180 likes | 723 Vues
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%].
E N D
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%] • Free cup • Partial flap • Irregular flap • Thin flap • Buttonhole Jacobs JM. J Cat Refract Surg. 2002 Gimbel HV. Ophthalmology 1998
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
We studied the outcome of PARTIAL CUTS and BUTTONHOLES at the Laser Center in Hadassah University Hospital, Jerusalem Israel.
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
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
METHODS • Steroids 14 days Topical antibiotics 4 days • Evaluation: VA, topography, slit lamp • Follow-up 3-4 months
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
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
RESULTS • Microkeratome Cut Through the pupil n=14 Peripheral cornea n=2
RESULTS • Mild scarring • Topographic irregular patterns
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
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
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
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
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