Visual outcomes of second surgery LASEK following aborted LASIK surgeries due to flap complications

Abstract

Refractive surgery is designed to minimize the need for glasses and/or contact lenses and is often used for convenience, cosmetic or occupational purposes. The two most common types of laser eye surgery are LASIK and LASEK. During LASIK, the first step is the creation of the corneal flap using either a femtosecond laser or a mechanical microkeratome. The femtosecond laser has been seen to create more uniform flaps that reduce the risk of intraoperative and postoperative flap complications compared to the mechanical microkeratome. The purpose of this study was to investigate the effect on visual outcomes of second surgery LASEK on patients following aborted LASIK surgeries due to Femtosecond laser flap complications. LASIK was performed as planned and the corneal flap was created by the femtosecond laser but could not be lifted when a surgical cut was made. The procedure was aborted and LASEK was performed within a few weeks to attain the desired vision correction. A total of 14 patients were identified over a 6-year period ranging from 2009-2015. Most patients underwent surface ablation within two weeks of the initial aborted procedure. 12 of the 14 patients had a UCVA of 20/20, while the remaining 2 patients had a UCVA of 20/25 at their last postoperative visit. None of the patients required surgical enhancements despite the flap complications and no major postoperative complications were noted in any of the patients. Provided the corneal flap was well centered and there was no evidence of microstriae or epithelial ingrowth, surface ablation LASEK can be performed within a week of the aborted LASIK procedure to minimize discomfort and trauma to the patient. LASEK is associated with a slightly longer healing time but no evidence of corneal or retinal issues were noted in these patients. None of the patients experienced any significant changes in refraction between surgeries and was thus a reliable indicator of refractive stability following the flap complication. No significant differences were noted with delaying the second surgery LASEK as several patients attained 20/20 vision when it was performed within a week. The most common flap complication was the formation of an incomplete flap that could not be lifted. The cause could not be identified.