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Y. Myung, M.O. Price, F.W. Price, Jr; Central Flap Necrosis: Stage 4 Diffuse Lamellar Keratitis or a Separate Entity? . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4341.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To describe a series of central flap necrosis after LASIK in cases where the flap was created using a variety of microkeratomes Methods:Retrospective analysis of 8 eyes in 7 patients who underwent uncomplicated LASIK surgery and developed severe central flap necrosis Results:The progression of lamellar inflammation was strikingly similar in all cases. Inflammation occurred within 48 hours of surgery, culminating in the Mercedes sign between post op days 5 to 10. The inflammation then diminished over two months. This flap necrosis occurred in only the first eye to have had LASIK in five patients. One patient had bilateral involvement. One patient had LASIK in one eye only. Significant findings were central clouding of anterior stroma, flap striae, loss of UCVA and BCVA. Inflammation did not respond to intense topical steroids or antibiotic–steroid combination. 4 eyes had their flaps lifted and irrigated and 2 appeared to respond to this treatment. The anterior portion of the flap had a jelly–like consistency. The end result was a hyperopic shift from stromal tissue loss with loss of BCVA. Conclusions: This severe central flap necrosis appears to be different from inflammation that begins in the interface. The etiology remains to be elucidated but could be caused by substances that diffuse into the flap anteriorly during LASIK.
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