Recutting the cornea versus lifting the flap: Comparison of two enhancement techniques following laser in situ keratomileusis

PURPOSE: To evaluate enhancement techniques following laser in situ keratom ileusis (LASIK). METHODS: Recutting was performed on 263 eyes and the flap was lifted in 55 eyes that had LASIK for simple myopia or myopic astigmatism. The time inter val between LASIK and retreatment was 340 +/- 46 days (range, 270 to 892 da ys) in the recutting group and 215 +/- 36 days (range, 53 to 617 days) in t he flap lifting group. Mean spherical equivalent refraction, refractive cyl inder, uncorrected and best spectacle-corrected visual acuity were examined prior to, and 1, 3, and 6 months after retreatment. RESULTS: Seventeen eyes were lost to follow-up in the lifting group and 53 eyes in the recutting group. In the recutting group, mean spherical equival ent refraction improved from -1.48 +/- 1.25 D to -0.49 +/- 0.88 D at 6 mont hs. In the flap lifting group, mean spherical equivalent refraction improve d from -1.05 +/- 1.49 D to -0.45 +/- 0.39 D at 6 months. Refractive cylinde r did not change significantly in either group (P = .2). There was a signif icant increase in uncorrected visual acuity (UCVA) of 6/6 in each group. In the recutting group, UCVA of 6/6 increased from 3.8% to 65.2% at 6 months, and in the lifting group from 3.6% to 71.1% at 6 months. In the recutting group, seven free flaps and three macerated flaps that required removal occ urred. One eye in the recutting group and two in the lifting group develope d significant epithelial ingrowth. No patient lost more than one line of be st spectacle-corrected visual acuity (BSCVA). CONCLUSION: Both procedures were safe, effective, and highly predictable fo r enhancements, but flap complications may be more likely with recutting.