Traumatic flap dislocation 4 years after LASIK due to air bag injury

PURPOSE: To report a patient who developed corneal flap dislocation following air bag injury 48 months after LASIK. METHODS: Evaluation by slit-lamp microscopy and fluorescein angiography. RESULTS: A 29-year-old man was treated after air bag injury that occurred 48 months after LASIK. Examination revealed corneal flap dislocation, with severe folds and flap edema. Preoperative visual acuity was finger counting at 1 m. Visual acuity was 20/400 24 hours after repositioning the corneal flap. Retinal angiography revealed Berlin macular edema, which was injected with periocular steroids. Five days after injection, visual acuity remained 20/400, but improved to 20/40 1 month after injection. CONCLUSIONS: Significant trauma can dislocate a corneal flap many months after surgery.     

LASIK术后角膜瓣移位的处理

目的 探讨LASIK术后角膜瓣移位的临床特点及处理方法.方法 研究我院2002年7月至2008年5月行LASIK的患者共4 219例(8 316眼),对术后发生角膜瓣移位者23例(23眼)行移位修复术.术后第1天、第3天、1周、1个月、3个月进行复诊.结果 移位前和移位修复术后视力(1.16±0.14,1.12±0.20)、屈光度(0.75±0.37,0.74±0.34)、散光(0.82±0.39,0.83±0.43)比较差异均无统计学意义(P均>0.05).19例恢复到LASIK术前最佳矫正视力,3例外伤患者恢复至LASIK术后受伤前视力,仅1例木块击伤者视力低于受伤前.结论 LASIK术后角膜瓣移位只要及时发现,正确处理就可达到术前理想矫正视力.[眼科新进展2009;29(6):446-447,451]     

Late traumatic flap dislocations after LASIK

PURPOSE: To report the management and outcome of late onset traumatic dislocation of LASIK flaps. METHODS: This retrospective, interventional case series presents three patients with late onset LASIK flap dislocation following mechanical trauma 1 to 7 years postoperatively. RESULTS: In all cases, the flap was surgically repositioned. Epithelial ingrowth was removed and diffuse lamellar keratitis was treated with an intensive steroid regimen. All patients returned to their preoperative best spectacle-corrected visual acuity. Aggressive steroid treatment during the perioperative period and meticulous handling of the epithelium are important in preventing further recurrence. CONCLUSIONS: Laser in situ keratomileusis flaps may experience mechanical dislocation as late as 7 years postoperatively. Diffuse lamellar keratitis and epithelial ingrowth are associated with flap dislodgment.     

Ultrabiomicroscopy (UBM) in flap dislocation following LASIK: a case report

PURPOSE: To describe postoperative laser-assisted in situ keratomileusis (LASIK) flap dislocation occurred after trauma METHODS: Ultrabiomicroscopy (UBM) is used to obtain a high-resolution imaging of the cornea. RESULTS: The UBM results are presented and compared with histologic and confoscan findings CONCLUSIONS: The technique is useful and easy to perform, offering more opportunities to study the anatomical changes in LASK flap dislocation occurred after trauma.     

准分子激光角膜原位磨镶术中游离瓣的形成及处理

目的：总结准分子激光角膜原位磨镶术（LASIK）术中出现游离瓣的原因及防治方法。方法：8眼LASIK术中出现的游离瓣，给予逐项分析，并对结果进行随访观察，结果：8眼游离瓣的患者术后第2天裸眼视力（OBCV）≥1．0者3眼，裸眼和≥0．6者5眼，术后3月视力明显提高，1年视力仍稳定，结果：LASIK术中出现游离瓣，只要及时处理，不影响疗效。     

LASIK术后角膜瓣移位皱折的处理

目的:探讨LASIK术后角膜瓣移位、皱折的治疗方法。方法:在手术显微镜下去除角膜基质裸露区新生的角膜上皮组织,刮除角膜瓣皱折处上皮,BSS液瓣下冲洗,使角膜瓣展平,覆盖透氧角膜接触镜。结果:经治疗的19例患者角膜瓣复位良好,视力较LASIK术后无下降。结论:及时正确地治疗,可以避免严重的并发症并获得良好的视觉结果。     

Late traumatic LASIK flap loss during contact sport

Three years and 5 months after uneventful laser in situ keratomileusis, the left eye of a 39-year-old man was struck by the finger of a friend while the two were practicing karate, resulting in loss of the flap. The patient had performed this contact sport regularly for years. When last seen 16 weeks after injury, the best corrected visual acuity in the left eye was 20/40 with -1.75 -0.50x30. Mild central corneal haze was observed under slitlamp examination, the flap was missing, and the patient complained of dysphotopsia. Pachymetry in the left eye was 394 mum, with an irregular corneal contour. Flap loss is a serious complication because severe irregular astigmatism and unpredictable refractive change can occur. This case highlights the vulnerability of flaps to trauma even late postoperatively.     

Epithelial folds following slippage of LASIK flap

We present a case of a slipped corneal flap after laser-assisted in-situ keratomileusis, LASIK. A 22-year-old, female with myopia and a refractive error of -5.50 D sph OU had an uneventful LASIK performed on her left eye with a Chiron Automated Corneal Shaper (ACS) and a VISX-Star Excimer laser using a nasal hinged flap. On the first postoperative day, slit lamp examination revealed 4.0 mm slippage of the corneal flap. The flap was rolled and folded on itself within the inferior cul-de-sac. With the aid of the operating microscope, the flap was repositioned on the stromal bed. Immediately following the repositioning, many folds were still visible despite centering the flap on the stromal bed and performing stretching maneuvers. Detailed examination showed the folds to be of edematous epithelial origin. The underlying stromal bed was flat. Within days following repositioning, the folds had disappeared and the flap assumed the typical postoperative LASIK appearance. The final uncorrected visual acuity returned to 20/20.     

OCT visualization of corneal structural changes in traumatic dislocation of LASIK flap

A 45-year-old woman presented with a traumatic laser-assisted in situ keratomileusis (LASIK) flap dislocation in the right eye. Anterior segment optical coherence tomography (OCT) showed the presence of macrostriae, flap stromal edema, epithelial hyperplasia between the striae and epithelial ingrowth. The flap was surgically repositioned with optimal visual recovery. Anterior segment OCT can efficiently visualize corneal structural changes associated with LASIK flap dislocation.     

Treatment of traumatic LASIK flap dislocation and epithelial ingrowth with fibrin glue

PURPOSE: To describe a case of a traumatic late dislocation of a laser-assisted in situ keratomileusis (LASIK) flap complicated by epithelial ingrowth. DESIGN: Interventional case report. METHODS: A 50-year-old woman presented 21 months after uncomplicated LASIK with painful vision loss in the right eye after minor trauma. RESULTS: A dislocation of the LASIK flap was noted at examination and was repositioned. One week later, epithelial ingrowth was detected in the flap interface. The ingrowth was treated with flap lifting, debridement, and sealing of the flap with fibrin glue. Visual acuity returned to baseline, and there was no recurrence after 20 months of follow-up. CONCLUSIONS: Traumatic dislocations of LASIK flaps may occur many months after uncomplicated surgery and may be associated with epithelial ingrowth after successful repositioning. The additional use of fibrin glue in conjunction with thorough debridement may be helpful in preventing the recurrence of epithelial ingrowth.     

Corneal lamellar flap retraction after LASIK following penetrating keratoplasty

PURPOSE: To describe a case of lamellar flap retraction after laser in situ keratomileusis (LASIK) to correct myopia and astigmatism after penetrating keratoplasty (PKP). METHODS: Eleven months after PKP, a 34-year-old man underwent uneventful LASIK. Preoperative manifest refraction was -5.50 + 4.00 x 55, giving a best-corrected visual acuity (BCVA) of 20/20. Three days after LASIK, the central cornea was clear with a 1- to 2-mm displacement and marked swelling of the inferior edge of the lamellar corneal flap, without central striae. The patient's uncorrected visual acuity (UCVA) was 20/60. The flap was repositioned, sutured with 6 10-0 nylon interrupted sutures, and covered with a bandage contact lens. RESULTS: Five months after the repair, the cornea was clear, UCVA was 20/400, and manifest refraction was -9.50 + 6.00 x 75, giving a BCVA of 20/60. Three years later, manifest refraction was - 9.00 + 4.00 x 70, giving a BCVA of 20/40+2. CONCLUSION: In LASIK surgery after PKP, there is a risk of flap edema leading to retraction of the transplant wound. It may therefore be advisable to wait at least 1-2 years after PKP before performing LASIK. Patients who have corneal transplants should also be warned that they might have unique risks in LASIK treatment that may result in the loss of vision.     

Traumatic late flap dehiscence and Enterobacter keratitis following LASIK

PURPOSE: To report a case of traumatic flap dehiscence and Enterobacter keratitis 34 months after LASIK. METHODS: A 36-year-old man sustained a flap dehiscence following traumatic right eye gouging by a seagull claw. He presented the following day with uncorrected visual acuity (UCVA) in the affected eye of 3/200 and organic foreign body deposits underneath the flap. Systemic and topical antibiotics were administered and urgent surgical debridement and replacement of the LASIK flap was performed. An Enterobacter species was cultured from an intraoperative swab. RESULTS: After a prolonged postoperative course, including administration of topical ofloxacin, tobramycin, chloramphenicol, and dexamethasone, UCVA returned to 20/20. CONCLUSIONS: Good visual outcome after early debridement and appropriate antibiotics was achieved. Patients should be injury advised to seek prompt ophthalmic consultation after LASIK.     

Late traumatic flap dislocation after laser in situ keratomileusis

Three patients who had laser in situ keratomileusis (LASIK) experienced severe direct corneal trauma 3 to 38 months postoperatively. Flap dislocation resulted in all 3 patients. Presentation following trauma ranged from a few hours to 9 days. All patients were successfully managed by surgical flap repositioning, and all maintained a best corrected visual acuity of 20/20. A literature review of traumatic flap dislocation cases and the most recent methods of diagnosis and management are included.     

Late partial dislocation of a laser in situ keratomileusis flap

We report an apparently atraumatic asymptomatic flap dislocation 4 months after uneventful laser in situ keratomileusis (LASIK) in the right eye of a 43-year-old woman. The patient developed partial dislocation of the LASIK flap during the week after the 4 month examination. The LASIK flap was subsequently lifted to perform an enhancement, and the postenhancement course has been unremarkable. This case illustrates the potential susceptibility of LASIK flaps to dislocation either spontaneously or, more likely, after presumed minor trauma as late as 4 months after the original procedure.     

Protective effect of LASIK flap in penetrating keratoplasty following blunt trauma

Penetrating keratoplasty (PKP) often results in large and unpredictable refractive errors following suture removal in the postoperative period. Laser in situ keratomileusis (LASIK) is an effective means of correcting these errors. However, LASIK following PKP is believed to further weaken an already weak graft-host junction and may predispose such eyes to traumatic dehiscence of the graft-host junction. We describe a case in which the LASIK surgery following PKP seemed to benefit the patient by preventing complete dehiscence of the graft-host junction.