Outcome of Flap Outcome of Flap Complications Following Complications Following

LASIK SurgeryLASIK Surgery

Faik Orucov MD, A. Solomon MD, Faik Orucov MD, A. Solomon MD, E. Shtrasman MD, F. Raiskup E. Shtrasman MD, F. Raiskup MD, D. Landau MD, J. Frucht-Pery MD, D. Landau MD, J. Frucht-Pery

MDMD

Department of OphthalmologyDepartment of OphthalmologyHadassah University HospitalHadassah University Hospital

Jerusalem, Israel Jerusalem, Israel

Intraoperative Flap Intraoperative Flap Complications [0.3% -2.6%]Complications [0.3% -2.6%]

Free cup Free cup Partial flapPartial flap Irregular flapIrregular flap Thin flapThin flap ButtonholeButtonhole

Jacobs JM. J Cat Refract Surg. 2002 Jacobs JM. J Cat Refract Surg. 2002

Gimbel HV. Ophthalmology 1998Gimbel HV. Ophthalmology 1998

Reasons for Flap ComplicationsReasons for Flap Complications

Loss of suction Loss of suction Blockage of microkeratome Blockage of microkeratome

[drapes, eyelashes, [drapes, eyelashes, speculum]speculum]

Poor cleaning or assemblyPoor cleaning or assembly Blade- sharpness\damageBlade- sharpness\damage Motor\microkeratome breakdown or loss of Motor\microkeratome breakdown or loss of

powerpower Electric power failureElectric power failure Ocular anatomy: steep\flat corneaOcular anatomy: steep\flat cornea small size eyesmall size eye

We studied the outcome of We studied the outcome of PARTIAL CUTS and BUTTONHOLES PARTIAL CUTS and BUTTONHOLES at the Laser Center in Hadassah at the Laser Center in Hadassah University Hospital, Jerusalem University Hospital, Jerusalem Israel.Israel.

METHODS - 4864 METHODS - 4864 Consequtive Consequtive LASIK SurgeriesLASIK Surgeries

18 eyes of 18 patients 18 eyes of 18 patients [8 females / 10 males][8 females / 10 males]

Group 1Group 1 8 buttonholes 8 buttonholes 10 partial cuts10 partial cuts

Group 2Group 2 18 none-complicated 18 none-complicated fellow eyesfellow eyes

METHODS METHODS Microkeratome - Hansatome Microkeratome - Hansatome 160 microns head 160 microns head [B&L][B&L]

Flap complication - LASIK termination Flap complication - LASIK termination

Fellow eye surgeries postponedFellow eye surgeries postponed

Not Lifted Not Lifted LiftedLifted

Partial flap Partial flap n= 8n= 8 n= 2n= 2

Buttonholes Buttonholes n= 3n= 3 n= 5 n= 5

Flap complications - microkeratome examinationFlap complications - microkeratome examination

METHODSMETHODS

Steroids 14 days Steroids 14 days

Topical antibiotics 4 daysTopical antibiotics 4 days

Evaluation: VA, topography, slit Evaluation: VA, topography, slit lamplamp

Follow-up 3-4 monthsFollow-up 3-4 months

METHODS METHODS LASIK Retreatment After 3-5 MonthsLASIK Retreatment After 3-5 Months

[one surgeon JFP][one surgeon JFP]

1616 of of 1818 pts. pts. Microkeratome head Microkeratome head 180180 microns microns

B&L 217-Z laser system B&L 217-Z laser system Follow-up: 6 to12 mo.Follow-up: 6 to12 mo.

Statistics: Paired T-test Statistics: Paired T-test complicated vs fellow eyecomplicated vs fellow eye

RESULTSRESULTSReasons for the Adverse EventsReasons for the Adverse Events

Failure of the suction Failure of the suction n=4n=4

Obstruction of microkeratome pass Obstruction of microkeratome pass

[speculum, eyelashes,glove] [speculum, eyelashes,glove] n=4n=4

Squeezing of the lids Squeezing of the lids n=3n=3

Breakage in the engine Breakage in the engine n=1n=1

RESULTSRESULTS

Microkeratome Cut Microkeratome Cut

Through the pupil Through the pupil n=14 n=14

Peripheral cornea Peripheral cornea n=2n=2

RESULTSRESULTS

Mild scarringMild scarring Topographic irregular patternsTopographic irregular patterns

RESULTSRESULTS[age - 22 to 57 years][age - 22 to 57 years]

Group 1 Group 1 Group 2 Group 2 SEQSEQ -3.62 -3.62 ++ 3.11 [D] 4.02 3.11 [D] 4.02 ++ 3.38 [D] 3.38 [D][K’s][K’s] 44.57 44.57 ++ 1.05 [D] 44.64 1.05 [D] 44.64 ++ 1.03 [D] 1.03 [D] BCVABCVA 1.1 1.1 1.1 1.1 SEQ, Ks ,BCVA p= nsSEQ, Ks ,BCVA p= ns [K’s][K’s] buttonhole \ incomplete flapbuttonhole \ incomplete flap

45.01 45.01 ++ 0.85 [D] \ 44.2 0.85 [D] \ 44.2 ++ 1.26 [D] 1.26 [D] p= nsp= ns

RESULTS RESULTS Recovery Period -Prior to RetreatmentRecovery Period -Prior to Retreatment

OCULAR CHANGESOCULAR CHANGES

SEQs: SEQs: changes up to 0.3 [D] changes up to 0.3 [D] K’s:K’s: changes up to 0.75 [D]changes up to 0.75 [D]

No loss of BCVA No loss of BCVA

RESULTS RESULTS Final Examination [6-12 mo.]Final Examination [6-12 mo.]

Group 1 Group 2Group 1 Group 2 SEQSEQ -0.15 -0.15 ++ 0.28 [D] -0.16 0.28 [D] -0.16 ++ 0.26 [D] [ 0.26 [D] [p=0.91p=0.91]] UCVAUCVA 0.88 0.88 ++ 0.15 1.04 0.15 1.04 ++ 0.27 [ 0.27 [p=0.02p=0.02]] BCVA BCVA 0.99 0.99 ++ 0.15 1.09 0.15 1.09 ++ 0.22 [ 0.22 [p=0.03p=0.03] ]

BCVA BCVA gain gain n=1 n=5 n=1 n=5 loss [1 line] loss [1 line] n=5 n=1 n=5 n=1

RESULTS RESULTS Buttonholes VS Incomplete CutButtonholes VS Incomplete Cut

[paired T-test][paired T-test]

SEQSEQ p=0.38p=0.38 UCVAUCVA p=0.83p=0.83 BCVABCVA p=0.43 p=0.43 Gain/Loss of BCVAGain/Loss of BCVA p=0.82p=0.82

CONCLUSIONSCONCLUSIONS

Buttonhole/incomplete cut: Buttonhole/incomplete cut: perfect replacement of the flap perfect replacement of the flap and abortion of lasing procedureand abortion of lasing procedure

Retreatment after 3-5 months Retreatment after 3-5 months provides an excellent outcome provides an excellent outcome but of lesser quality as compared but of lesser quality as compared with the fellow eyewith the fellow eye