Management of severe flap wrinkling or dislodgment after laser in situ keratomileusis

To review the management and results of cases with severe flap wrinkling or dislodgment after laser in situ keratomileusis (LASIK).

University Eye Center, Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong.

Four patients with severe flap wrinkling or dislodgment after LASIK are described. Surgical repositioning of the flap was performed in all cases. Flap status, refractive changes, and final uncorrected and best corrected visual acuities were used to evaluate the outcome of flap repositioning.

Flap repositioning required suturing in 2 patients, 1 of whom developed severe epithelial ingrowth with melting of the corneal flap and stromal bed and eventually required flap removal. The stromal inflammation resolved, and the corneal surface re-epithelialized after flap excision. In 2 other patients, wedge-shaped tissue excision (1.0 x 1.5 mm) from the superior portion of the corneal flap was necessary to allow better flap realignment. In 1 of these patients, the corneal flap was eventually converted to a free cap to correct residual wrinkling. At a mean follow-up of 15 months, the postoperative uncorrected visual acuity ranged from 20/20 to 20/60, and the best spectacle-corrected visual acuity (BSCVA) was 20/30 or better in all patients. In 1 patient, BSCVA decreased by 1 line.

Flap dislodgment and wrinkling are serious postoperative complications of LASIK. Early recognition of these complications and prompt surgical management are crucial to achieve a successful surgical and visual outcome.