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Dvivedi A, Murthy SI, Akkulugari V, Ali H. Surgical and visual outcomes of flap repositioning for various flap-related pathologies post laser in-situ keratomileusis (LASIK). Indian J Ophthalmol 2024; 72:489-494. [PMID: 38146972 PMCID: PMC11149534 DOI: 10.4103/ijo.ijo_788_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/27/2023] [Indexed: 12/27/2023] Open
Abstract
To evaluate the surgical and visual outcomes of flap repositioning for various post-laser-assisted in-situ keratomileusis (LASIK) flap pathologies. Retrospective review of consecutive cases between April 1, 2017 and February 28, 2022, where surgical flap repositioning was performed following LASIK for various flap-related complications. Of the 6018 eyes, 31 needed flap repositioning (0.51%). Indications were flap displacement and folds in 20 eyes (64%), flap subluxation in five eyes (16%), epithelial ingrowth and interface debris in two each, and one eye each of diffuse lamellar keratitis and incomplete flap. Final best spectacle-corrected visual acuity of ≥ 20/25 was obtained in 25/31 (80%) eyes. The efficacy index pre to post repositioning showed significant improvement (0.86 ± 0.39 vs. 0.63 ± 0.29 preop, P = 0.011). Flap repositioning incidence was significantly higher (7/602 (1.16%)) during the COVID lockdown phases compared to the non-COVID lockdown phase (24/5416 (0.44%, P = 0.019)). The COVID group had lower efficacy (0.72 ± 0.36 vs. 0.90 ± 0.39, P = 0.300) and safety indices (0.85 ± 0.24 vs. 1.06 ± 0.35, P = 0.144) compared to the non-COVID group; however, the results were not statistically significant. The flap displacement rate was statistically higher in nasal hinged (microkeratome) flaps (18/2013, 0.89%) compared to superior hinged (Femto) flaps (13/4005, 0.32%) (0.32%, P = 0.003). Our study shows that flap repositioning has a low incidence in LASIK, with the most common indication being flap displacement/folds. The outcome post flap repositioning was poorer during the lockdown period, perhaps due to the inability to follow up early. Early identification and surgical repositioning are successful in both anatomical and visual restoration.
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Affiliation(s)
- Arundhati Dvivedi
- Department of Cataract and Refractive Service, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- Department of Cornea Service, Shantilal Sanghvi Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Vidhyadhar Akkulugari
- Department of Cataract and Refractive Service, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Hasnat Ali
- Department of Cornea Service, Shantilal Sanghvi Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
- Department of Computational Bio-Statistics and Data Sciences, LV Prasad Eye Institute, Telangana, India
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Peterson J, Zubricky RD, Matharu K, Prakash G. LASIK Flap Dislocation Masquerading as Corneal Abrasion: Lessons and Pearls. J Emerg Med 2023; 65:e137-e139. [PMID: 37451964 DOI: 10.1016/j.jemermed.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Jonathan Peterson
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ryan D Zubricky
- Department of Ophthalmology, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Kanwal Matharu
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Gaurav Prakash
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Peraka RP, Murthy SI, Akkulugari V, Rathi VM. 'Infolded' LASIK flap: an unusual variant of early postoperative flap dislocation. BMJ Case Rep 2022; 15:e247255. [PMID: 35977749 PMCID: PMC9389127 DOI: 10.1136/bcr-2021-247255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/04/2022] Open
Abstract
Flap displacement is a rare but vision-threatening complication of laser-assisted in situ keratomileusis (LASIK). A young male patient underwent uneventful microkeratome-assisted LASIK. One-week postoperatively, flap displacement was noted in his right eye with its lower edge folded inwards, macrostria at the superior edge and the epithelium covering the bare stroma and into the interface. Anterior segment optical coherence tomography (AS-OCT) delineated the morphology of the displaced flap and the extent of epithelial ingrowth. The flap was repositioned by unrolling the fold and all the exposed surfaces were debrided to remove the epithelial ingrowth. Two months later, his corrected distance visual acuity improved to 20/30, and a smooth surface could be achieved. Infolded LASIK flap is a rare complication, which requires timely surgical intervention to achieve successful anatomical and functional outcomes. AS-OCT can be pivotal in determining the extent of infolding as well to delineate the extent of epithelial ingrowth within the interface.
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Affiliation(s)
- Raghav Preetam Peraka
- Cornea Service, The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila I Murthy
- Cornea Service, The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vidhyadhar Akkulugari
- Cataract and Refractive Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Varsha M Rathi
- GPR ICARE, LV Prasad Eye Institute, Hyderabad, Telangana, India
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He X, Li SM, Zhai C, Zhang L, Wang Y, Song X, Wang Y. Flap-making patterns and corneal characteristics influence opaque bubble layer occurrence in femtosecond laser-assisted laser in situ keratomileusis. BMC Ophthalmol 2022; 22:300. [PMID: 35820852 PMCID: PMC9277786 DOI: 10.1186/s12886-022-02524-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Opaque bubble layer (OBL), which generates from photo-disruptive procedures on the cornea, has been a common phenomenon during femtosecond laser-assisted refractive surgeries and it would potentially impact eye tracking and flap lifting. And we have observed that an updated flap-making pattern could form less OBL clinically than the traditional pattern, which needed further approval. Thus, the purpose of this study is to prove our observation and investigate the possible risk factors related to the occurrence and type of OBL in laser in situ keratomileusis (LASIK) flaps using the Visumax laser system. Methods This prospective study included 167 eyes of 86 patients (mean age: 27.5 ± 6.1 years) undergoing bilateral femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for myopia/myopic astigmatism by the same surgeon from April 2020 to August 2020. Preoperative data on refraction, central corneal thickness (CCT), and keratometry as well as intraoperative data were included for analysis. A new flap-making pattern creating an offset between flap-cut and side-cut was adopted to compare with the traditional pattern. The operation video of flap formation was analyzed to identify the existence and type of OBL. The area covered by OBL and the ratio of OBL to flap were calculated using Image J software. Results Among 167 eyes, 54 eyes (32.3%) developed OBLs, consisting of 31 as hard OBL coexisting with soft OBL, and 23 as soft OBL alone. The OBL incidence was significantly reduced in eyes with the new flap-making pattern compared with the traditional pattern (13.8% vs. 52.5%, P < 0.001). Hard OBLs had larger area ratios than soft OBLs (14.3 ± 8.3% vs. 1.1 ± 1.8%, P < 0.001). Univariate analyses revealed that eyes with more myopia, thicker CCT, and traditional flap-making patterns were more likely to develop OBLs. Multivariate analysis further confirmed that more myopia, thicker CCT, and traditional flap-making pattern were risk factors for OBLs. A Larger corneal diameter was associated with a higher incidence of hard OBL when applying the traditional flap-making process. Conclusion More myopia, thicker CCT, and larger corneal diameter were risk factors for OBL development during flap creation, whereas a flap-making pattern with an offset between flap-cut and side-cut could reduce the incidence of OBL.
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Affiliation(s)
- Xi He
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China.
| | - Changbin Zhai
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China.
| | - Li Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Yue Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Xiumei Song
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
| | - Yi Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China
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Fernández-Barrientos Y, Ortega-Usobiaga J, Beltran-Sanz J, Druchkiv V, Ramos-Navarro JL, González-de-Gor-Crooke JL. Efficacy and Safety of Surgically Managed Late Traumatic LASIK Flap Displacements in a Study of 66 Cases. J Refract Surg 2022; 38:270-276. [PMID: 35412921 DOI: 10.3928/1081597x-20220128-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate safety and efficacy in the management of flap displacement after laser in situ keratomileusis (LASIK) and subsequent complications. METHODS This was a retrospective study performed using data recorded at the center's database from October 2002 to August 2021. Efficacy and safety were both converted to binary outcomes (loss of one or more lines and no change or gain in lines of visual acuity). The effects of time from surgery to complication and from complication to repair were assessed and the odds ratios and probabilities were calculated. The same procedure was applied to investigate the effect of these temporal variables on complications. RESULTS A total of 66 eyes with late traumatic LASIK flap displacements were studied. Efficacy remained unchanged in 48 patients (64 eyes, 75%), and safety remained unchanged in 53 patients (59 eyes, 90%). Sixty-six patients (64 eyes, 100%) achieved visual acuity values of 20/40 and 45 patients (64 eyes, 70.3%) achieved values of 20/20. The flap displacement was resolved in the first 24 hours (SD ± 0.1 days). Surgery was performed in 58 patients (65 eyes, 90%). Epithelial ingrowth was the most frequent complication. Patients who underwent surgery tended not to lose lines (P = .05). The risk of developing epithelial ingrowth increases with time after LASIK surgery until traumatic flap displacement (odds ratio: 1.001; P < .001). The prevalence of dislocation during the study period was 0.012%. CONCLUSIONS Visual safety values were favorable after resolution of the flap complication. Immediate surgical management leads to better visual efficacy, and the time between LASIK and trauma increases the risk of epithelial ingrowth after flap displacement. [J Refract Surg. 2022;38(4):270-276.].
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Management of late traumatic LASIK flap dislocation related to dog scratch 16 Years postoperatively. Am J Ophthalmol Case Rep 2022; 25:101270. [PMID: 35169656 PMCID: PMC8829057 DOI: 10.1016/j.ajoc.2022.101270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 07/06/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This report details a case of an unusual late dislocation of a laser in situ keratomileusis (LASIK) flap due to animal-related trauma 16 years after the initial surgery. Observations A 59-year-old woman with history of LASIK surgery on both eyes 16 years prior, and uncomplicated cataract surgery on the left eye (oculus sinister; OS) 3 years prior, arrived at our institution with sudden painful visual loss 3 hours after receiving a scratch on OS from her dog. Corneal examination revealed a completely displaced nasally hinged LASIK flap folded irregularly over the hinge, with multiple creases over its entire thickness. The flap was intact but edematous and opaque, with detritus present both on the flap surface and stromal face. Treatment was initiated with topical moxifloxacin and oral clindamycin. The next morning, the flap was refloated, and debris was removed from both sides of the flap while irrigating with preservative-free moxifloxacin. The flap was repositioned and a bandage contact lens placed. Postoperative topical medication included moxifloxacin, prednisolone acetate, and sodium hyaluronate. At the final follow-up visit, the patient was asymptomatic, with a measured uncorrected distance visual acuity (UDVA) of 20/25 OS. Conclusion and importance This uncommon case highlights the longest reported interval—16 years— between initial surgery and traumatic LASIK flap displacement, caused by animal-related trauma. Patients experiencing LASIK surgery complications, including contaminated trauma many years after the original ablation, can still recover excellent visual acuity when managed appropriately and in a timely fashion.
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Nair S, Kaur M, Bari A, Titiyal JS. Flap amputation for long-standing post-LASIK flap dislocation with epithelial ingrowth. BMJ Case Rep 2022; 15:e247068. [PMID: 35135801 PMCID: PMC8830197 DOI: 10.1136/bcr-2021-247068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/04/2022] Open
Abstract
A man aged 26 years presented with complaints of diminution of vision in his right eye for 1 year following a fist injury. He had a history of laser-assisted in situ keratomileusis in both eyes 5 years earlier. On examination, his uncorrected distance visual acuity (UDVA) in the right eye was 1.0 logMAR. Slit-lamp examination of the right eye revealed a superotemporal dislocation of the flap with coexisting epithelial ingrowth encroaching the pupillary area. Due to the presence of long-standing fixed flap folds, a flap amputation was performed along with removal of the epithelial ingrowth using 0.02% mitomycin C as adjunct. Postoperatively, the UDVA was 0.3 logMAR on day 1, which improved to 0.2 logMAR at 1 week. At 1 year, the UDVA was 0.2 logMAR improving to 0.1 logMAR with refraction, with minimal paracentral corneal haze and no signs of corneal ectasia.
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Affiliation(s)
- Sridevi Nair
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Aafreen Bari
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Nair S, Kaur M, Titiyal JS. LASIK flap dislocation following direct face mask-induced mechanical trauma. BMJ Case Rep 2022; 15:e247824. [PMID: 35131797 PMCID: PMC8823137 DOI: 10.1136/bcr-2021-247824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sridevi Nair
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Mattout HK, Fouda SM. The use of topical nalbuphine in different concentrations to control pain after photorefractive keratectomy. Int Ophthalmol 2022; 42:2145-2153. [PMID: 35020101 DOI: 10.1007/s10792-022-02214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE This is a randomized controlled study aiming to evaluate the safety and efficacy of two different concentrations of topical nalbuphine hydrochloride, when used to relieve pain in the first days following photorefractive keratectomy (PRK). METHODS This is a prospective double blinded randomized clinical trial that included 189 patients who had PRK for correction of low and moderate refractive errors. Patients were randomly assigned to three groups according to the eye drops given to relieve pain in the first three postoperative days; the first group received topical nalbuphine with a concentration of 2 mg/ml (Group A = 64 patients), the second group received topical nalbuphine in a concentration of 1 mg/ml (Group B = 69 patients) and the third group received topical artificial tears only (Group C = 56 patients).The patients were asked to rate their pain daily using a numeric rating scale and to record the number of drops instillation times/day. The time needed for complete epithelial healing, best-corrected visual acuity (BCVA) and spherical equivalent after three months were recorded in each group. RESULTS In the first three days, there was a statistically significant difference in pain score among the three groups with lower values in the two topical nalbuphine groups when compared with the control group receiving artificial tears. Moreover, the higher concentration group showed significantly lower pain score and less number of drops used /day in comparison with the lower concentration group.There were no statistically significant differences in epithelial healing time, BCVA and spherical equivalent after three months among the three groups. CONCLUSION The use of topical nalbuphine is effective in relieving pain in the first few days following PRK and this pain relief is not associated with any compromise regarding epithelial healing nor refractive outcome. The pain control with 2 mg/ml concentration is significantly higher than that with 1 mg/ml concentration of nalbuphine. Trial registration numberISRCTN21394752 https://doi.org/10.1186/ISRCTN21394752 The trial is retrospectively registered in ISRCTN registry at March 08, 2021.
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Affiliation(s)
- Hala Kamal Mattout
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Sameh Mosaad Fouda
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Mohammadpour M, Rezaei F, Heirani M, Khorrami-Nejad M. Comparison of Postoperative Symptoms of Alcohol-Assisted Versus Mechanical Epithelial Removal in Photorefractive Keratectomy: A Contralateral Double Blind Clinical Trial. Eye Contact Lens 2021; 47:655-659. [PMID: 34393178 DOI: 10.1097/icl.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the short-term complaints of postoperative pain, and other ocular discomfort symptoms in patients who underwent photorefractive keratectomy (PRK) with alcohol-assisted epithelial removal in one eye versus mechanical debridement in the other eye. METHOD A prospective, interventional, contralateral double blind clinical trial was performed on 164 eyes of 82 candidates of PRK surgery. The patients were divided into two groups. The first group was alcohol-assisted PRK group in which the epithelial removal was performed on their right eye. The second group was mechanical PRK group in which epithelial removal was performed on their left eye. A numerical rating scale was given to the patients to describe the severity of postoperative pain on the first day following PRK. Postoperative discomfort symptoms including the complaints of light sensitivity, tearing, blurring, and foreign body sensation was also provided by the survey form. RESULTS One day following PRK, the mean pain score of the alcohol-assisted PRK group and the mechanical PRK group was 3.4±3.1 and 4.1±3.3, respectively (P=0.019). The highest scores recorded for alcohol-assisted and mechanical treated groups were burning (5.22) and light sensitivity (5.46), respectively. Sixty-eight (82.9%) of all patients experienced postoperative pain, and in 52 (76.5%) of them, the time of pain onset was less than 2 hrs. CONCLUSION We found less pain and discomfort using alcohol-assisted technique compared with mechanical epithelial removal that was provided by a detailed pain and ocular discomfort symptoms assessment one day following PRK surgery.
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Affiliation(s)
- Mehrdad Mohammadpour
- Translational Ophthalmology Research Center (M.M., F.R., M.H., M.K.-N.), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; and School of Rehabilitation (M.K.-N.), Tehran University of Medical Sciences, Tehran, Iran
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Sahay P, Bafna RK, Reddy JC, Vajpayee RB, Sharma N. Complications of laser-assisted in situ keratomileusis. Indian J Ophthalmol 2021; 69:1658-1669. [PMID: 34146007 PMCID: PMC8374806 DOI: 10.4103/ijo.ijo_1872_20] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/19/2020] [Accepted: 10/27/2020] [Indexed: 11/25/2022] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is one of the most commonly performed kerato-refractive surgery globally. Since its introduction in 1990, there has been a constant evolution in its technology to improve the visual outcome. The safety, efficacy, and predictability of LASIK are well known, but complications with this procedure, although rare, are not unknown. Literature review suggests that intraoperative complications include suction loss, free cap, flap tear, buttonhole flap, decentered ablation, central island, interface debris, femtosecond laser-related complications, and others. The postoperative complications include flap striae, flap dislocation, residual refractive error, diffuse lamellar keratitis, microbial keratitis, epithelial ingrowth, refractive regression, corneal ectasia, and others. This review aims to provide a comprehensive knowledge of risk factors, clinical features, and management protocol of all the reported complications of LASIK. This knowledge will help in prevention as well as early identification and timely intervention with the appropriate strategy for achieving optimal visual outcome even in the face of complications.
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Affiliation(s)
- Pranita Sahay
- Department of Ophthalmology, Lady Hardinge Medical College, New Delhi, India
| | - Rahul Kumar Bafna
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jagadesh C Reddy
- Cataract and Refractive Surgery Services, Cornea Institute, L V Prasad Eye Institute, L V Prasad Marg, Roan No-2, Banjara Hills, Hyderabad, Telangana, India
| | - Rasik B Vajpayee
- Vision Eye Institute, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK. J Clin Med 2021; 10:jcm10112478. [PMID: 34204958 PMCID: PMC8199895 DOI: 10.3390/jcm10112478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022] Open
Abstract
Although the use of femtosecond lasers instead of mechanical devices has decreased the incidence of flap complications following laser-assisted in situ keratomileusis (LASIK), dislocations and striae still occur. Flap repositioning is an effective intervention to improve visual outcomes after acute flap complications in both microkeratome-assisted and femtosecond-assisted LASIK. This retrospective case series included patients undergoing flap repositioning secondary to acute flap dislocation and/or visually significant striae within the first two weeks following femtosecond LASIK (FS-LASIK) from 2015 to 2020 at a single institution. Preoperative, intraoperative, and postoperative de-identified data were analyzed for incidence, risk factors, and visual acuity outcomes. The incidence of flap repositioning was 0.35% in 21,536 eyes (n = 70). Indications for repositioning included acute flap dislocation (35.7%) and visually significant striae (64.3%). High myopia (OR = 3.04, p = 0.001) and patient age over 50 years (OR = 3.69, p = 0.001) were the strongest risk factors for these complications. Prior to flap repositioning, uncorrected distance visual acuity (UDVA) of 20/20 or better and 20/40 or better occurred in 19% and 57% of eyes, respectively. After repositioning, a final UDVA of 20/20 or better and 20/40 or better occurred in 78% and 98% of eyes, respectively. After repositioning, one line of UDVA was lost in two eyes (2.8%) and two lines were lost in one eye (1.4%). Risk factors for acute flap dislocation included high myopia and age over 50 years. Flap repositioning was effective in salvaging visual outcomes.
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Ripa M, Betts B, Dhaliwal S, Wang K, Pouly S, Chen D, Mifflin M. Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs. Clin Ophthalmol 2020; 14:1459-1466. [PMID: 32546954 PMCID: PMC7266408 DOI: 10.2147/opth.s255441] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate and compare postoperative pain following photorefractive keratectomy (PRK) in patients using a preventive regimen of oral versus topical nonsteroidal anti-inflammatory drugs (NSAIDs). Patients and Methods A prospective, randomized, longitudinal survey of postoperative PRK pain was performed on 157 subjects in a tertiary academic medical center setting. Patients were randomized to either topical ketorolac 0.4% every 12 hours or oral naproxen sodium 220 mg every 12 hours for 72 hours following PRK, beginning at the time of surgery. The primary outcome measure was the daily peak pain score from the validated numerical rating scale (NRS) for five days after surgery. Results The peak pain scores were significantly higher in the oral NSAID group (mean 5.82, SD 1.94) compared to the topical NSAID group (mean 4.2, SD 2.19) (p<0.0001) after PRK. When comparing each postoperative day after PRK, the pain scores from 24 to 48 hours (day 2) were significantly higher in the oral NSAID group (mean 5.17, SD 2.25) as compared to the topical NSAID group (mean 3.21, SD 2.09) (p<0.0001). Pain scores 24–72 hours after surgery (days 2 and 3) were higher than pain scores on days 1, 4, and 5 for both groups. Conclusion Twice daily oral naproxen sodium 220 mg is inferior to twice daily topical ketorolac 0.4% in the treatment of early postoperative pain after PRK. This study also identified a consistent trend in which pain scores were highest 24–72 hours after the procedure. This additional observation may be useful in understanding, preventing, and treating post-PRK pain.
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Affiliation(s)
- Madeline Ripa
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Brent Betts
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Shagun Dhaliwal
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Kaidi Wang
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Severin Pouly
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Danli Chen
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Mark Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Alvarez MT, Montesel A, Bataille L. Late traumatic flap dislocation seven years after femtosecond laser-assisted in situ keratomileusis. Int J Ophthalmol 2019; 12:862-865. [PMID: 31131251 DOI: 10.18240/ijo.2019.05.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/13/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- María T Alvarez
- Cataract and Refractive Surgery Department, VISSUM, Madrid 28035, Spain.,Research and Development Department, VISSUM, Alicante 03016, Spain
| | - Andrea Montesel
- Research and Development Department, VISSUM, Alicante 03016, Spain
| | - Laurent Bataille
- Research and Development Department, VISSUM, Alicante 03016, Spain
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15
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Galvis V, Tello A, Ortiz AI, Quintero MP, Parra MM, Blanco NA. Traumatic corneal flap avulsion and loss 13 years after LASIK. Saudi J Ophthalmol 2018; 33:172-176. [PMID: 31384163 PMCID: PMC6664271 DOI: 10.1016/j.sjopt.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/12/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022] Open
Abstract
Postoperative flap displacements after Laser In Situ Keratomileusis (LASIK) are uncommon complications, and flap losses are even less frequent, occurring most commonly within 24 hours after the procedure. Although cases of late subluxation have been reported up to 14 years after the surgery, the longest reported time after surgery for late flap loss is four years after LASIK. We report a case of a 54-year-old man that presented a traumatic total flap avulsion and loss 13 years after LASIK. According to our knowledge, this is the longest time reported in such a case in the literature. Medical treatment yielded an acceptable visual result. This case reinforces the concept that there could be a lifelong potential risk of traumatic corneal flap loss after LASIK.
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Affiliation(s)
- Virgilio Galvis
- Fundación Oftalmológica de Santander FOSCAL, Ophthalmology Department, Floridablanca, Colombia.,Universidad Autonoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Colombia.,Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
| | - Alejandro Tello
- Fundación Oftalmológica de Santander FOSCAL, Ophthalmology Department, Floridablanca, Colombia.,Universidad Autonoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Colombia.,Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
| | - Alvaro I Ortiz
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
| | - María P Quintero
- Fundación Oftalmológica de Santander FOSCAL, Ophthalmology Department, Floridablanca, Colombia.,Universidad Industrial de Santander, Faculty of Health, Bucaramanga, Colombia
| | - M Margarita Parra
- Fundación Oftalmológica de Santander FOSCAL, Ophthalmology Department, Floridablanca, Colombia.,Universidad Industrial de Santander, Faculty of Health, Bucaramanga, Colombia
| | - Nicolás A Blanco
- Fundación Oftalmológica de Santander FOSCAL, Ophthalmology Department, Floridablanca, Colombia.,Universidad Industrial de Santander, Faculty of Health, Bucaramanga, Colombia
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16
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Late-onset traumatic dislocation of laser in situ keratomileusis corneal flaps: a case series with many clinical lessons. Int Ophthalmol 2018; 39:1397-1403. [DOI: 10.1007/s10792-018-0946-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
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17
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18
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Shetty R, Shroff R, Kaweri L, Jayadev C, Kummelil MK, Sinha Roy A. Intra-Operative Cap Repositioning in Small Incision Lenticule Extraction (SMILE) for Enhanced Visual Recovery. Curr Eye Res 2016; 41:1532-1538. [PMID: 27044473 DOI: 10.3109/02713683.2016.1168848] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To study the role of intra-operative cap repositioning in acute visual recovery after small incision lenticule extraction (SMILE). MATERIALS AND METHODS Ninety-four eyes of 47 patients underwent the SMILE procedure for correction of myopic refractive error. Manifest refraction and visual quality parameters (optical quality analysis system) were evaluated before surgery. The Bowman's membrane was imaged using a handheld spectral domain optical coherence tomography device. All patients underwent an uneventful SMILE surgery by a single experienced surgeon. Intra-operative cap repositioning was done in the "right" eye of all patients (repositioned group) and the "left" eye of each patient served as controls (non-repositioned group). Visual acuity and optical quality were assessed 1 day and 1 week after surgery. RESULTS Bowman's membrane microdistortions were found in 21.3% of eyes in the repositioned group and 59.57% of the eyes in the non-repositioned group (p = 0.003) on the first day after surgery. Comparison of optical quality parameters was carried out between eyes where repositioning was done and control eyes (with and without microdistortions). On the first day after surgery, the modulation transfer function (MTF) and Strehl's ratio (SR) were significantly better in the repositioned group when compared with the controls (p = 0.002 and p = 0.003, respectively). Refractive error and lenticule thickness in eyes with microdistortions were similar (p > 0.05) between the two groups indicating other contributors to acute optical quality postoperatively. CONCLUSIONS Although the refractive error before surgery determines the extent of microdistortions, intra-operative cap repositioning can reduce them, thereby expediting acute visual recovery after SMILE.
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Affiliation(s)
- Rohit Shetty
- a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India.,b Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
| | - Rushad Shroff
- a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
| | - Luci Kaweri
- a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
| | - Chaitra Jayadev
- a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
| | - Mathew Kurian Kummelil
- a Cornea and Refractive Surgery Division , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
| | - Abhijit Sinha Roy
- c Imaging, Biomechanics and Mathematical Modeling Solutions , Narayana Nethralaya Eye Hospital , Bangalore , Karnataka , India
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