Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK.

Majid Moshirfar,Preston A. Baker,Phillip C. Hoopes,David G. West,Kathryn M. Shmunes,Chase M Miller,Shannon E. McCabe,William B. West,Yasmyne C. Ronquillo

doi:10.3390/jcm10112478

Abstract

Although the use of femtosecond lasers instead of mechanical devices has decreased the incidence of flap complications following laser-assisted in situ keratomileusis (LASIK), dislocations and striae still occur. Flap repositioning is an effective intervention to improve visual outcomes after acute flap complications in both microkeratome-assisted and femtosecond-assisted LASIK. This retrospective case series included patients undergoing flap repositioning secondary to acute flap dislocation and/or visually significant striae within the first two weeks following femtosecond LASIK (FS-LASIK) from 2015 to 2020 at a single institution. Preoperative, intraoperative, and postoperative de-identified data were analyzed for incidence, risk factors, and visual acuity outcomes. The incidence of flap repositioning was 0.35% in 21,536 eyes (n = 70). Indications for repositioning included acute flap dislocation (35.7%) and visually significant striae (64.3%). High myopia (OR = 3.04, p = 0.001) and patient age over 50 years (OR = 3.69, p = 0.001) were the strongest risk factors for these complications. Prior to flap repositioning, uncorrected distance visual acuity (UDVA) of 20/20 or better and 20/40 or better occurred in 19% and 57% of eyes, respectively. After repositioning, a final UDVA of 20/20 or better and 20/40 or better occurred in 78% and 98% of eyes, respectively. After repositioning, one line of UDVA was lost in two eyes (2.8%) and two lines were lost in one eye (1.4%). Risk factors for acute flap dislocation included high myopia and age over 50 years. Flap repositioning was effective in salvaging visual outcomes.

Highlights

It is important to note that three patients required an enhancement procedure during the follow-up period after flap repositioning (FR), and that these eyes were included in our analysis of VA
This study adds to the literature on the visual outcomes of eyes undergoing a flap repositioning procedure for acute flap dislocation and striae secondary to FS-Laser-assisted in situ keratomileusis (LASIK) [3,4,5,8,9,10,11]
This is consistent with other studies comparing microkeratome and FS-LASIK, in which femtosecond laser was shown to decrease the rate of acute flap dislocation and striae compared to microkeratome [4,5]

Summary

Introduction

Laser-assisted in situ keratomileusis (LASIK) is currently the most commonly performed refractive surgery in the United States, and visually significant complications are rare. Studies on the quality of life after LASIK surgery have shown that 96% of patients have an uncorrected distance visual acuity (UDVA) of 20/20 or better three months after surgery. Flap complications may require additional intervention to restore baseline corrected distance visual acuity (CDVA). The most common visually significant flap complications in the early postoperative period are striae and acute flap dislocation [1,2]

Methods

Results

Discussion

Conclusion