Wavefront-guided surface ablation with prophylactic use of mitomycin C after a buttonhole laser in situ keratomileusis flap

PURPOSE: To describe the surgical outcome of a patient who had a previous buttonhole after laser in situ keratomileusis (LASIK) and 3 months later, had wavefront-guided photorefractive keratectomy (PRK) with topical mitomycin C 0.02%. METHODS: A 38-year-old man underwent bilateral LASIK for correction of myopic astigmatism. A buttonhole in his right eye LASIK flap occurred, but the surgeon decided to proceed with ablation due to the small size of the buttonhole. After LASIK, the patient complained of monocular diplopia in his right eye with 20/30 best spectacle-corrected visual acuity. Wavefront analysis showed a large amount of higher order aberrations, especially coma. Slit-lamp examination revealed a moderate buttonhole scar. Three months after LASIK, the patient underwent wavefront-guided PRK with application of topical mitomycin C 0.02% on the stromal bed, for a duration of 2 minutes. RESULTS: One month after wavefront-guided PRK, his uncorrected visual acuity was 20/25 in the right eye, with no symptoms. Best spectacle-corrected visual acuity in the right eye was 20/15 with +0.25 -0.50 x 110 degrees. No haze or scar was seen on slit-lamp examination. Wavefront analysis showed a decrease in higher order aberrations, especially coma and spherical aberration. CONCLUSIONS: Wavefront-guided PRK with prophylactic topical mitomycin C was effective in treating a patient with visual symptoms and loss of BSCVA after a LASIK flap buttonhole. No delayed epithelial healing, side effects or complications were noted due to mitomycin C.