Case Reports

A LASIK flap folded for 2 years. What to do?

Case Report Details

First Author: H.Elnashar EGYPT

Co Author(s):                        

Abstract Details

Purpose:

to show how to improve vision in such complicated situation using femto lasik. how to creat new flap and the too much challenges i faced to elevate this flap (as shown in video of this case) and the resurfacing of the cornea with marked improvement in its topography and refraction

Setting:

international eye hospital

Report of Case:

a 30 years old male came to my clinic complaining of left drop of vision after lasik 2 years ago by another doctor with history of deterioration of vision in this eye directly after lasik. his 1st follow up was after lasik by 10 days with another surgery was done in the same day with no improvement in vision . the patient consult many doctors and all told him to do keratoplasty but he refused.when i examined him i see that the temporal 1/4 of the flap folded under the flap with elevation at this area and depression in the temporal part of flap with unaided VA 3/60 and refraction +6.00/-10.00 x 170 and best corrected 6/36 by +5.00/-8.00 x 170 and other eye 6/6 without glasses. as the patient refuse to do keratoplasty i offered him to give the eye a chance with femto lasik to try to resurface cornea to correct vision in this eye as much as i can and he accepted the idea. my plan was to create new flap more deep to 1st flap and use the following refraction +3.00/-6.00 x 170 (-6.00 cylinder was the max number accepted by laser machine) to resurface cornea to improve vision. but i change the plan during surgery due to the too much challenges i faced during elevation of flap as presence of two planes one for old flap and other for new one, sever adherence at multiple points,......(shown in video) but finally i elevate flap and apply laser with marked improvement in corneal topography and refraction as the refraction of this eye become +2.50/-4.50x 155 (after 2 months) with uncorrected VA 0.4 which correct by +1.00 /-3.00 x 155 to 0.7

Conclusion/Take Home Message:

early follow up after lasik prevent many complication and make the management of complications much more easy. we can use femto lasik to mange irregular cornea(within limits) before go to keratoplasty

Financial Disclosure:

None