Traumatic displacement of laser in situ keratomileusis flaps: an integrated clinical case presentation

Abstract

Background Traumatic dislocation of laser-assisted in situ keratomileusis (LASIK) corneal flaps is an uncommon postoperative complication that could occur any time after LASIK, and could be visually devastating. We evaluated the visual outcomes, corneal sensation, tear function, and dry eye questionnaire results of patients with traumatic dislocation of LASIK flaps, including one LASIK flap amputation. Methods This is a retrospective case series. Seven patients who were diagnosed with traumatic displacement of the LASIK flap and underwent flap replacement surgery between August 2014 and January 2019 were included.Patient’s visual acuity, refraction, corneal sensitivity, non-invasive tear breakup time (NIBUT), tear meniscus height (TMH), and ocular surface disease index (OSDI) results were evaluated. Results The patients’ mean age was 35.86 ± 5.84 years, and 42.9 % (3/7) were male. The mean duration from LASIK to trauma was 8.86 ± 2.48 years.The mean preoperative and postoperative six-month corrected distance visual acuity (CDVA) were 0.55 ± 0.34 and 0.02 ± 0.03, respectively. The mean spherical equivalent and astigmatism at six months postoperatively was − 1.0 ± 0.95 D and − 0.5 ± 0.25 D, respectively. The corneal flap was clear and well-positioned at the final follow-up (mean: 28.57 ± 6.9 months). 85.71 % (6/7) of the patients showed worse corneal sensation in the injured eye. Interocular OSDI discrepancy was less in those whose last visit was more than 30 months after the trauma. Conclusions Postoperative CDVAat six months was improved, and the refractive data also showed some improvement. The corneal nerve and tear function recovery peaked before 30 months, while the OSDI continued to show a strong trend of improvement beyond 30 months.

Traumatic flap dehiscence 15 years after LASIK: case report and review of the literature

“…Three cases reported epithelial ingrowth (grades 2 to 3) present at initial presentation, which resolved after flap dehiscence repair. 10,14,17 The other 3 cases reported epithelial ingrowth appearing after the initial flap repair, with one requiring a repeat procedure to resolve the ingrowth. 8 The other 2 were grade 1 epithelial ingrowths that did not require repair because they showed no progression and were not obstructing the visual axis.…”

Clinical Pearls in Postoperative LASIK Management

“…Traumatic Flap Subluxation 32,33 Early or late traumatic flap subluxation results in blurred vision and foreign body sensation.…”

Flap-making patterns and corneal characteristics influence opaque bubble layer occurrence in femtosecond laser-assisted laser in situ keratomileusis

“…Flap creation using femtosecond laser allows designing flaps more personally, and many studies have proved its safety and efficiency [ 2 , 3 , 4 ]. It has been suggested that FS-LASIK behaves as good as or even better than mechanical microkeratomes in the predictability of postoperative spherical equivalent, and seems to have several advantages, but on the other hand no clear evidence of differences between the two modalities in terms of outcomes has been published [ 5 , 6 and both early and late flap-related complications have been reported with both approaches [ 7 , 8 , 9 , 10 ]. In addition, despite that femtosecond laser was a great technical breakthrough, several special complications have followed up, such as suction loss, rainbow glare, light-sensitivity syndrome, and gas-related complications [ 4 , 11 ].…”