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Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents
Lorena Romero-Diaz-de-Leon1, Juan Carlos Serna-Ojeda1, Alejandro Navas1
1Department of Cornea and Refractive Surgery, Instituto de Oftalmologia "Conde de Valenciana", Mexico City, Mexico.
Purpose:
To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications.
Methods:
We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t-test and relative risks were calculated.
Results:
There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free-cap (n = 5; 1.83%), and flap-buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K-min (P = 0.01), and K-max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications.
Conclusion:
Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye.
Insights
Flap-related complications occurred in 6.95% of LASIK surgeries performed by residents. Higher keratometry readings and a surgeon's initial procedures were associated with increased risk, highlighting areas for improved resident training in laser-assisted in situ keratomileusis (LASIK).
Area of Science:
- Ophthalmology
- Surgical Training
- Refractive Surgery
Background:
- Laser-assisted in situ keratomileusis (LASIK) is a common refractive surgery.
- Ensuring patient safety during LASIK is paramount, especially when performed by surgeons in training.
- Understanding complication rates and risk factors is crucial for optimizing surgical education and outcomes.
Purpose of the Study:
- To determine the incidence of flap-related complications during LASIK procedures conducted by ophthalmology residents.
- To identify patient-specific and surgeon-specific risk factors associated with these intraoperative complications.
Main Methods:
- A retrospective analysis of 273 LASIK flap dissections performed by 32 residents between March 2013 and February 2014.
- Data collected included all flap-related complications, patient demographics, and ocular biometric measurements (pachymetry, keratometry, white-to-white diameter, spherical equivalent).
- Statistical analysis, including independent Student's t-test and relative risk calculations, was used to compare groups and identify risk factors.
Main Results:
- A total of 19 flap-related complications (6.95%) were observed, with incomplete flap dissection being the most frequent (3.66%).
- Significant differences in mean keratometry, K-min, and K-max were found between eyes with and without complications.
- While not statistically significant, factors like the surgeon's first LASIK procedure and female gender showed trends towards increased complication risk.
Conclusions:
- Flap-related complications are a notable intraoperative event in LASIK surgery performed by residents.
- Ocular keratometry measurements and a surgeon's experience level (specifically, their first procedure) appear to be more significant risk factors than other biometric parameters.
- These findings underscore the importance of focused training and risk factor awareness in resident education for LASIK surgery.
