How is the real final outcome of these eyes?

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Presentation transcript:

How is the real final outcome of these eyes? EARLY FLAP DISPLACEMENT AFTER LASIK How is the real final outcome of these eyes? Rosario Cobo-Soriano MD PhD Félix González-López MD Rafael Bilbao-Calabuig MD Fernando Llovet MD PhD The authors have no financial disclosure to declare

INTRODUCTION Postop LASIK complication Benign complication Variable reported incidence: 0.012% a 5,8% Ordinariy detected promptly (first 24-48h) Late dislocations:Trauma (days to years) Dislodged Flap Causes Interface overhydration , poor adherence. Brimonidine ? Eye rubbing, excessive blinking, squeezing from discomfort/ photophobia. Nasal/superior hinge? Dryness and adhesion of the flap to the upper tarsal conjunctiva. Intralase vs mechanical microkeratome? Other factors: Flap diameter/thickness? Refraction? mean K?, Pictures taken from Melki SA et al., Ophthalmology 2000;107

INTRODUCTION Flap remains wrinkled for several hours or overnight Incongruous fitting and apposition between the edematous folded flap and bed surfaces despite prompt surgical replacement. But , even after a prompt surgical flap reposition.. What is the real outcome of these eyes…? How long to recover optimal vision? Worse UCVA? Do they lose BCVA? Higher enhancement rate? Anatomic complications rate? DLK, epithelial ingrowth?

STUDY PURPOSE, PATIENTS & METHOD Main objective: To evaluate in a large series, the refractive and visual outcomes of eyes that suffered from an early postoperative flap dislocation . Retrospective, comparative (case/control) study Cases: Dislocated flap eyes from July/2002 to March/2015 Controls: Eyes operated-on uneventfully from January to June/2012 Clínica Baviera-Spain (24h-Emergency Service) Microqueratome: Manual Moria-LSK-One N= 536 dislodged flaps Late (>3 days): n= 77 eyes (4 bilateral cases) Early (<48h): n= 459 eyes 0,12% 408 patients (51 bilateral cases) 0,12%

RESULTS. PREOP DATA Measurement CASES N=459 CONTROLS N=12,624 P 51,2 - Laterality (% OS) 51,2 - Age 38,9 (12) 33,8(8) <0,01 Mean K pre 43,6 (2) 43,7 (1,6) NS Mean Cil K -1,28 (0,9) -1,08 (1,1) <0,05 SE pre -2,72 (3,2) -2,85 (2,8) Myopia (%) Hyperopia (%) Significant astigmatism (≥2D) (%) BCVA Pachymetry 555 (28) 555 (31) NS Pachym BED 460 (31) 462 (30) Ablation 70 (29) 66 (29) Flap Thickness 94 (20%) 92,4 (18 %)

RESULTS POSTOP DATA P<0,01 Mean follow-up until discharge: 190 days Anatomic Complications N (%) Epithelial ingrowth 73(16) Folds (different severity) 70(15) DLK 14(3) Peripheral haze 10(2) Central-Difuse haze 7 (1,5) Complete/Free Flap 4 (0,8) (1flap lost) Recurrent keratitis Mean follow-up until discharge: 190 days 9% eyes with follow-up > 1 year Efficacy: % eyes postop UCVA ≥ preop BCVA. / Safety: % eyes with loss ≥ 2 lines of BCVA.

DISCUSSION. LITERATURE REVIEW Ref. N Efficacy Safety Predictability % Enhancmt Walter, Ophthalmology 2001. Prospective Brimonidina 6/39 15,4% 69% >20/40 P<0,01 1 ojo (16%) < 2 líneas BCVA SE= -0,88D 36% P<001 Clare. Ophthalmology 2011. Retrospective 10 /81,000 61,8% vs 83,2% (AV =1) SE = +0,16D vs -0,07D (control) Recep. JCRS 2000 Comparative contralateral uneventful eye 21 No dif ES Clínica Baviera 459 0,12% 61% 4,7% 75% 12% Scarce bibliography to compare with

CONCLUSIONS Post-LASIK flap dislocation is an infrequent complication Incidence rate aceptable (0,1%). Our series shows that a flap dislocation after LASIK changes the final outcomes despite early detection and prompt surgical reposition, compared with eyes with an uneventful postoperative healing. Our results show a slower recovery and poorer visual performance in all functional and refractive parameters (efficacy, predictability, enhancement and safety). There are no studies to compare with. Higher rate of anatomical complications.