Microfold incidence low with three-stage LASIK flap replacement protocol
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Key takeaways:
- A three-stage LASIK flap replacement protocol resulted in a low incidence of microfolds.
- Eyes with thinner flaps, higher corrections and larger optical zones were more likely to have microfolds.
A standardized three-stage LASIK flap replacement protocol demonstrated a low incidence of clinically visible microfolds and no visually significant microfolds, according to a study.
“Unlike many of the other published approaches to microfold management that focus primarily on treatment of visually significant cases, we describe a protocol to prevent the formation of visually significant microfolds resulting in a low probability of having to readjust the flap on postoperative day 1, and a near-zero chance of needing to return to the operating room for flap replacement almost exclusively limited to after physical trauma in the early postoperative period,” the authors wrote.
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The retrospective analysis included 14,374 consecutive LASIK procedures, with 3-month data available for 12,490 eyes. All eyes underwent the three-stage flap replacement protocol: flap repositioning after ablation with minimal irrigation; microscopic flap adjustments at the slit lamp after completion of the second eye; and day 1 slit lamp adjustments, if required. Flap thicknesses were 80 µm to 89 µm (7.2% of eyes), 90 µm to 99 µm (51.7% of eyes), 100 µm to 109 µm (17.8% of eyes), and 110 µm to 130 µm (23.2% of eyes).
At day 1, slit lamp flap adjustments were performed in 6.77% of eyes, with 27.6% occurring in eyes in the 80 µm to 89 µm group. A flap slip occurred in 0.16% of eyes, with management occurring at the slit lamp for 21 eyes and in the operating room for two eyes.
At 3 months, trace microfolds were found in 1.1% of eyes, grade 1 microfolds in 0.184% of eyes and grade 2 microfolds in 0.016% of eyes. Eyes in the 80 µm to 89 µm group accounted for 39.1% of grade 1 microfolds, with the 90 µm to 99 µm group having an incidence of 30.4%, the 100 µm to 109 µm group at 13%, and the 110 µm to 130 µm group at 17.4%. Operating room flap lifts for microfolds were not needed in any eyes.
The incidence for microfolds was higher in eyes with thinner flaps, higher corrections and larger optical zones, according to a multivariate regression analysis.
The study reiterates the importance of checking for and treating microfolds the day after LASIK, particularly in eyes with ultra-thin 80 µm to 89 µm flaps.
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