Long-Term Outcomes of Flap Amputation After LASIK Priyanka Chhadva BS, Florence Cabot MD, Anat Galor MD, Sonia H. Yoo MD Bascom Palmer Eye Institute, University of Miami Miller School of Medicine Miami Veterans Administration Medical Center; Miami, FL, USA. The authors of this presentation have no financial interests to disclose. ASCRS 2015
Background Laser in situ keratomileusis (LASIK) is an increasingly popular refractive surgical procedure performed to improve visual acuity in ametropic patients Complications of this procedure revolve around the creation of a corneal flap, and include flap irregularities/abnormalities, astigmatism, over/under correction, dry eye, infection, and epithelial ingrowth When corneal flap problems persist, debridement and amputation of the insulting flap might be considered a reasonable intervention
Purpose To assess the long-term visual and structural outcomes of flap amputation after LASIK
Description of Case Series Three eyes of 3 patients with a history of flap amputation were included in this retrospective study Flap amputation was performed at Bascom Palmer Eye Institute in Miami, FL, between 2006 and 2014 Reasons for flap amputation, preoperative and postoperative slitlamp examination, visual acuity, optical coherence tomography (OCT, Visante, Carl Zeiss Meditec, Jena, Germany) and corneal topography parameters such as central corneal thickness and keratometry readings (Ks) using Tomey (Nagoya, Japan) were assessed
Case 1 Ocular history: LASIK OU 10 years prior, current use of soft contact lenses Presented with pain, redness, and photophobia in left eye for one month Clinical exam: UCVA of 20/400, intraepithelial keratitis, ring infiltration with mild stromal involvement, culture results revealed acanthamoeba keratitis overlying the LASIK flap Trial of PHMB, Neomycin, Chlorhexidine persistent infection 3 weeks after presentation: LASIK flap amputation to debulk the infection. UCVA after amputation was 20/300 with glasses; POM #6: BCVA 20/30 Slit-lamp photography detailing the corneal infection
Case 2 Ocular history: LASIK in both eyes 4 years ago Clinical exam: Presented after being poked in the right eye with a chopstick; 2.5mm paracentral keratitic epithelial defect overlying the LASIK flap; UCVA: 20/200 (corticosteroids and polytrim QID) 5 days later: UCVA: counting fingers; edema and swelling of the corneal flap The patient thus had flap lift, scraping of epithelial cells, flap suturing, and BCL placement 2.5 weeks after his trauma 1.5 months later: UCVA of 20/400; flap retraction with macrostraie and increased haze on clinical exam scheduled for flap amputation POY #3: VA 20/30 UCVA, slight corneal haze centrally, BCVA: 20/25 Partially truncated LASIK flap LASIK flap suturing
Case 3 Ocular history: LASIK OU 2 months ago, accompanied by broken suction during flap creation in the left eye Clinical exam: UCVA of 20/80, partially truncated flap temporally with small nests of epithelial ingrowth under the flap in the visual axis Vision remained poor despite the use of Lotemax BID scheduled for flap amputation with PTK and MMC 3 months after LASIK surgery POD #1: UCVA was 20/400, stoma was clear, and a BCL was in place. POY #1: UCVA stable at 20/30 Slit-lamp photography detailing epithelial ingrowth
Results Mean follow-up time was 2.8±1.2 years Mean preoperative best corrected visual acuity (BCVA) was 0.6 LogMAR, which improved to a mean of 0.2 LogMAR postoperatively All patients have BCVA of at least 20/30 (0.154 LogMAR) postoperatively Mean postoperative central corneal thickness was 438μm Mean preoperative average K was 50.5D, which flattened to 44.76D at 1year follow-up No ectasia was noted in any patients after flap amputation
Conclusion Although flap amputation is one of the final options for treating flap related LASIK complications, this study showed good visual and structural long-term outcomes
References Wilson, S.E., LASIK: management of common complications. Laser in situ keratomileusis. Cornea, 1998. 17(5): p. 459-67. Gimbel, H.V., E.E. Penno, J.A. van Westenbrugge, et al., Incidence and management of intraoperative and early postoperative complications in 1000 consecutive laser in situ keratomileusis cases. Ophthalmology, 1998. 105(10): p. 1839-47; discussion 1847-8. Stulting, R.D., J.D. Carr, K.P. Thompson, et al., Complications of laser in situ keratomileusis for the correction of myopia. Ophthalmology, 1999. 106(1): p. 13-20. McLeod, S.D., D. Holsclaw, and S. Lee, Refractive, topographic, and visual effects of flap amputation following laser in situ keratomileusis. Arch Ophthalmol, 2002. 120(9): p. 1213-7. Sun, Y., A. Jain, and C.N. Ta, Aspergillus fumigatus keratitis following laser in situ keratomileusis. J Cataract Refract Surg, 2007. 33(10): p. 1806-7.
Acknowledgements Dr. Galor is supported by: the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development Clinical Sciences Research and Development s Career Development Award CDA-2-024-10S (Dr. Galor), NIH Center Core Grant P30EY014801 and NIDCR RO1 DE022903, and Research to Prevent Blindness Unrestricted Grant, Department of Defense (DOD- Grant# W81XWH-09-1-0675 and Grant# W81XWH-13-1-0048 ONOVA) (institutional).