Incidence of Microfolds Using a Standardized Three-Stage LASIK Flap Replacement Protocol

Area of Science:

• Ophthalmology
• Corneal Surgery
• Laser Vision Correction

Background:

• Laser in situ keratomileusis (LASIK) is a common refractive surgery procedure.
• Flap-related complications, such as microfolds, can impact visual outcomes.
• Standardized surgical protocols are crucial for minimizing complications.

Purpose of the Study:

• To detail a standardized three-stage flap replacement protocol for femtosecond laser-assisted LASIK.
• To determine the incidence of microfolds following this protocol.

Main Methods:

• Retrospective analysis of 14,374 LASIK procedures using the VisuMax femtosecond laser.
• Implementation of a three-stage flap replacement protocol including irrigation, repositioning, and slit-lamp adjustments.
• Classification of microfolds using a 6-point grading system by independent observers.

Main Results:

• A low incidence of microfolds was observed: trace (1.10%), grade 1 (0.184%), and grade 2 (0.016%).
• No visually significant microfolds requiring flap lift occurred.
• Day 1 slit-lamp adjustments were more frequent with ultra-thin flaps (80-89 µm).
• Higher correction, larger optical zones, and thinner flaps were associated with increased microfold incidence.

Conclusions:

• The three-stage flap replacement protocol effectively minimizes clinically significant microfolds after femtosecond laser-assisted LASIK.
• Ultra-thin flaps (80-89 µm) require more frequent day 1 adjustments.
• The protocol contributes to favorable visual outcomes by reducing flap-related complications.