1. 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

2. 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

3. 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?

4. 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%

5. 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 %)

6. 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.

7. 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

8. 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.