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Femtosecond laser-created flap complications rare, easily treatable
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HONG KONG — Femtosecond laser-created flap complications are rare in LASIK procedures, but the complications that do occur are often easily dealt with, a surgeon said here. John S. Chang, MD, of Hong Kong, described his own experiences with femtosecond laser complications and the steps he took to remedy those problems.
 John S. Chang |
"Surgery with femtosecond laser-created thin flaps is slightly more difficult, and a new set of potential complications can occur but are easily dealt with," Dr. Chang said. Dr. Chang described one case in which he had an avulsed flap after mistaking a nasal hinge for a superior hinge.
"Fortunately, this was discovered early enough, and the dissection was stopped at the distal edge," he said. "So a new pseudo hinge was created."
In cases where the flap is moved, Dr. Chang said the flap should be repositioned as soon as possible and a bandage lens can be used to promote healing.
"Remove the epithelial cells from the stromal bed edge to avoid epithelial ingrowth," he noted.
Vertical gas breakthrough can also occur, and in these cases the breakthrough can prevent further bubbles from forming and the flap cannot be created, Dr. Chang said.
"If the vertical gas bubbles do not go through the epithelium, surgery can be completed, but if they do go through, the bubble will be large and the surgery cannot go on," he said.
Dr. Chang said he has encountered two cases with the large bubble vertical gas breakthrough. In one case, he recut with the femtosecond laser at the same depth from another direction. In the other, he recut the flap with a mechanical microkeratome. In both cases, he successfully lifted the flap and continued the laser procedure without further complications.
Cases of epithelial ingrowth should be treated early because of the higher risk of flap necrosis, he said.
"Be sure to remove the epithelial cells from the stromal bed as well as underneath the flap," he said. He uses 0.02% alcohol to kill the epithelial cells.
In cases of diffuse lamellar keratitis, he advised aggressive early treatment to avoid flap necrosis and perforation. In cases in which the DLK is grade 2 or worse, the eyes are given a washout in the operating room and then treated with topical and systemic steroids.
Dr. Chang said all complications should be dealt with on the same day of surgery.