incidence, treatment modalities, and visual prognosis of epithelial-related complications in corneal refractive surgeries, including laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE). A systematic search of multiple databases was conducted by two independent examiners using various search terms related to epithelial-related complications and corneal refractive surgeries. A total of 91 research articles were included, encompassing a sample size of 66,751 eyes across the three types of surgeries. The average incidence of epithelial-related complications varied across the different types of corneal refractive surgeries. LASIK had an average incidence of 4.9% for epithelial defects, while PRK and SMILE had lower rates of 3.3% and 3.9%, respectively. Our findings indicate that SMILE has a lower incidence of epithelial defects compared to LASIK, potentially due to the less invasive nature of lenticule incision in SMILE. Visual prognosis after epithelial complications (EC) is generally favorable, with various supportive care and surgical interventions leading to significant improvements in postoperative visual acuity and full recovery. Understanding the incidence rates and management approaches for epithelial-related complications can guide clinicians in enhancing patient safety, refining surgical techniques, and optimizing postoperative outcomes in corneal refractive surgeries.

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Section: Reviewmentioning

confidence: 99%

A Literature Review of the Incidence, Management, and Prognosis of Corneal Epithelial-Related Complications After Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE)

Moshirfar,

Santos,

Wang

et al. 2023

Cureus

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“…Unlike macrostriae, which can be due to flap slippage,7 microstriae are not associated with flap displacement. They can be caused by excessive hydration during surgery or subsequent tissue loss caused by diffuse lamellar keratitis8 or central toxic keratopathy 9. Recognition of the absence of flap displacement is also helpful in the differential diagnosis and management of these cases.…”

mentioning

confidence: 99%

High-resolution optical coherence tomography visualization of LASIK flap displacement

Salaroli

Huang

2009

Journal of Cataract and Refractive Surgery

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Uneventful myopic laser in situ keratomileusis (LASIK) was performed in both eyes of a 33-year-old woman. Two weeks after LASIK, examination of the left eye revealed flap striae radiating inferonasally from the superior hinge. The flap was relifted and repositioned to remove the irregular astigmatism and reduce the striae. Before the flap was relifted, Fourier-domain optical coherence tomography (FD-OCT) showed the gap at the temporal flap, which had not been detected by biomicroscopy. After the flap was relifted, FD-OCT documented that the gap was closed. High-resolution FD-OCT was helpful in the visualization and management of flap displacement.

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“…These include stretching the flap at the slit lamp,[ 9 ] surgical intervention by flap massage,[ 10 ] or by relifting and smoothening the flap,[ 11 ] or in recalcitrant cases, relifting and suturing the flap,[ 12 ] or high-temperature spatula stretching,[ 13 ] or by the wet and dry techniques. [ 14 ] In our study, even in the case that was delayed by 4 months, we did not have to resort to heat stretching.…”

Section: Discussionmentioning

confidence: 93%

Surgical and visual outcomes of flap repositioning for various flap-related pathologies post laser in-situ keratomileusis (LASIK)

Dvivedi,

Murthy,

Akkulugari

et al. 2023

Indian Journal of Ophthalmology

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To evaluate the surgical and visual outcomes of flap repositioning for various post-laser-assisted in-situ keratomileusis (LASIK) flap pathologies. Retrospective review of consecutive cases between April 1, 2017 and February 28, 2022, where surgical flap repositioning was performed following LASIK for various flap-related complications. Of the 6018 eyes, 31 needed flap repositioning (0.51%). Indications were flap displacement and folds in 20 eyes (64%), flap subluxation in five eyes (16%), epithelial ingrowth and interface debris in two each, and one eye each of diffuse lamellar keratitis and incomplete flap. Final best spectacle-corrected visual acuity of ≥ 20/25 was obtained in 25/31 (80%) eyes. The efficacy index pre to post repositioning showed significant improvement (0.86 ± 0.39 vs. 0.63 ± 0.29 preop, P = 0.011). Flap repositioning incidence was significantly higher (7/602 (1.16%)) during the COVID lockdown phases compared to the non-COVID lockdown phase (24/5416 (0.44%, P = 0.019)). The COVID group had lower efficacy (0.72 ± 0.36 vs. 0.90 ± 0.39, P = 0.300) and safety indices (0.85 ± 0.24 vs. 1.06 ± 0.35, P = 0.144) compared to the non-COVID group; however, the results were not statistically significant. The flap displacement rate was statistically higher in nasal hinged (microkeratome) flaps (18/2013, 0.89%) compared to superior hinged (Femto) flaps (13/4005, 0.32%) (0.32%, P = 0.003). Our study shows that flap repositioning has a low incidence in LASIK, with the most common indication being flap displacement/folds. The outcome post flap repositioning was poorer during the lockdown period, perhaps due to the inability to follow up early. Early identification and surgical repositioning are successful in both anatomical and visual restoration.

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Results of Phototherapeutic Keratectomy in the Management of Flap Striae after LASIK before and after Developing a Standardized Protocol

Cited by 22 publications

References 19 publications

A Literature Review of the Incidence, Management, and Prognosis of Corneal Epithelial-Related Complications After Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE)

A Literature Review of the Incidence, Management, and Prognosis of Corneal Epithelial-Related Complications After Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE)

High-resolution optical coherence tomography visualization of LASIK flap displacement

Surgical and visual outcomes of flap repositioning for various flap-related pathologies post laser in-situ keratomileusis (LASIK)

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