Flap lifting better than recutting for long-term visual stability, study finds

MINNEAPOLIS, Minn. — Lifting the flap for LASIK enhancement may be better for long-term stability than recutting the flap, according to a study here.

Elizabeth Davis, MD, FACS, and colleagues here at Minnesota Eye Consultants reviewed the records of 212 eyes of 152 patients that had undergone a myopic LASIK enhancement procedure over the course of 5 years. Relifting the flap was performed in 164 eyes, and recutting was used in 48 eyes. Mean patient age was 44 years and the average time between the initial LASIK procedure and the enhancement was 10.2 months in the relifting group and 10.9 months in the recutting group.

There were no significant differences in early visual outcomes between the two groups. At 1 year, mean uncorrected vision was significantly better if the flap was lifted (20/25) rather than recut (20/31) for enhancement (P < .008).

Additionally, the flap lift group had a significantly more stable refraction at 1 year than did the recut group. The change in spherical equivalent for the flap lift group was +0.05 D and for the recut group was –0.57 D. The frequency of complications was low, and there was no significant difference between the complication rates of the two groups.

The authors note that, despite the differences they found, LASIK enhancements can be performed safely and effectively with either recutting or lifting. The better results achieved in the flap lift group “might be explained by several unproven theories,” the authors speculate in the December issue of Ophthalmology. Among the possibilities: a second lamellar cut has an additional refractive effect not accounted for in the surgeon’s nomogram; additional flap creation stimulates more epithelial hyperplasia and subsequent regression; or a recut stromal bed is relatively more hydrated.