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Buttonholes during LASIK: etiology and outcome.

Henia Lichter1, R Doyle Stulting, George O Waring

  • 1In View, Atlanta, Ga, USA. lichter_henia@yahoo.com

Journal of Refractive Surgery (Thorofare, N.J. : 1995)
|May 26, 2007
PubMed
Summary

Laser-Assisted In Situ Keratomileusis (LASIK) flap buttonholes occurred in 0.06% of eyes, predominantly in the second eye of consecutive procedures. Surgeons should consider using a new blade for the second eye to mitigate this risk.

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Area of Science:

  • Ophthalmology
  • Refractive Surgery
  • Corneal Surgery

Background:

  • Laser-Assisted In Situ Keratomileusis (LASIK) is a common refractive surgery.
  • Flap creation is a critical step in LASIK.
  • Complications during flap creation can impact visual outcomes.

Purpose of the Study:

  • To analyze the clinical features and outcomes of eyes experiencing a flap buttonhole during LASIK.
  • To identify factors associated with LASIK flap buttonhole formation.

Main Methods:

  • Retrospective review of LASIK procedures using the Hansatome microkeratome.
  • Identification of eyes with flap buttonhole complications.
  • Analysis of pre-, intra-, and postoperative data to find predictive factors.

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Main Results:

  • Five flap buttonholes (0.06% of 7672 eyes) occurred between June 2001 and September 2002.
  • All buttonholes happened in the second eye of consecutively treated pairs (P = .03).
  • Untreated buttonholes caused myopic shift and astigmatism; one eye lost best spectacle-corrected visual acuity.

Conclusions:

  • Flap buttonholes are significantly more likely in the second of two consecutively treated eyes.
  • Consider using a new microkeratome blade for the second eye, especially if the first flap is thin.
  • Exercise caution with laser ablation immediately after buttonhole formation.