Results of phototherapeutic keratectomy in the management of flap striae after LASIK

OBJECTIVE: To evaluate the efficacy of phototherapeutic keratectomy (PTK) in reducing or resolving visually significant surface irregularities resulting from flap striae after LASIK. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-three eyes of 22 patients with flap striae after LASIK and reduced best-corrected visual acuity or visual symptoms that resolved with diagnostic contact lens fitting treated between January 2001 and April 2002 with at least 1 month of follow-up. The mean follow-up interval was 134 days (range, 30-354 days). INTERVENTION: Transepithelial PTK. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), resolution or reduction of preoperative symptoms, corneal haze, and best spectacle-corrected visual acuity (BSCVA). RESULTS: Mean BSCVA and UCVA improved significantly from 20/32 and 20/48 to 20/22 and 20/33 (P<0.0001 and P = 0.027), respectively, after PTK. There was a significant mean hyperopic shift of 0.88 diopters (D; P = 0.002, range, -1.38 to +3.88 D). Fourteen eyes (61%) were clinically clear, 6 eyes (23%) had trace haze, and 3 eyes (16%) had 1+ haze at the last follow-up visit. Mean spherical equivalent refractive error before LASIK was -7.23 D (range, -2.88 to -13.55 D). Twenty-two of 23 eyes had significant qualitative resolution or reduction of preoperative visual symptoms. CONCLUSIONS: In cases of visually significant LASIK flap striae, PTK is effective in improving best-corrected visual acuity and reducing visual symptoms. High myopia may be a risk factor for development of visually significant microstriae. Development of anterior stromal haze did not exceed 1+ density and was not correlated to either the number of laser pulses or the length of the follow-up period.