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Outcome of Flap Complications Following LASIK Surgery

Outcome of Flap Complications Following LASIK Surgery. Faik Orucov MD, A. Solomon MD, E. Shtrasman MD, F. Raiskup MD, D. Landau MD, J. Frucht-Pery MD Department of Ophthalmology Hadassah University Hospital Jerusalem, Israel. Intraoperative Flap Complications [0.3% -2.6%].

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Outcome of Flap Complications Following LASIK Surgery

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  1. Outcome of Flap Complications Following LASIK Surgery Faik Orucov MD, A. Solomon MD, E. Shtrasman MD, F. Raiskup MD, D. Landau MD, J. Frucht-Pery MD Department of Ophthalmology Hadassah University Hospital Jerusalem, Israel

  2. Intraoperative Flap Complications [0.3% -2.6%] • Free cup • Partial flap • Irregular flap • Thin flap • Buttonhole Jacobs JM. J Cat Refract Surg. 2002 Gimbel HV. Ophthalmology 1998

  3. Reasons for Flap Complications • Loss of suction • Blockage of microkeratome [drapes, eyelashes, speculum] • Poor cleaning or assembly • Blade- sharpness\damage • Motor\microkeratome breakdown or loss of power • Electric power failure • Ocular anatomy: steep\flat cornea small size eye

  4. We studied the outcome of PARTIAL CUTS and BUTTONHOLES at the Laser Center in Hadassah University Hospital, Jerusalem Israel.

  5. METHODS - 4864 Consequtive LASIK Surgeries 18 eyes of 18 patients [8 females / 10 males] • Group 1 8 buttonholes 10 partial cuts • Group 2 18 none-complicated fellow eyes

  6. METHODS Microkeratome - Hansatome 160 microns head[B&L] • Flap complication - LASIK termination Fellow eye surgeries postponed Not Lifted Lifted Partial flap n= 8 n= 2 Buttonholes n= 3 n= 5 • Flap complications - microkeratome examination

  7. METHODS • Steroids 14 days Topical antibiotics 4 days • Evaluation: VA, topography, slit lamp • Follow-up 3-4 months

  8. METHODS LASIK Retreatment After 3-5 Months[one surgeon JFP] • 16 of 18 pts. • Microkeratome head 180 microns B&L 217-Z laser system • Follow-up: 6 to12 mo. • Statistics: Paired T-test complicated vs fellow eye

  9. RESULTSReasons for the Adverse Events • Failure of the suction n=4 • Obstruction of microkeratome pass [speculum, eyelashes,glove] n=4 • Squeezing of the lids n=3 • Breakage in the engine n=1

  10. RESULTS • Microkeratome Cut Through the pupil n=14 Peripheral cornea n=2

  11. RESULTS • Mild scarring • Topographic irregular patterns

  12. RESULTS[age - 22 to 57 years] Group 1 Group 2 SEQ -3.62 + 3.11 [D] 4.02 + 3.38 [D] [K’s] 44.57 + 1.05 [D] 44.64 + 1.03 [D] BCVA 1.1 1.1 SEQ, Ks ,BCVA p= ns [K’s]buttonhole \ incomplete flap 45.01 + 0.85 [D] \ 44.2 + 1.26 [D] p= ns

  13. RESULTS Recovery Period -Prior to Retreatment OCULAR CHANGES • SEQs: changes up to 0.3 [D] • K’s: changes up to 0.75 [D] • No loss of BCVA

  14. RESULTS Final Examination [6-12 mo.] Group 1 Group 2 • SEQ -0.15 + 0.28 [D] -0.16 + 0.26 [D] [p=0.91] • UCVA 0.88 + 0.15 1.04 + 0.27 [p=0.02] • BCVA 0.99 + 0.15 1.09 + 0.22 [p=0.03] • BCVA gain n=1 n=5 loss [1 line] n=5 n=1

  15. RESULTS Buttonholes VS Incomplete Cut[paired T-test] • SEQ p=0.38 • UCVA p=0.83 • BCVA p=0.43 • Gain/Loss of BCVA p=0.82

  16. CONCLUSIONS • Buttonhole/incomplete cut: perfect replacement of the flap and abortion of lasing procedure • Retreatment after 3-5 months provides an excellent outcome but of lesser quality as compared with the fellow eye

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