1. 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

2. 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

3. 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

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

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

6. 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

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

8. 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

9. 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

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

11. RESULTS
Mild scarring
Topographic irregular patterns

12. RESULTS [age - 22 to 57 years]
Group Group 2
SEQ [D] [D]
[K’s] [D] [D]
BCVA
SEQ, Ks ,BCVA p= ns
[K’s] buttonhole \ incomplete flap
[D] \ [D]
p= ns

13. 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

14. RESULTS Final Examination [6-12 mo.]
Group Group 2
SEQ [D] [D] [p=0.91]
UCVA [p=0.02]
BCVA [p=0.03]
BCVA
gain n= n=5
loss [1 line] n= n=1

15. 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

16. 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