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O. L. Lee, R. S. Koplin, J. Patel, D. C. Ritterband, J. A. Seedor; Slit Lamp Repair of LASIK Flap Complications. Invest. Ophthalmol. Vis. Sci. 2009;50(13):557.
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To describe a technique in which laser in situ keratomileusis (LASIK) flap complications can be treated at the slit lamp biomicroscope.
This retrospective case series included six eyes of five patients who had previously undergone LASIK. The eyes required flap lift due to post-operative epithelial ingrowth in 5 eyes and traumatic flap dislocation in one eye. Under topical anesthesia, a blunt corneal spatula is used to lift and reflect the flap to the extent necessary for epithelial debridement. Islands or sheets of epithelial cells are then identified by slit lamp biomicroscopy. A specially designed rake-shaped spatula is used to peel and remove epithelium from the bed and the underside of the flap. The epithelium is debrided 1-2mm outside the flap gutter. Repositioning of the flap onto the stromal bed is achieved with the corneal spatula. A wet cellulose sponge is used to smooth and refine the flap position. After the procedure, all eyes were treated with topical antiobiotics and steroids.
No complications associated with this procedure were observed during the follow-up period (mean 3 months, range 1 day to 7 months). No further surgical intervention was required in any eye. Epithelial ingrowth did not recur during the follow-up period. All eyes achieved final uncorrected visual acuity of 20/20.
In appropriately chosen patients, LASIK flap complications can be repaired at the slit lamp. The indications for this technique include post-operative epithelial ingrowth as well as traumatically dislocated LASIK flaps.
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