Interactive Case Reports

Post LASIK complete flap traumatic loss

Case Report Details

First Author: M.del Buey SPAIN

Co Author(s):    P. Casas   C. Caramello   N. Lopez   E. Minguez   J. Ascaso   E. Lanchares     

Abstract Details

Purpose:

A traumatic flap loss is a rare and serious complication of LASIK. As far as we know, this is the first traumatic loss of a LASIK flap occurring so late (15 years postoperatively).

Setting:

Department of Ophthalmology, University Clinic Hospital “Lozano Blesa”, Zaragoza, Spain.

Report of Case:

A 54-year-old woman went to the hospital after hitting her left eye with the corner of a chair and felt a strong pain and loss of vision in her left eye. As ophthalmological history she reported LASIK in both eyes fifteen years ago to correct a moderate myopia. At that moment visual acuity (VA) was counting fingers at 2 meters. On biomicroscopy examination, a large central erosion was observed under fluorescein staining, without other evident alterations. As a Treatment: a bandage contact lens (CL) was inserted with topical medication (moxifloxacin and hyaluronic acid without preservatives). Two days later we can see the patient and we observed a huge corneal abrasion with corneal edema and a depressed area of centripetal epithelization. At that time the patient had a VA of 1/10 in this eye. We suspected a traumatic flap amputation and to confirm it we decided doing an OCT and a topography. In the topographies of both eyes we can see a lower corneal thickness in the flap area of the left eye with high values of irregularity in the 3 and 5 mm areas. in the OCT we can see the healing line of the LASIK flap in the right eye. OCT of the left eye confirms flap loss. We started treatment with oral doxycycline, CL and topical medication, including a Matrix regenerating agent Cacicol® every 2 days, until total epithelization. 5 days after the trauma the cornea had epithelialized but a diffuse haze with greater central affectation was observed. One year later the central corneal haze has disappeared there is no corneal staining with fluorescein and only a superior nasal peripheral opacity is observed. Currently, VA is 8/10 without correction. In the OCT the epithelium has regularized the cornea, as we can also see in the topography without astigmatism.

Conclusion/Take Home Message:

After flap loss, the corneal surface would be re-epithelialised (similar to the healing process after PRK). Refractive changes (myopia and astigmatism) of some cases published, might be attributed to the flap´s thickness irregularity or a stromal significant scarring. A post-LASIK complete flap traumatic loss s a rare and serious complication but not dramatic since the loss of vision may not be severe. In our experience, a waiting period of 12 months after the flap loss was required to attain stabilization of refraction and corneal surface.

Financial Disclosure:

None