Very late-onset flap margin corneal ulcer following laser in situ keratomileusis

  • Gilad Rabina
  • Nur Azem
  • Michael MimouniEmail author
  • Idan Hecht
  • David Varssano
Original Paper



To report and characterize cases of very late onset (5 years or more after surgery) flap margin corneal ulcers after laser in situ keratomileusis (LASIK) procedure.


A retrospective case series of consecutive patients who were diagnosed with very late flap margin corneal ulcers following LASIK, between January 2014 and July 2017. All patients were treated with topical antibiotics and were followed up until complete resolution.


A total of eight patients, with a mean age of 46.5 ± 11 years, (range 31–64 years), were included in this study. All patients underwent uneventful myopic LASIK 13.3 ± 3 (range 10–20) years before presentation. Patients best corrected visual acuity (BCVA) at presentation was 0.20 ± 0.15 logMAR compared to a final BCVA of 0.10 ± 0.10 logMAR (p = 0.28). The ulcer was located in the bottom two clock hours of the flap margin (5–7 o’clock) in six (75%) patients and superior (11 o’clock) in the remaining two patients (p = 0.048). Seven patients (87.5%) suffered from blepharitis, and only one did not.


LASIK may be associated with an increased risk of late-onset corneal ulcer occurring years after the procedure. Instability of the flap margin, blepharitis and dry eye are possible causes of epithelial disturbance and may account for this complication.


LASIK Corneal ulcer Late complication Blepharitis Dry eye 


Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived due to the retrospective nature of this study.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Division of Ophthalmology, Sourasky Medical Center Affiliated to the Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Department of OphthalmologyRambam Health Care CampusHaifaIsrael
  3. 3.Ruth and Bruce Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael
  4. 4.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael

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