Traumatic corneal flap displacement after laser in situ keratomileusis (LASIK)

Figures & data

Figure 1 A late-onset corneal flap displacement with superior and inferior portion of flap being folded is shown. Bare stroma is exposed and intact nasal hinge is visible under surgical microscope.

Figure 2 After reposition of the corneal flap a bandage soft contact lens is placed on the cornea for protection under surgical microscope. without epithelial ingrowth.

Figure 3 Four months after surgery, the corneal flap is clear and smooth in situ without epithelial ingrowth.

Table 1 Summary of previous literature reporting late flap dislocations or displacements after LASIK

Case number	Reference	Age/gender	Mechanism of injury	Injury time after LASIK	VA after trauma	Flap condition after trauma	Case number	Reference	Age/gender	Mechanism of injury	Injury time after LASIK	VA after trauma	Flap condition after trauma
1	Sinha et al^Citation4	26/F	Wooden splinter	4 years	20/60	Dislocation, infolding, macrostriae, epithelial ingrowth epithelial ingrowth	Nil	Nil	Reposition, debridement	Nil	12 days	20/20	(−)
2	Esteban et al^Citation5	29/M	Screwdriver	10 years	Nil	Dislocation, inverted corneal flap tear	Nil	Nil	Reposition, soft contact lens	Epithelial ingrowth	Nil	Nil	(−)
3	Khoueir et al^Citation6	Nil	Recreational activities	10 years	Nil	Dislocated	Nil	Nil	Nil	Nil	Nil	20/20	(−)
4	Holt et al^Citation7	59/NR	Blunt trauma	14 years	Nil	Dislocation, epithelial ingrowth, significant macrostriae	Nil	Nil	Reposition, debridement	Nil	35 days	20/30	(−)
5	Tai et al^Citation8	34/M	Struck with a basketball	1 years	Nil	Nil	Nil	Nil	Reposition, debridement, soft contact lens, antibiotics, steroid	Nil	Nil	20/20	(−)
6	Tai et al^Citation8	27/M	“Finger-flick” in sporting	1 year	CF	Total dislocated, corneal flap, 100% exposed bed	Nil	Nil	Reposition, debridement, soft contact lens, antibiotics, steroid	Nil	Nil	20/20	(−)
7	Tumbocon et al^Citation9	25/M	Struck by a dog’s paw	26 months	20/25	Dislocation, flap folding and striae	Nil	4 hours	Reposition, debridement, soft contact lens	Grade 1 diffuse lamellar keratitis	5 days	20/20	(+) 3 months
8	Tumbocon et al^Citation9	35/M	Struck a rock	7 months	CF at 1 m	Dislocation	Lid laceration, periorbital edema, orbital floor fracture	2 days	Reposition	Striae crossing the visual axis	17 days	20/40	(−)
9	Aldave et al^Citation10	29/M	Struck with a finger while playing basketball	18 months	20/200	Dislocation, exposed stromal bed	Nil	1 hour	Reposition, soft contact lens	Epithelial ingrowth	1 day	20/25	(+) 4 months
10	Sridhar et al^Citation11	35/F	Self removal with SCL	10 days	20/70	Loss of the flap	Nil	Immediately	Soft contact lens	Nil	10 days	20/70	(−)
11	Lombardo and Katz^Citation12	43/F	Asymptomatic	4 months	20/60	Dislocation, flap wrinkled	Nil	Immediately	Reposition, soft contact lens	Nil	20 days	20/25	(+) 4 months
12	Iskander et al^Citation13	51/F	Pecan falling from a tree	3 months	20/70	Flap folding	1+ anterior chamber cells	48 hours	Reposition, debridement	Epithelial ingrowth	1 week	20/20	(−)
13	Iskander et al^Citation13	32/M	Hit with a cable	3 months	Nil	Dislocation, microfolds, gutter	Nil	Few hours	Reposition, debridement	Minimal fibrosis	Nil	20/20	(−)
14	Iskander et al^Citation13	20/F	Airbag deployed	38 months	20/20	Dislocation, flap wrinkling	Nil	Immediately	Reposition	Nil	Nil	20/20	(−)
15	Melki et al^Citation14	28/M	Basketball	10 days	Nil	Dislocation, flap tear, flap folding	Nil	<6 hours	Reposition, soft contact lens, topical antibiotics, steroids	Nil	2 months	20/30	(−)
16	Melki et al^Citation14	21/M	Finger	24 days	Nil	Dislocation, flap folding, epithelial ingrowth	Nil	12 hours	Reposition, debridement, soft contact lens, topical antibiotics, steroids	Nil	1 week	20/20	(−)
17	Melki et al^Citation14	61/F	Dog’s paw	6 weeks	Nil	Dislocation, exposed stromal bed	Nil	<6 hours	Reposition, debridement, soft contact lens, topical antibiotics, steroid	Nil	5 weeks	20/21	(−)
18	Melki et al^Citation14	38/M	Snowball	2 months	20/60	Dislocation, edema, exposed stromal bed	Nil	<6 hours	Reposition, debridement, soft contact lens, topical antibiotics, steroid	Nil	2 weeks	20/20	(−)
19	Lemley et al^Citation15	37/F	Airbag deployment	17 months	Nil	Corneal abrasions, dislocation	Hyphema	Immediately	Reposition	Epithelial ingrowth	8 months	20/40	(−)

Notes: (−) indicates no second surgery; (+) indicates yes.

Abbreviations: CF, counting fingers; LASIK, laser in situ keratomileusis; NR, not reported; SCL, soft contact lens; VA, visual acuity; UCVA, uncorrected visual acuity.

Table 2 Vision prognosis and average age according to mechanisms of injury

	Sharp trauma	Blunt trauma	P value
Percentage of different mechanisms of injures	31.58	52.63
Average age (years)	31.50	35.70	0.5676
LogUCVA	−0.0162	−0.0954	0.0495

Abbreviation: UCVA, uncorrected visual acuity.

Table 3 Percentage of vision after trauma and after treatment according to OTS

	After LASIK and trauma (%)	After treatment (%)
OTS Grade 1	18.18	94.74
OTS Grade 2	54.55	5.26
OTS Grade 3	27.27	0.00

Note: Grade 1: ≥20/40; Grade 2: 20/200–20/50; and Grade 3: 1/200–19/200.

Abbreviations: OTS, ocular trauma score, LASIK, laser in situ keratomileusis.

Table 4 Percentage of cases with respect to corneal flap conditions after trauma

Flap condition	Case (%)
Flap dislocation (with or without striae or fold)	73.7
Flap folds or striae without flap dislocation	15.8
Isolated severe flap edema	10.5
Isolated epithelial ingrowth	15.8
Loss of flap	5.3
Flap tear with or without part loss	10.5

Table 5 Percentage of cases which received treatments after trauma

Treatment	Case (%)
Flap replacement	100.0
Epithelial scrape	63.2
Isolated eye drops	36.8
Conjunctival laceration suture	5.3
Bandage contact lens	73.7
Epithelial removal	5.3

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