Satisfactory clinical outcome following delayed repositioning of a traumatic post-LASIK flap with dislocation and shrinkage managed by irrigation, stretching, and debridement

Abstract

Objective

To report surgical management and favorable outcome in a case with delayed repair of traumatic laser in situ keratomileusis (LASIK) flap dislocation with shrinkage and folds.

Methods

A 30-year-old man with a five-year history of bilateral LASIK experienced blunt trauma to his right eye followed by decreased vision for 5 weeks. The surgical management included initially softening the flap by irrigation with balanced salt solution (BSS). The shrinkage folds were carefully and gently stretched by scraping with a 26-gauge cannula accompanied by BSS irrigation. All of the epithelial ingrowth on the flap inner surface and on the bed was thoroughly debrided by scraping and irrigation. After the flap was repositioned to match its original margin, a soft bandage contact lens was placed.

Results

At his initial visit, slit-lamp microscopy and optical coherence tomography (OCT) showed shrinkage of the LASIK flap with an elevated margin approximately 3 mm above the original position. The flap covered half of the pupil and had multiple horizontal folds. Two months after surgery, the flap remained well positioned with only faint streaks in the anterior stroma. The uncorrected visual acuity of the right eye was 20/20 with a manifest refraction of Plano.

Conclusions

For delayed repair of traumatically dislocated LASIK flaps, sufficient softening by BSS, stretching the shrinkage folds, and thorough debridement of ingrowth epithelium enable resetting the flap and provide satisfactory results.

摘要

目的

报道一例手术处理延迟复位的准分子激光原位角 膜磨镶术(LASIK)后瓣移位伴皱缩并取得良好结果的案例。

创新点

首次详细描述对延迟复位的LASIK 术后瓣移位的 手术方法。首次报道了长期延迟复位的LASIK 术后瓣移位伴大皱缩经过无缝线的手术治疗也 可取得良好的临床结果。

方法

一例30 岁男性在双眼LASIK 术5 年后受到右眼 钝挫伤,并延误治疗5 周。手术方法包括平衡盐 溶液软化角膜瓣,仔细并轻柔地用26G 针头刮除 上皮和平衡盐溶液冲洗以伸展瓣皱褶。所有位于 瓣内侧面和基质床的内生上皮都被仔细地刮除 和冲洗去除。在复位角膜瓣后放置绷带式软性接 触镜。

结论

对于延迟处理的外伤性LASIK 瓣移位,通过平衡 盐溶液充分软化角膜瓣、伸展瓣皱褶以及彻底清 创内生上皮可将瓣复位并得到良好的临床结果。