Traumatic Dislocation of LASIK Flaps 4 and 9 Years After Surgery

Abstract

Original Article Hyunjin Jane Kim, MD; Cary M. Silverman, MD To report two patients who developed a corneal flap dehiscence 4 years and 9 years after LASIK, respectively, following trauma during routine domestic activities. Retrospective chart review of two patients. Clinical presentation, mechanism of injury, treatment, complications, and outcome were studied. A review of published cases in the English literature on late onset flap dislocation was performed. Case 1 involved a 30-year-old man who presented 4 years after LASIK, after his eye was struck with a piece of wood from a window trim. Examination showed uncorrected visual acuity (UCVA) of 20/25 and flap displacement, creating a fold at the superior edge. Because the injury involved the periphery of the flap, the patient was treated medically only. Final UCVA was 20/20⁻¹ with a persistent fold. Case 2 involved a 29-year-old man who dislocated his flap after being hit with a dog’s paw 9 years after LASIK. Uncorrected visual acuity was count fingers, and a complete flap dislocation that was folded at the hinge with 30% epithelial ingrowth was noted. Immediate surgical removal of the epithelium from the stromal bed was completed and a bandage contact lens was used along with topical medication. Final UCVA was 20/25, with no complications. Flap dehiscence is a rare, late complication of LASIK. Case 1 is the second report of flap dislocation treated medically only and case 2 is the latest report. Tangential force applied to the flap during routine activities of life can result in flap displacement for up to 9 years after LASIK. From University of Medicine and Dentistry of New Jersey, Newark; and Eye Care 20/20, East Hanover, NJ. The authors have no proprietary interest in the materials presented herein. Correspondence: Cary M. Silverman, MD, EyeCare 20/20, 46 Eagle Rock Ave, East Hanover, NJ 07936. Tel: 973.560.1500; Fax: 973.560.0419; E-mail: CSilverman@eyecare2020.com 10.3928/1081597X-20090710-03 To report two patients who developed a corneal flap dehiscence 4 years and 9 years after LASIK, respectively, following trauma during routine domestic activities. Retrospective chart review of two patients. Clinical presentation, mechanism of injury, treatment, complications, and outcome were studied. A review of published cases in the English literature on late onset flap dislocation was performed. Case 1 involved a 30-year-old man who presented 4 years after LASIK, after his eye was struck with a piece of wood from a window trim. Examination showed uncorrected visual acuity (UCVA) of 20/25 and flap displacement, creating a fold at the superior edge. Because the injury involved the periphery of the flap, the patient was treated medically only. Final UCVA was 20/20⁻¹ with a persistent fold. Case 2 involved a 29-year-old man who dislocated his flap after being hit with a dog’s paw 9 years after LASIK. Uncorrected visual acuity was count fingers, and a complete flap dislocation that was folded at the hinge with 30% epithelial ingrowth was noted. Immediate surgical removal of the epithelium from the stromal bed was completed and a bandage contact lens was used along with topical medication. Final UCVA was 20/25, with no complications. Flap dehiscence is a rare, late complication of LASIK. Case 1 is the second report of flap dislocation treated medically only and case 2 is the latest report. Tangential force applied to the flap during routine activities of life can result in flap displacement for up to 9 years after LASIK. From University of Medicine and Dentistry of New Jersey, Newark; and Eye Care 20/20, East Hanover, NJ. The authors have no proprietary interest in the materials presented herein. Correspondence: Cary M. Silverman, MD, EyeCare 20/20, 46 Eagle Rock Ave, East Hanover, NJ 07936. Tel: 973.560.1500; Fax: 973.560.0419; E-mail: CSilverman@eyecare2020.com