Outcome of Flap Complications Following LASIK Surgery Faik Orucov MD, A. Solomon MD, E. Shtrasman MD, F. Raiskup MD, D. Landau MD, J. Frucht-Pery MD Department of Ophthalmology Hadassah University Hospital Jerusalem, Israel

Intraoperative Flap Complications [0.3% -2.6%] Free cup Partial flap Irregular flap Thin flap Buttonhole Jacobs JM. J Cat Refract Surg. 2002 Gimbel HV. Ophthalmology 1998

Reasons for Flap Complications Loss of suction Blockage of microkeratome [drapes, eyelashes, speculum] Poor cleaning or assembly Blade- sharpness\damage Motor\microkeratome breakdown or loss of power Electric power failure Ocular anatomy: steep\flat cornea small size eye

We studied the outcome of PARTIAL CUTS and BUTTONHOLES at the Laser Center in Hadassah University Hospital, Jerusalem Israel.

METHODS - 4864 Consequtive LASIK Surgeries 18 eyes of 18 patients [8 females / 10 males] Group 1 8 buttonholes 10 partial cuts Group 2 18 none-complicated fellow eyes

METHODS Microkeratome - Hansatome 160 microns head [B&L] Flap complication - LASIK termination Fellow eye surgeries postponed Not Lifted Lifted Partial flap n= 8 n= 2 Buttonholes n= 3 n= 5 Flap complications - microkeratome examination

METHODS Steroids 14 days Topical antibiotics 4 days Evaluation: VA, topography, slit lamp Follow-up 3-4 months

METHODS LASIK Retreatment After 3-5 Months [one surgeon JFP] 16 of 18 pts. Microkeratome head 180 microns B&L 217-Z laser system Follow-up: 6 to12 mo. Statistics: Paired T-test complicated vs fellow eye

RESULTS Reasons for the Adverse Events Failure of the suction n=4 Obstruction of microkeratome pass [speculum, eyelashes,glove] n=4 Squeezing of the lids n=3 Breakage in the engine n=1

RESULTS Microkeratome Cut Through the pupil n=14 Peripheral cornea n=2

RESULTS Mild scarring Topographic irregular patterns

RESULTS [age - 22 to 57 years] Group 1 Group 2 SEQ -3.62 + 3.11 [D] 4.02 + 3.38 [D] [K’s] 44.57 + 1.05 [D] 44.64 + 1.03 [D] BCVA 1.1 1.1 SEQ, Ks ,BCVA p= ns [K’s] buttonhole \ incomplete flap 45.01 + 0.85 [D] \ 44.2 + 1.26 [D] p= ns

RESULTS Recovery Period -Prior to Retreatment OCULAR CHANGES SEQs: changes up to 0.3 [D] K’s: changes up to 0.75 [D] No loss of BCVA

RESULTS Final Examination [6-12 mo.] Group 1 Group 2 SEQ -0.15 + 0.28 [D] -0.16 + 0.26 [D] [p=0.91] UCVA 0.88 + 0.15 1.04 + 0.27 [p=0.02] BCVA 0.99 + 0.15 1.09 + 0.22 [p=0.03] BCVA gain n=1 n=5 loss [1 line] n=5 n=1

RESULTS Buttonholes VS Incomplete Cut [paired T-test] SEQ p=0.38 UCVA p=0.83 BCVA p=0.43 Gain/Loss of BCVA p=0.82

CONCLUSIONS Buttonhole/incomplete cut: perfect replacement of the flap and abortion of lasing procedure Retreatment after 3-5 months provides an excellent outcome but of lesser quality as compared with the fellow eye