ArticleIncidence, management, and visual outcomes of buttonholed laser in situ keratomileusis flapsAl-Mezaine, Hani S. MD∗; Al-Amro, Saleh A. MD; Al-Obeidan, Saleh MD Author Information From the Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia ∗Corresponding author: Hani S. Al-Mezaine, MD, Department of Ophthalmology, College of Medicine, King Saud University, PO Box 230387, Riyadh 11321, Kingdom of Saudi Arabia. E-mail: [email protected] Submitted: December 2, 2008. Final revision submitted: January 14, 2009. Accepted: January 14, 2009. No author has a financial or proprietary interest in any material or method mentioned. Melody G. Olayta helped with data processing. SymbolFirst author:Symbol: No Caption available.Hani S. Al-Mezaine, MD Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia Journal of Cataract & Refractive Surgery: May 2009 - Volume 35 - Issue 5 - p 839-845 doi: 10.1016/j.jcrs.2009.01.013 Buy Metrics Abstract PURPOSE: To describe the incidence, management, and visual outcomes of buttonholed laser in situ keratomileusis (LASIK) flaps. SETTING: Private practice, Riyadh, Saudi Arabia. METHODS: This retrospective review identified eyes that developed buttonholed flaps during LASIK. Preoperative, intraoperative, and postoperative data were obtained to identify factors predictive of this complication. RESULTS: Of 4250 primary LASIK procedures, 17 eyes (0.4%) with buttonholed flaps were identified. Buttonholes occurred with the Hansatome microkeratome in 64.7% of eyes and with the Moria microkeratome in 35.3% of eyes, the incidence of buttonholed flaps was 0.62% and 0.19%, respectively (P = .03). Laser ablation was performed at the same time as buttonhole formation in 8 eyes (47.1%) and was aborted in the other eyes. Retreatment was performed in 10 eyes (58.8%); of retreated eyes, 6 had repeat LASIK and 3 had surface ablation. The final spherical equivalent refraction was −0.38 diopter ± 0.79 (SD). Two eyes had a final loss of more than 2 lines of best corrected visual acuity (BCVA). The mean loss of BCVA lines was 0.72 in eyes that had complete LASIK, 0.62 in eyes that had aborted LASIK followed by retreatment with repeat LASIK, and 0.80 in eyes that had aborted LASIK followed by retreatment with surface ablation. CONCLUSIONS: Buttonholed flaps occurred more frequently in the second of 2 consecutively treated eyes. Microkeratomes that produce a larger diameter flap were more likely to produce flap buttonholes. The least loss of BCVA was achieved when LASIK was aborted and then repeated after refractive stability. © 2009 by Lippincott Williams & Wilkins, Inc.
