Dislocated LASIK Flap Repair
Contributors: James M. Huffman, MD and Mark A. Greiner, MD
Additional Note: Length 03:41
Posted May 31, 2019
The patient underwent previous myopic LASIK with microkeratome flap creation. Prior to presentation the patient was struck in the face with a cardboard box and presented with a traumatic dislocated LASIK flap. During the initial examination it was noted that the flap was folded under onto itself and nascent epithelium had already grown over the stromal bed. Prior to repair, a retrobulbar block was administered.
- Prior to flap elevation the nascent epithelium is removed from the stromal bed and peripheral border of the flap with a 69-Beaver blade.
- The flap is lifted with a flap elevator.
- The flap is unscrolled with the flap elevator and Cindy sweeper.
- The undersurface of the flap is scraped with a 69-Beaver blade to remove any nascent epithelium.
- The flap is repositioned with the flap elevator and the interface debris is removed with gentle irrigation of basic salt solution on a 30-gauge canula.
- Flap striae are removed with a Merocel sponge.
- Compression sutures are placed with a 10-0 nylon suture on an AU5 needle. Special care is taken to take deeper bites outside of the flap to aid with compression and prevent epithelial ingrowth.
- Slip knots are used. This allows for the adjustment of the suture tension as additional sutures are placed. Once the tension is appropriate, the third and fourth throw are completed and the knot is buried.
- Macrostriae are removed with a Cindy sweeper.