Therapeutic flap massage for microstriae after laser in situ keratomileusis: treatment technique and implications

To study the effect of a technique of external flap massage for the treatment of clinically significant flap microstriation after uneventful laser in situ keratomileusis (LASIK).

TLC Laser Eye Center, Elmwood Park, New Jersey, USA.

Twenty-five consecutive eyes with loss of best corrected visual acuity (BCVA) due to flap microstriation were treated using therapeutic external flap massage with a Caro flap manipulator (Moria) at the slitlamp. After topical anesthesia and carboxymethylcellulose drops (Celluvisc) were instilled in the eye, gentle pressure was applied to the flap centrally over the pupil area and then in enlarging concentric circles over the entire microstriation zone for 30 seconds with 3 repetitions at each treatment session. After the massage, collagen intracanalicular plugs were placed and patients were instructed to lubricate aggressively for 48 to 72 hours before reassessment. Patients were evaluated for improvement in uncorrected visual acuity, BCVA, and flap appearance as well as with serial axial topography. If a minimum of 3 massage cycles failed to improve the clinical status, patients were advised to have standard "lift and smooth" flap stretching procedures.

In 24 (96%) of the 25 treated eyes, the BCVA returned to the preoperative level; 1 patient required a flap lift. Twenty eyes obtained a BCVA of 20/20 without laser enhancement [correction]. One eye had a persistent loss of BCVA limited to 1 line. In no eye did the acuity deteriorate after massage.

External flap massage was an effective treatment of symptomatic flap microstriation after LASIK.