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Lorena Romero-Díaz-de-León, Juan Carlos Serna- Ojeda, Arturo J Ramirez-Miranda, Enrique O Graue; INTRAOPERATIVE FLAP COMPLICATIONS IN LASIK SURGERY PERFORMED BY OPHTHALMOLOGY RESIDENTS IN TRAINING. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1521.
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To determine the incidence of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and the risk factors involved in those complications.
We analyzed 219 flap sections from 118 patients from March to December 2013. We included all cases performed by 25 ophthalmology residents using a Moria II microkeratome. All patients were aware that a surgeon-in-training would be operating as part of the surgical team.
There were 16 flap-related complications out of the 219 flap sections involved (7.3%). The most common complication was an incomplete flap section (n=8; 3.65%), followed by free-cap (n=4; 1.89%) and flap-buttonhole (n=2;0.94%). There were 2 infrequent complications of an irregular flap and an oval flap that allowed ablation. Ablation treatment was not applied to 11 eyes out of the 16 flap-related complications (68.75%). Flap-related complications were the cause of 4 contralateral eye surgical suspensions. The relative risk for ablation suspension is 1.4 (CI 95% 0.53 to 3.67) when an incomplete flap section is presented. There were no significant differences in right or left eye, flat or steep keratometries, white-to-white diameter, plate size used or spherical equivalent between complicated and uncomplicated cases. Final visual acuity after rescheduling laser treatment was also similar between complicated and uncomplicated groups. Relative risks for flap-related complications were 1.5 for first flap section (CI 95% 0.37 to 6.28) ; and 1.89 (CI 95% 0.71 to 5.04) for the surgeon’s first twenty flap sections.
Flap-related complications are a common intraoperative complication during LASIK surgery performed by in-training ophthalmologists. Surgeon’s first twenty corneal sections represent a higher risk for flap related complications than biometric parameters of patient’s eye. Our incidence of flap related complications is just above the incidence reported in literature. This type of complication is a major cause of surgical suspension and the incidence should be considered as part of the informed consent in training hospitals, although it does not seem to affect final visual outcome when the laser treatment is rescheduled.
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