Management of severe flap wrinkling of dislodgment after laser in situ keratomileusis

Purpose: To review the management and results of cases with severe flap wri nkling or dislodgment after laser in situ keratomileusis (LASIK). Setting: University Eye Center, Department of Ophthalmology and Visual Scie nces, Prince of Wales Hospital, The Chinese University of Hong Kong. Methods: Four patients with severe flap wrinkling or dislodgment after LASI K are described. Surgical repositioning of the flap was performed in all ca ses. Flap status, refractive changes, and final uncorrected and best correc ted visual acuities were used to evaluate the outcome of flap repositioning . Results: Flap repositioning required suturing in 2 patients, 1 of whom deve loped severe epithelial ingrowth with melting of the corneal flap and strom al bed and eventually required flap removal. The stromal inflammation resol ved, and the corneal surface re-epithelialized after flap excision. In 2 ot her patients, wedge-shaped tissue excision (1.0 x 1.5 mm) from the superior portion of the corneal flap was necessary to allow better flap realignment . In 1 of these patients, the corneal flap was eventually converted to a fr ee cap to correct residual wrinkling. At a mean follow-up of 15 months, the postoperative uncorrected visual acuity ranged from 20/20 to 20/60, and th e best spectacle-corrected visual acuity (BSCVA) was 20/30 or better in all patients. In 1 patient, BSCVA decreased by 1 line; Conclusions.. Flap dislodgment and wrinkling are serious postoperative comp lications of LASIK. Early recognition of these complications and prompt sur gical management are crucial to achieve a successful surgical and visual ou tcome. J Cataract Refract Surg 1999;25:1441-1447 (C) 1999 ASCRS and ESCRS.