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

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. Twelve patients were diagnosed with traumatic displacement of the LASIK flap between August 2014 and January 2019. Of these, seven who underwent flap replacement surgery 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 best-corrected visual acuity were 0.55 ± 0.34 and 0.02 ± 0.03, respectively. Vision improvement was significant (P = 0.018). 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 significantly less (P = 0.048) in those whose last visit was more than 30 months after the trauma. Conclusions Postoperative vision at six months was significantly 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 improve beyond 30 months.