[Complications of femto-LASIK and features of cavitation injuries]

Modern approach to refractive laser surgery features three main types of lamellar surgery. Two of them are types of open laser keratomileusis (LASIK and femtosecond laser-assisted LASIK), and the third - closed (SMILE). All of these techniques allow achieving good clinical outcomes but differ in possible complications. This article reviews the complications of femto-LASIK and specifically the post-operative cavitation injuries, describes the mechanism of their occurrence, variants of their course, and presents the prevention measures.

[Epithelial ingrowth after anterior lamellar keratoplasty (clinical observation)]

Epithelial ingrowth (EI) is a rarely occurring complication of surgeries on the anterior eye segment characterized by migration and proliferation of epithelial cells along the wound tract or into the anterior chamber. Several decades ago, EI often led to severe complications, including enucleation. Modern treatment methods allow not only removing the pathological focus of EI, but also minimizing the risk of its reoccurrence. This article presents a clinical case of EI after anterior lamellar keratoplasty involving formation of implant bed under the pathological focus without cutting open the interface zone. The technique helps minimize dissemination of epithelial cells in the area of the lesion. To prevent growth reoccurrence, the method was supplemented with application of a cytostatic agent. The treatment resulted in stable remission throughout the follow-up period (26 months).

Epithelial ingrowth as a rare complication of nonpenetrating traumatic corneal injury

Trauma-related corneal epithelial ingrowth is a rare condition which was defined in only one previous report among the literature. A sequela-free recovery can be achieved with appropriate diagnosis, treatment, and follow-up. A 40-year-old female patient with a history of trauma about 6 months ago was referred to our clinic with the corneal scar in the left eye. In the slit-lamp examination, granular, well-defined opacities in the left corneal stroma were observed. Anterior segment optical coherence tomography (AS-OCT) revealed superficial intrastromal hyperreflective structures. Keratectomy were performed assuming epithelial ingrowth. Histological findings of excised flap confirmed the diagnosis. Six weeks later, no detectable ingrowth was observed and the BCVA improved.

Intraoperative optical coherence tomography-guided management of post-laser-assisted in situ keratomileusis epithelial ingrowth

We describe a modified technique of intraoperative optical coherence tomography (iOCT)-guided removal of post-laser-assisted in situ keratomileusis (LASIK) epithelial ingrowth with interface ethyl alcohol and mitomycin C application to prevent a recurrence. Epithelial ingrowth was visualized as hyperreflective deposits in the interface on iOCT, and the location and extent were noted at the beginning of the procedure. A simple dimple-down maneuver was performed to help identify the circumference of the LASIK flap. iOCT helped to delineate the flap edge and ensure dissection in the correct plane with complete removal of epithelial cell nests. Real-time visualization of the interface helped in on-table decision making regarding the extent of lifting the flap to encompass the entire region of hyperreflective epithelial ingrowth, as well as the need for additional interventions to ensure complete flap apposition at the end of surgery. All patients gained an uncorrected visual acuity of 20/20–20/25 with no recurrence.

Effect of Time Since Primary Laser-Assisted In Situ Keratomileusis on Flap Relift Success and Epithelial Ingrowth Risk

PURPOSE

To assess the association of time since primary laser-assisted in situ keratomileusis with flap relift success and risk of epithelial ingrowth in eyes undergoing flap relift after primary laser-assisted in situ keratomileusis.

SETTING

Hong Kong Sanatorium & Hospital, Hong Kong Special Administrative Region.

DESIGN

Retrospective, observational case series.

METHODS

Seventy-three eyes with flaps relifted for refractive enhancement laser-assisted in situ keratomileusis were included. Main outcome measures included rate of relift success and epithelial ingrowth; associations of time since primary laser-assisted in situ keratomileusis, sex, age at relift, year of relift, and flap creation method in primary laser-assisted in situ keratomileusis with relift success and epithelial ingrowth.

RESULTS

Relifting was successful in 71 eyes (97.3%). Among the successfully relifted eyes, 12 (16.9%) developed epithelial ingrowth, of which 3 (4.2%) were clinically significant. No eyes lost more than one line of corrected distance visual acuity. The time since primary laser-assisted in situ keratomileusis (up to 22 years), sex, age at relift, year of relift, and flap creation method in primary laser-assisted in situ keratomileusis were not associated with relift success or epithelial ingrowth.

CONCLUSIONS

With our described surgical technique, flaps could be successfully relifted without much difficulty up to 22 years after primary laser-assisted in situ keratomileusis with a low incidence of epithelial ingrowth.

Epithelial ingrowth following small incision lenticule extraction

A 27-year-old female patient came for a routine postoperative check-up, with a history of bilateral ReLEx small incision lenticule extraction (SMILE) surgery done 1.5 years back. On examination, epithelial ingrowth was noticed in the left eye at 8-9'o'clock position. Topography showed excess flattening in the area of ingrowth. Anterior Segment OCT showed hyper-reflectivity and was measured to be at a depth of 120 microns from the corneal surface. As the ingrowth appeared non-progressive, with no involvement of the pupillary axis and no visual complaints, no active intervention was done. Nonetheless, treatment options available include mechanical scraping and Nd:YAG laser procedure.

Clinically significant laser in situ keratomileusis flap striae

PURPOSE

To describe the incidence, risk factors, and outcomes before and after irrigation of clinically significant laser in situ keratomileusis (LASIK) flap striae.

SETTING

Multisurgeon multicenter standardized protocol practice.

DESIGN

Retrospective case-control series.

METHODS

Eyes with striae necessitating flap relift and irrigation were identified. Preoperative, intraoperative, and postoperative variables were collected. Incidence, risk factors, and outcomes were assessed.

RESULTS

Of the 109 403 eyes that had LASIK, the incidence of striae-treated eyes was 0.79% (n = 875), with 8.7% irrigated the first hour after surgery. The preoperative spherical equivalent (SE) and ablation depth exponentially increased the striae risk (R² = 0.9674; P < .001). Striae induced a small hyperopic shift that reversed after the relift (mean 0.22 diopter [D] ± 0.52 [SD] versus -0.02 ± 0.45 D) (P < .001). After relifting, 68.0%, 87.0%, and 96.0% of eyes had an uncorrected distance visual acuity (UDVA) of 20/20, 20/25, 20/40 or better versus 25.0%, 55.0%, and 84.0%, respectively, before the relift (P < .001). Thirteen percent fewer striae-treated eyes achieved a UDVA of 20/20. Before relifting, 51.0% of striae eyes lost 1 or more lines of corrected distance visual acuity, with a safety index reverting to control values (0.99 versus 1.00) (P > .05) after the relift. A laser refractive enhancement was performed in 6.28% of relifted striae eyes versus 3.04% in nonstriae control eyes.

CONCLUSIONS

Flap striae requiring surgeon intervention occurred in 0.79% of eyes. Higher preoperative SE values were associated with an exponential increase risk for striae. Treatment by lifting and irrigation significantly improved the accuracy, efficacy, and safety to a level close to that of contralateral control eyes, although striae-treated eyes were more likely to need excimer laser retreatment.

Resolution of epithelial ingrowth after combined photorefractive keratectomy and corneal crosslinking in a patient with post-LASIK ectasia

A 34-year-old man was referred to our institute for evaluation of the left eye because of corneal ectasia 10 years after bilateral laser in situ keratomileusis (LASIK). Three months before his referral, the patient had a flap lift for the management of interface fluid accumulation. Topography demonstrated post-LASIK corneal ectasia and slitlamp evaluation revealed epithelial ingrowth in the stromal interface inferiorly. The patient underwent uneventful combined photorefractive keratectomy (PRK) and corneal crosslinking (CXL) to stabilize the corneal ectasia and improve his functional vision. One month after the treatment, slitlamp evaluation revealed complete resolution of stromal interface epithelial ingrowth. At 12 months postoperatively, significant visual and topographic improvement was noted without any evidence of epithelial ingrowth recurrence or corneal ectasia progression. Combined PRK-CXL seemed to not only treat the corneal pathology of this patient successfully, resulting in visual and topographic improvement, but it also resolved the stromal interface epithelial ingrowth.

Post-Laser In Situ Keratomileusis Epithelial Ingrowth: Treatment, Recurrence, and Long-Term Results

PURPOSE

To study outcomes after surgical removal of epithelial ingrowth (EI) in post-laser in situ keratomileusis patients, specifically comparing visual results and recurrence rates between 2 different EI management techniques.

METHODS

In this retrospective chart review of 67 eyes of 54 patients who underwent surgical treatment for EI after laser in situ keratomileusis between July 1999 and July 2014 at the Bascom Palmer Eye Institute, Miami, FL, surgical techniques, recurrence rates, visual acuity (VA), and refractive error were assessed.

RESULTS

Of the 67 eyes, 56 eyes (83.6%) had flap lift + scraping alone, and 11 eyes (16.4%) had flap lift + scraping + suturing. After mean follow-up of 2.5 years, 11 of 56 eyes (19.6%) treated with flap lift + scraping alone had EI recurrence, whereas no eyes treated with flap lift + scraping + suturing had EI recurrence. VA results and refractive errors were better in eyes treated with lift + scraping alone compared with lift + scraping + suturing at 1 month. In the 67 eyes with 1-year follow-up, VA and refractive errors improved from preoperative values and were comparable between groups.

CONCLUSIONS

Scraping alone provides significantly better initial visual outcomes but higher EI recurrence rates compared with scrape-suturing. Long-term visual outcomes are comparable between 2 techniques.

Flap-Lift LASIK 10 or More Years After Primary LASIK

PURPOSE

To evaluate the safety and efficacy of flap-lift LASIK performed 10 or more years after the original LASIK procedure.

METHODS

All patients who were treated with flap-lift LASIK 10 or more years after primary LASIK for whom records of the primary treatment could be obtained and at least 45-day follow-up refractions after re-treatment were available were included in this study. A total of 23 eyes of 20 patients were identified. The median time between primary LASIK and flap-lift LASIK was 13.9 years (range: 10 to 18.7 years).

RESULTS

A total of 22 of 23 eyes (96%) retained the same corrected distance visual acuity (CDVA) postoperatively that was present preoperatively. One of 23 eyes (4%) experienced a loss of CDVA from 20/20 to 20/25 as the result of clinically significant epithelial ingrowth requiring multiple treatments followed by photorefractive keratectomy (PRK) treatment. One additional eye experienced clinically significant epithelial ingrowth that required a single surgical treatment. Fourteen of 20 eyes with a goal of plano achieved uncorrected distance visual acuity (UDVA) of 20/20 or better and 6 eyes achieved UDVA of 20/25 (2 of these eyes had preoperative CDVA of 20/25). For the eyes with a goal of plano, 16 of 20 eyes (80%) achieved UDVA equal to the preoperative CDVA.

CONCLUSIONS

Flap-lift LASIK is an effective treatment for refractive error when performed between 10 and 18.7 years after the initial flap was created. Epithelial ingrowth is the major complication, occurring to a clinically significant degree in 9% of the eyes. [J Refract Surg. 2018;34(9):604-609.].

Risk Factors for Epithelial Ingrowth Following Microkeratome-Assisted LASIK

PURPOSE

To analyze the incidence and risk factors associated with epithelial ingrowth following uncomplicated microkeratome-assisted LASIK.

METHODS

All patients who underwent microkeratome-assisted LASIK between January 2006 and December 2014 in a single surgical center were reviewed. Epithelial ingrowth cases were identified and associated factors were assessed.

RESULTS

Overall, 149 (0.49%) of 30,574 cases developed epithelial ingrowth. The epithelial ingrowth group was older compared to controls (35.3 ± 12.3 vs 31.7 ± 10.3 years, P = .001) and had a higher percentage of moderate to high hyperopia (13.7% vs 5.3%, P < .001), early postoperative flap slippage requiring flap repositioning (9.4% versus 2.8%, P < .001), or flap lifting for enhancement (48.6% vs 4.3%, P < .001), were treated with a smaller optic zone (6 mm) (37.7% vs 15.2%, P < .001), with a Moria M2 microkeratome (Moria SA, Antony, France) (70.1% vs 55.5%, P = .02), by low volume surgeons (n < 1,000) (5.8% vs 1.3%, P < .001), in a lower operating room temperature (22.3 ± 1.8 vs 22.8 ± 1.6, P = .005), and with a greater maximum ablation depth (67.3 ± 29.7 vs 57.3 ± 30.3, P < .001). There was a high incidence of epithelial ingrowth in the enhancement group compared to primary LASIK (4.8% vs 0.2%, P < .001). The time between treatments (primary and enhanced LASIK) was significantly greater in the epithelial ingrowth group (mean: 1,110 ± 870 vs 626 ± 662 days, P < .001). There was a significant rise in epithelial ingrowth rates as time between primary and enhancement LASIK increased, peaking at 4 to 5 years (P < .001). In multivariate analysis, flap lifting for enhancement (odds ratio [OR] = 19.5, P < .001), 6-mm optic zone (OR = 2.2, P < .001), moderate to severe hyperopia (OR = 2.4, P = .005), greater ablation depth (OR = 1.005, P < .001), and low volume surgeon (OR = 3.9, P = .01) were associated with epithelial ingrowth (total R² = 15.4).

CONCLUSIONS

The potential risk factors described above may forewarn surgeons as to which individuals merit closer observation for this complication. [J Refract Surg. 2018;34(2):100-105.].

Visual outcomes and management after corneal refractive surgery: A review

Corneal refractive surgery procedures are widely performed to permanently correct refractive errors. Overall, refractive surgeries are safe, predictable and present high rates of satisfaction. Nevertheless, the induced epithelial, stromal and nerve damage alters corneal integrity and function, triggering a regenerative response. Complications that arise from corneal wound healing process might directly impact on visual outcomes of keratorefractive procedures. Most of these complications can be prevented or effectively treated with minimal consequences and minor impact on optical quality. Nevertheless, it is crucial to accurately and timely identify these corneal regeneration-related complications for successful counseling and management. Optometrists, as primary eye care providers, play an essential role in detecting anatomic and functional alterations in vision. It is therefore of great interest for optometrists to be familiar with the principal postoperative complications derived from alterations in regenerative process after corneal laser refractive surgeries. This review aims to provide a basis for optometrists to better understand, identify and manage the main wound healing-related complications after refractive surgery.

Epithelial ingrowth following laser in situ keratomileusis (LASIK): prevalence, risk factors, management and visual outcomes

The number of laser in situ keratomileusis (LASIK) procedures is continuing to rise. Since its first application for correcting simple refractive errors over 25 years ago, the role of LASIK has extended to treat other conditions, including postkeratoplasty astigmatism/ametropia, postcataract surgery refractive error and presbyopia, among others. The long-term effectiveness, predictability and safety have been well established by many large studies. However, due to the creation of a potential interface between the flap and the underlying stroma, interface complications such as infectious keratitis, diffuse lamellar keratitis and epithelial ingrowth may occur. Post-LASIK epithelial ingrowth (PLEI) is an uncommon complication that usually arises during the early postoperative period. The reported incidence of PLEI ranged from 0%–3.9% in primary treatment to 10%–20% in retreatment cases. It can cause a wide spectrum of clinical presentations, ranging from asymptomatic interface changes to severe visual impairment and flap melt requiring keratoplasty. PLEI can usually be treated with mechanical debridement of the affected interface; however, additional interventions, such as alcohol, mitomycin C, fibrin glue, ocular hydrogel sealant, neodymium:yttriumaluminum garnet laser and amniotic membrane graft, may be required for recurrent or refractory cases. The aims of this review are to determine the prevalence and risk factors of PLEI; to describe its pathogenesis and clinical features and to summarise the therapeutic armamentarium and the visual outcome of PLEI.

Use of a hydrogel sealant in epithelial ingrowth removal after laser in situ keratomileusis

We describe 2 cases in which clinically significant epithelial ingrowth was removed by debridement and followed by the use of a hydrogel sealant (Resure) to seal the flap edge. In both cases, the epithelial ingrowth was seen after otherwise uneventful laser in situ keratomileusis retreatment. The visual outcomes were good with no recrudescence of interface epithelium.

FINANCIAL DISCLOSURE

Neither author has a financial or proprietary interest in any material or method mentioned.

Corneal Densitometry as a Tool to Measure Epithelial Ingrowth After Laser In Situ Keratomileusis

PURPOSE

This study evaluates the correlation between corneal densitometry and epithelial ingrowth (EI) after laser in situ keratomileusis (LASIK).

METHODS

Corneal densitometry of 3 patients who developed EI after LASIK was measured with the Oculus Pentacam. Corneal densitometry readings of each patient were obtained preoperatively and postoperatively after ingrowth was discovered. Densitometry was recorded at the central nest of opacity and at the leading edges of EI.

RESULTS

For all patients, the most severe stages of EI observed on slit-lamp photographs correlated with the highest densitometry readings, with peak densitometry ranging from 73.3 to 95.1. These values were much higher than preoperative densitometry readings, which ranged from 21.8 to 27.2. In 2 cases, the Pentacam densitometry map revealed progression of EI toward the visual axis that was only faintly detectable or not detectable at all on the corresponding slit-lamp photographs.

CONCLUSIONS

Corneal densitometry seems to be an objective measure of the severity and progression of EI after LASIK.

Outcomes of photorefractive keratectomy following laser in situ keratomileusis: a cohort study

OBJECTIVE

To analyze the outcomes of photorefractive keratectomy (PRK) on residual myopia and hyperopia post-laser in situ keratomileusis (LASIK) and to compare these results with PRK on eyes without previous laser refractive surgery.

DESIGN

Retrospective comparative cohort study.

PARTICIPANTS

Patients undergoing PRK between 2006 and 2010 were reviewed.

METHODS

Patients were divided into 4 groups, myopic or hyperopic PRK post-LASIK (mPRK-PL and hPRK-PL, respectively) and myopic or hyperopic PRK on corneas without previous laser refractive surgery (mPRK and hPRK, respectively). Uncorrected and corrected distance visual acuity, mean refractive spherical equivalent (MRSE), and mean keratometry and aberrations (total, higher order [HOA], coma, trefoil, and spherical aberration) were recorded at months 3 and 6 postoperatively, as were complications and attempted versus achieved MRSE.

RESULTS

Thirty-three eyes of 25 patients who underwent PRK post-LASIK (21 eyes of 14 patients for hPRK-PL and 12 eyes of 11 patients for mPRK-PL) and 35 eyes of 21 patients who underwent PRK on virgin eyes (11 eyes of 8 patients for hPRK and 24 eyes of 13 patients for mPRK) were included in the study. The only significant differences in outcomes were found to be HOA at 3 months for hPRK-PL as compared with both hPRK and mPRK. Achieved MRSE was significantly different from expected MRSE for hPRK-PL at 3 months postoperatively. No haze- or flap-related complications were observed.

CONCLUSION

Outcomes of PRK were not different in myopic and hyperopic corrections post-LASIK by 6 months or when compared with PRK in virgin eyes. HOA may render hPRK-PL results less predictable early in the postoperative period.

Combined laser in situ keratomileusis and prophylactic high-fluence corneal collagen crosslinking for high myopia: two-year safety and efficacy

PURPOSE

To evaluate the safety, efficacy, and refractive and keratometric stability of myopic femtosecond laser in situ keratomileusis (LASIK) with concurrent prophylactic high-fluence corneal collagen crosslinking (CXL) compared with the outcomes of standard femtosecond LASIK.

SETTING

Private clinical practice, Athens, Greece.

DESIGN

Consecutive randomized prospective comparative study.

METHODS

Eyes that had myopic LASIK or myopic LASIK with concurrent high-fluence CXL were evaluated preoperatively and up to 2 years postoperatively for manifest refraction spherical equivalent (MRSE), refractive astigmatism, visual acuity, corneal keratometry (K), and endothelial cell count.

RESULTS

One hundred forty consecutive eyes had myopic LASIK; 65 of the eyes were treated additionally with CXL. In the LASIK-CXL eyes, the mean postoperative MRSE was -0.18 diopter (D) ± 17.0 (SD) from -6.67 ± 2.14 D preoperatively. The postoperative flat K was 37.67 D from 43.92 D, and the steep K was 38.38 D from 45.15 D. The correlation coefficient of SE correction predictability was 0.975. In the LASIK-only eyes, the mean postoperative MRSE was -0.32 ± 0.24 D from -5.49 ± 1.99 D preoperatively. The flat K was 38.04 D from 43.15 D, and the steep K was 38.69 D from 44.03 D. The correlation coefficient of SE correction predictability was 0.968. The differences between the 2 groups at the 20/20 and 20/25 levels were statistically significant (P = .045 and P = .039, respectively).

CONCLUSION

Two-year results indicate that the application of prophylactic CXL concurrently with high-myopic LASIK appears to improve refractive and keratometric stability, presumably by affecting corneal biomechanical properties.

FINANCIAL DISCLOSURE

Dr. Kanellopoulos is a consultant to Alcon Surgical, Inc., Wavelight Laser Technologie AG, Allergan, Inc., Avedro, Inc., and i-Optics Corp. Dr. Asimellis has no financial or proprietary interest in any material or method mentioned.

Comparison of prophylactic higher fluence corneal cross-linking to control, in myopic LASIK, one year results

Purpose

To compare 1-year results: safety, efficacy, refractive and keratometric stability, of femtosecond myopic laser-assisted in situ keratomileusis (LASIK) with and without concurrent prophylactic high-fluence cross-linking (CXL) (LASIK-CXL).

Methods

We studied a total of 155 consecutive eyes planned for LASIK myopic correction. Group A represented 73 eyes that were treated additionally with concurrent prophylactic high-fluence CXL; group B included 82 eyes subjected to the stand-alone LASIK procedure. The following parameters were evaluated preoperatively and up to 1-year postoperatively: manifest refractive spherical equivalent (MRSE), refractive astigmatism, visual acuity, corneal keratometry, and endothelial cell counts. We plotted keratometry measurements pre-operatively and its change in the early, interim and later post-operative time for the two groups, as a means of keratometric stability comparison.

Results

Group A (LASIK-CXL) had an average postoperative MRSE of −0.23, −0.19, and −0.19 D for the 3-, 6-, and 12-month period, respectively, compared to −6.58±1.98 D preoperatively. Flat keratometry was 37.69, 37.66, and 37.67 D, compared to 43.94 D preoperatively, and steep keratometry was 38.35, 38.36, and 38.37 D, compared to 45.17 D preoperatively. The predictability of Manifest Refraction Spherical Equivalent (MRSE) correction showed a correlation coefficient of 0.979. Group B (stand-alone LASIK) had an average postoperative MRSE of −0.23, −0.20, and −0.27 D for the 3-, 6-, and 12-month period, respectively, compared with −5.14±2.34 D preoperatively. Flat keratometry was 37.65, 37.89, and 38.02 D, compared with 43.15 D preoperatively, and steep keratometry was 38.32, 38.57, and 38.66 D, compared with 44.07 D preoperatively. The predictability of MRSE correction showed a correlation coefficient of 0.970. The keratometric stability plots were stable for the LASIK CXL group and slightly regressing in the standard LASIK group, a novel stability evaluation metric that may escape routine acuity and refraction measurements.

Conclusion

Application of prophylactic CXL concurrently with myopic LASIK surgery appears to contribute to improved refractive and keratometric stability compared to standard LASIK. The procedure appears safe and provides a new potential for LASIK correction.

Management of residual refractive error after laser in situ keratomileusis and photorefractive keratectomy

PURPOSE OF REVIEW

To review the various steps and methods in managing residual refractive error after laser in situ keratomileusis and photorefractive keratectomy (PRK).

RECENT FINDINGS

Past studies have shown the efficacy and safety of flap relifts over recuts and for surface ablation over the flap. Other previous and also more recent studies show the use of a femtosecond laser for side cuts only. Recently, the creation of a femtosecond mini flap has been described. New studies also demonstrate the use of collagen cross-linking in postrefractive surgery ectasia.

SUMMARY

Residual refractive error is a known complication after both laser in situ keratomileusis and PRK. A systematic approach should be taken to manage this complication starting with a thorough evaluation to determine if an enhancement is indicated and if so, which method will be the safest and most efficacious for the patient.

Advances in Refractive Surgery

PURPOSE

The objective of this study was to review advances in the field of refractive surgery as reported in the peer-reviewed literature over the previous year.

DESIGN

This was a literature review.

METHODS

We conducted a PubMed search for terms related to refractive surgery and reviewed prominent international ophthalmic journals published from May 2012 through April 2013. All pertinent articles were reviewed, and selected articles with the greatest relevance were included.

RESULTS

Many studies over the previous year have highlighted progress in the field of refractive surgery; topics included keratoconus screening, photorefractive keratectomy and laser in situ keratomileusis, corneal cross-linking, small-incision lenticule extraction, phakic intraocular lenses, corneal inlays, presbyopic corneal treatments, and femtosecond laser-assisted astigmatic keratotomy.

CONCLUSIONS

The field of refractive surgery continues to provide exciting developments. Improvements in established procedures and promising new surgical options make the current climate an appealing one for refractive surgeons and patients.

Complications of femtosecond laser-assisted re-treatment for residual refractive errors after LASIK

PURPOSE

To report complications of femtosecond laser-assisted re-treatment by the creation of side cuts within the old flaps for residual refractive error after primary LASIK in two patients.

METHODS

Case report.

RESULTS

Three eyes of two patients had complications with a circumferential sliver of stromal tissue displaced during surgery due to overlap of old and new side cuts. The displaced tissue was repositioned and corneal anatomy was restored. Two of three eyes demonstrated improvement in the uncorrected visual acuity, whereas one eye lost two lines of corrected visual acuity due to loss of tissue at side cut resulting from flap manipulation, which was done at 1 week.

CONCLUSIONS

These cases demonstrate a complication of femtosecond laser-enabled side-cut for LASIK enhancement and factors that may lead to this complication and precautions to avoid it.

Laser in situ keratomileusis in 2012: a review

Laser in situ keratomileusis (LASIK) is a safe and effective treatment for refractive error. A combination of technological advances and increasing surgeon experience has served to further refine refractive outcomes and reduce complication rates. In this article, we review LASIK as it stands in late 2012: the procedure, indications, technology, complications and refractive outcomes.