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Recutting LASIK flaps should be avoided, surgeons say

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Lifting the flap should be preferred to recutting the flap for enhancement after primary LASIK, a group of U.S. surgeons said after an analysis of surgical results.

Roy S. Rubinfeld, MD, and colleagues from several centers analyzed case histories of patients who developed serious complications after recutting LASIK flaps. Case histories, refractions, corneal topographies, slit-lamp photographs and measurements of uncorrected and best corrected visual acuity after recutting LASIK flaps were collected.

The authors identified 12 eyes of 12 patients that developed significant complications following recutting for enhancement. The mean age of the patients was 37.8 at the time of initial LASIK surgery. Mean preop spherical equivalent was –6.23 D, with a range of –3.75 D to –9 D, in 10 myopic eyes and +4.69 D, with a range of +3.5 D to +5.88 D, in two hyperopic eyes.

All patients had a preop BCVA of 20/20, normal pachymetry and symmetrical, unremarkable topographies before the initial surgery. BCVA postoperatively ranged from 20/20 to 20/25; mean spherical equivalent postop was 0.33 D. No eye lost more than 2 lines of BCVA postoperatively.

The microkeratome used in the initial surgery was used with a thicker plate in re-treatment of four eyes. Five eyes underwent re-treatment with the same microkeratome and the same plate thickness, and one eye was recut with a different microkeratome but same plate thickness. The remaining two eyes did not have complete data available.

After enhancement surgery, UCVA ranged from 20/30 to 20/400, the mean spherical equivalent increased to –0.49 D and the mean refractive cylinder was 1.48 D. Mean time between initial LASIK and enhancement was 11.5 months, with a range of 5.5 to 26 months.

After enhancement, seven eyes lost 2 or more lines of BCVA and all patients had visually significant complaints such as monocular diplopia, glare, loss of contrast sensitivity, ghosting and poor quality of vision.

“If lifting for enhancement is found to be generally preferable to recutting after future analysis in large multicenter prospective trials, there will still be indications for recutting when lifting is not possible,” the authors said in the December issue of Journal of Cataract & Refractive Surgery. Among the possible reasons for recutting are incomplete or thin initial flap, primary flap too small for subsequent hyperopic treatment, extensive healing of the initial flap, previous radial keratotomy surgery or previous recutting.