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Laser in situ keratomileusis buttonhole: classification and management algorithm
Mona Harissi-Dagher1, Amit Todani, Samir A Melki
1Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
Purpose:
To report the classification, management, and visual outcomes after laser in situ keratomileusis (LASIK) flap buttonhole caused by a microkeratome cut.
Setting:
Private practice, Boston, Massachusetts, USA.
Methods:
This retrospective observational case series comprised 15 patients with an intraoperative LASIK flap buttonhole or near buttonhole. In all cases, the flap was left in place or repositioned without excimer laser treatment. Buttonholes were classified by stage, and a treatment algorithm based on the stage was devised to determine the timing and type of intervention. The uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and complications associated with the laser vision correction surgery were reported.
Results:
Postoperative follow-up ranged from 1 week to 23 months. All 9 patients who were retreated had a postoperative UCVA of 20/25 or better. No retreated patient lost BSCVA. Before retreatment, the median UCVA was 20/80 (range 20/40(-1) to counting fingers), the median BSCVA was 20/20(-2) (range 20/15(-1) to 20/70), and the spherical equivalent (SE) refractive errors ranged from -1.00 to -6.62 diopters (D). After retreatment, the median UCVA was 20/20(-2) (range 20/15(-1) to 20/25(-1)), the median BSCVA was 20/20 (range 20/15 to 20/20(-3)), and the SE refractive errors ranged from +0.50 to -0.75 D. Complications after laser correction treatment included overcorrection in 3 patients and corneal haze in 2 patients.
Conclusions:
Classification of buttonholes was helpful in guiding treatment. Good UCVA and BSCVA were achieved by following a simple treatment algorithm based on surface ablation.
