Related Experiment Videos
Secondary microkeratome-induced flap interference with the pathway of the primary flap
Navin H Tekwani1, Maria Regina Chalita, Ronald R Krueger
1Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Purpose:
To report a flap-related complication that occurs when a secondary microkeratome pass interferes with the pathway of a complicated first microkeratome pass.
Design:
Small, retrospective, noncomparative, interventional case series.
Participants:
Three patients.
Methods:
In three cases, each patient experienced a different flap-related complication with the original surgery, followed by interference of a secondary flap with the primary. The first patient experienced a free cap, followed by an interference of the secondary flap at the nasal portion of the free cap. The second patient experienced a buttonhole, followed by secondary flap interference in the superior quadrant adjacent to the buttonhole. The third patient experienced a decentered flap originally, followed by secondary flap interference temporally.
Main Outcome Measures:
Visual result after secondary microkeratome-induced flap-related complications.
Results:
All three patients had poor best spectacle-corrected visual acuity on the first postoperative day, with subsequent visual recovery. All three patients had induced flattening on keratometry along the axis where stromal tissue was removed. In addition, two patients required multiple enhancements to achieve desired visual outcomes.
Conclusions:
Complications related to the primary microkeratome pass add further risk for complications to arise during a second microkeratome pass. A secondary microkeratome pass should be attempted only if the original flap cannot be identified, if it is the result of primary flap complication, or if the desired treatment zone is notably larger than the diameter of the original flap. Intraoperative pachymetry of the residual stromal bed should be performed routinely. It is important to examine the stromal bed closely for loose or displaced slivers of tissue and to remove them before excimer treatment.
Insights
Secondary microkeratome passes can cause flap complications after initial surgical errors. Surgeons should exercise caution with repeat passes, especially after primary flap issues, to avoid further visual impairment.
Area of Science:
- Ophthalmology
- Refractive Surgery
- Corneal Surgery
Background:
- Laser-assisted in situ keratomileusis (LASIK) flap complications can necessitate secondary surgical interventions.
- A secondary microkeratome pass carries inherent risks, particularly when the primary flap is compromised.
Observation:
- This case series reports on three patients who experienced flap-related complications during secondary microkeratome passes.
- Each patient had a distinct primary flap complication (free cap, buttonhole, decentered flap) followed by secondary flap interference.
Findings:
- Secondary microkeratome passes following primary flap complications led to poor initial visual acuity.
- Patients experienced induced corneal flattening and often required multiple enhancements for visual recovery.
- Interference between secondary and primary flaps resulted in significant visual disturbances.
Implications:
- Primary flap complications increase the risk of adverse events during secondary microkeratome passes.
- Careful intraoperative assessment, including pachymetry and removal of stromal debris, is crucial before excimer laser ablation.
- Secondary microkeratome passes should be reserved for specific indications, such as an unidentifiable flap or a significantly larger treatment zone.