Brief report
Late-onset traumatic laser in situ keratomileusis (LASIK) flap dehiscence

https://doi.org/10.1016/S0002-9394(00)00845-XGet rights and content

Abstract

PURPOSE: To report a case of laser in situ keratomileusis (LASIK) flap dehiscence following focal trauma six months after uneventful refractive surgery.

METHODS: Case report. A 37 year old man was seen one day after a tree branch snapped tangentially against his left cornea causing a dehiscence of his LASIK flap.

RESULTS: The flap was repositioned after treating the exposed flap stroma with a 50:50 mixture of distilled water and balanced salt solution. The patient regained 20/20 uncorrected visual acuity.

CONCLUSIONS: Patients should be informed about the potential for traumatic flap dehiscence following LASIK surgery and advised to wear eye protection when appropriate. Due to minimal wound healing except at the edges of the flap, corneal flap dehiscence may occur months or years after uneventful LASIK.

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    The other 2 complications associated with RD repair in patients with previous LASIK were flap dehiscence2–6 (range 4 to 57 months after LASIK) and striae,3,4 which, like epithelial ingrowth, can lead to decreased BCVA. There have been reports of noniatrogenic LASIK flap dehiscence (with causes ranging from a tree branch to a dog's paw)15–18occurring 10 days to 6 months after LASIK. As refractive surgeons have been able to relift flaps 9 to10 years after LASIK for purposes of enhancement,19 it is possible that iatrogenic flap dehiscences can also occur many years later.

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    The treatments for late-onset flap folds or disposition are flap lifting and stretching in most reported cases, even if the time from injury to treatment ranges from 1 hour to 4 weeks. Lifting and stretching the flap can clear the flap folds.5–16 In this case, the patient developed flap folds and dehiscence twice from similar blunt traumas.

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    2003, Refractive Surgery: A Guide to Assessment and Management
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