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Traumatic corneal flap dislocation one to six years after LASIK in nine eyes with favorable outcome PDF Print E-mail
Saturday, 05 May 2007 06:46

J Refract Surg. 2006 Nov;22(9):884-9.

Landau D, Levy J, Solomon A, Lifshitz T, Orucov F, Strassman E, Frucht-Pery J.

Cornea and Refractive Surgery Unit, Dept of Ophthalmology, Hadassah University Hospital, P.O.B. 12000, Jerusalem 91120, Israel. dvl_eyes@netvision.net.il

PURPOSE: To report our experience treating eye trauma after LASIK refractive surgery.

METHODS: Nine eyes of eight patients (one woman and seven men) were treated for ocular trauma: blunt trauma (n=5), sharp instrument trauma (n=2,) and trauma from inflation of automobile air bags during a traffic accident (n=2). The time from LASIK varied between 3 months and 6 years. All patients were hospitalized as a result of severe decrease in visual acuity and pain.

RESULTS: Seven of nine LASIK flaps had some degree of dislocation and were lifted, irrigated, and repositioned. Two flaps were edematous without dislocation. Intensive topical steroids and antibiotics were used in all patients up to 3 weeks after trauma. Three months after trauma, five eyes regained their pre-trauma visual acuity (between 20/20 and 20/40), and three eyes lost one line of best spectacle-corrected visual acuity.

CONCLUSIONS: Trauma occurring several months or years after LASIK may cause flap injury. Adequate and prompt treatment usually is successful.

Our report, as well as the related literature, indicates that the healing of the flap is incomplete even 6 years after LASIK surgery. The exact mechanism of long-term adhesion remains unclear. In an animal model, Maurice and Monroe20 demonstrated that after creation of a lamellar corneal stromal dissection, the adhesive force of the healed stroma lamellae approximated one-quarter to one-half that of normal. Perez et al21,22 suggested that drying increases stromal-stromal adhesion due to the increased concentration of surface molecules, which have high ionic charge densities and ionic binding. In rabbit corneas, the wound healing reaction after LASIK takes place only at the periphery of the microkeratome wound, leaving the central optical zone clear; similar findings have been described in human eyes after LASIK.