Study: Flap recutting a safe option in abandoned LASIK cases

Re-treatment after microkeratome flap complications by recutting the cornea was found to be a safe and effective treatment option in a Japanese study.

Mitsutoshi Ito, MD, PhD, and colleagues in Tokyo found that, in eyes re-treated with flap recutting after complications at initial LASIK surgery, the refractive and visual outcomes were comparable to those in uncomplicated cases by 6 months postop.

The authors studied the charts of 3,751 eyes of 2,033 patients (43% female; 57% male; mean age 34.7 years) who were followed for 6 months after primary LASIK. Of this group, 25 eyes (0.67%) had intraoperative flap complications. Fifteen eyes of the 25 complications were re-treated. Mean follow-up from primary LASIK to re-treatment was 127 days.

Overall incidence of complications was independent of surgical experience, but incomplete flaps occurred more often with inexperienced surgeons. Two eyes underwent initial LASIK with a disposable microkeratome; both these eyes had intraoperative flap complications. Complications occurred in fewer than 6% of eyes in which other types of microkeratomes were used.

Of the 25 complicated eyes, 12 (48%) had incomplete flaps, seven (28%) had thin flaps (thickness 80 µm or less), three (12%) had free caps, one (4%) had a thick flap, one had a torn flap, and one had a wrinkled flap.

Ten of the 12 incomplete flaps occurred with use of a manual microkeratome.

“These findings suggest the safety mechanism of the manual microkeratome regarding the rail track engagement system should be refined to facilitate its manipulation, and novice surgeons should be advised to start their initial cases with automatic models to avoid complications,” the study authors said.

Uncorrected visual acuity and manifest refraction cylinder in the re-treated group stabilized more slowly than in the uncomplicated group but were comparable within 6 months.

The spherical equivalent at 6 months after primary uncomplicated LASIK was within 0.5 D of emmetropia in 81.2% of eyes and within 1 D of emmetropia in 93.4% of eyes. The spherical equivalent 6 months after re-treatment was within 0.5 D of emmetropia in 50% of eyes and within 1 D of emmetropia in 83.3%.

The study is published in the June issue of Journal of Cataract & Refractive Surgery.