Vision outcomes favorable when flaps dislocate 8 to 10 years post-LASIK

Outcomes after late flap dislocations are generally good, even when there is a delay inreceiving medical attention said Angie E. Wen, MD.

Dr. Wen, instructor in clinical ophthalmology, Columbia University, New York, reported a caseseries of four eyes with late traumatic flap dislocation that presented to the Harkness EyeInstitute at Columbia University. The eyes were 8 to 10 years post-LASIK, and the triggers forthe flap dislocations included contact with a baby's finger or the edge of a map, falling on adeck, and alleged assault.

Two patients sought and received medical care within 24 hours, one patient delayed seeking carefor 6 weeks, and one dislocation-which was subtle and initially missed-was treated after beingreferred for epithelial ingrowth noted 1 month post-trauma.

All cases were managed with lifting, debridement, stretching, and irrigation of the cornealflap. The epithelium was recessed 1 mm in the area of the dislocation in order to reduceepithelial ingrowth risk. Three of the procedures were performed at the excimer lasermicroscope and one at the slit-lamp.

Three of four eyes regained predislocation best-corrected visual acuity, including two eyesthat achieved uncorrected visual acuity of 20/20 or better. One patient with the history oftrauma remained counting fingers. The poor vision in the latter case was considered due tokeratectasia-associated irregular astigmatism as the flap was well repositioned and there wereno residual striae or haze.

"Flap lifts and enhancements can be performed many years after LASIK because wound healingoccurs primarily at the flap edge and minimally in the lamellar interface. However, this alsoleaves LASIK patients vulnerable to flap dislocations even many years after the procedure,"said Dr. Wen.

"Therefore, patients should be counseled regarding this risk, especially if they haveoccupations or hobbies that place them at increased risk for ocular trauma," Dr. Wenconcluded.