Lasik COMPLICATIONS

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"Among potential intraoperative LASIK complications, perhaps the most feared problems are those related to the creation of the LASIK flap".
Source: LASIK Complications. Parag A. Majmudar, MD. AAO Focal Points Vol XXII Number 13 September 2004.

Problems from Lasik? File a MedWatch report with the FDA online. Alternatively, you may call FDA at 1-800-FDA-1088 to report by telephone, download the paper form and either fax it to 1-800-FDA-0178 or mail it to the address shown at the bottom of page 3, or download the MedWatcher Mobile App for reporting LASIK problems to the FDA using a smart phone or tablet. 

Patients with LASIK complications are invited to join the discussion on FaceBook

LASIK flap complications photos courtesy of Dr. Edward Boshnick.

Surgical mishaps during the cutting of the flap may result in serious damage to the cornea with vision loss. Images of some flap complications may be seen here: Link

There are several types of flap complications including thin flaps, thick flaps, irregular flaps, partial or incomplete flaps, buttonholed or donut-shaped flaps, free caps (the flap is cut completely off), flap striae (wrinkles), and decentered flaps.

Surface ablations such as PRK which do not require cutting a corneal flap are making a come-back with surgeons who wish to avoid dealing with flap complications.

"LASIK complications can be catastrophic and irreversible... LASIK has serious inherent defects associated with the flap creation." S. Percy Amoils, MD
Source: J Refract Surg. Vol 15 March/April (suppl) 1999

"In interview after interview, surgeons mentioned serious flap complications as the main reason they've either stopped performing LASIK or are seeking less invasive alternatives."
Source: Ophthalmology Management, September 2004. What's Next for LASIK? By Jerry Helzner

Flap Buttonhole in Thin-Flap Laser In Situ Keratomileusis: Case Series and Review.
Cornea. 2010 May 6.
Jain V, Mhatre K, Shome D.

PURPOSE:: To analyze the clinical features and the risk factors leading to formation of flap buttonhole during laser in situ keratomileusis (LASIK) and the postablation visual outcome.

METHODS:: Medical records of all eyes that developed flap buttonhole during LASIK were retrospectively reviewed. Pre-LASIK measurements and intraoperative parameters were analyzed to predict the risk factors.

RESULTS:: A total of 944 eyes underwent LASIK during the study duration. Four eyes (0.42%) developed partial thickness flap buttonhole. Thin-flap LASIK (flap thickness </=90 mum) was performed in 230 eyes. The incidence of buttonholes in thin-flap LASIK cases was 1.7% (4 of 230). LASIK procedures were performed at a tertiary eye institute between October 2006 and December 2008. The mean age was 31 +/- 8.7 years. Preablation mean spherical refractive error in the affected left eye was -7.8 +/- 1.2 diopters (D), mean steeper axis keratometry was 44.0 +/- 1.56 D, and the mean pachymetry was 520 +/- 16 mum. Buttonholing in the flap occurred in the second (left) eye of all 4 cases. All cases had undergone thin-flap LASIK with 90-mum blade using the Moria M2 microkeratome. Flap diameter was +2/7.5 and 0/8.0 for 2 eyes each. Twelve weeks after the initial procedure, transepithelial phototherapeutic keratectomy/photorefractive keratectomy was performed in all 4 eyes. Postablation visual outcome was 20/20 and 20/25 in 2 eyes each. One patient had a faint subepithelial scar at the last 1-year follow-up.

CONCLUSIONS:: Formation of flap buttonhole is significantly more common in the second eye and with the usage of Moria M2 microkeratome and 90-mum blade. In thin-flap LASIK, the practice of using the same microkeratome blade for the fellow eye, as is commonly followed at many refractive surgery centres, should be abandoned. Intraoperative subtraction pachymetry may be helpful in predicting the risk of buttonhole in the second eye. These precautions are especially mandatory in thin-flap LASIK irrespective of the other associated risk factors.