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  • Title: Refractive outcomes of laser in situ keratomileusis after flap complications.
    Author: Sharma N, Ghate D, Agarwal T, Vajpayee RB.
    Journal: J Cataract Refract Surg; 2005 Jul; 31(7):1334-7. PubMed ID: 16105603.
    Abstract:
    PURPOSE: To study the refractive and visual outcomes, including surgically induced astigmatism, of laser in situ keratomileusis (LASIK) after flap buttonholes and incomplete flaps. SETTING: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: This was a retrospective case series of 15 patients (15 eyes) who had LASIK after flap complications (6 eyes with buttonholes and 9 with incomplete flaps). The second surgery was performed after the refraction was stable for 2 months. The refractive and visual outcomes were studied. RESULTS: After the flap complication, the spheroequivalent did not change significantly (P = .78) but the mean pachymetry changed from 523.6 microm +/- 23.14 (SD) to 530.4 +/- 23.96 microm (P = .04) and the mean absolute cylinder changed from 0.63 +/- 1.01 diopter (D) to 0.88 +/- 0.87 D (P = .026). The second surgery was performed at a mean interval of 6.2 months (range 3 to 17 months). Two eyes had flap complications (irregular flaps) again after the second surgery. At the 6-month follow-up, the mean spheroequivalent was -0.34 +/- 0.65 D and the mean cylinder was 0.15 +/- 0.19 D x 83.6. Thirteen eyes (86.66%) were within 0.5 D of the attempted correction. Post-LASIK complications included diffuse lamellar keratitis (1 eye), epithelial ingrowth (1 eye), and flap striae (2 eyes). After the flap complication, no eye lost 2 or more lines of best spectacle-corrected visual acuity (BSCVA); but after the second surgery at 6 months, 1 eye had lost 2 lines of BSCVA. Six months postoperatively, all eyes had a BSCVA of 20/40 or better. CONCLUSION: Laser in situ keratomileusis after flap complications is associated with good refractive and visual outcomes; however, there is a higher risk for intraoperative and postoperative complications after the second surgery.
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