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Consultation section: Refractive

Long-term recurrent flap complication after previous laser in situ keratomileusis

March consultation #1

Nuijts, Rudy M.M.A. MD, PhD; Saelens, Isabelle E.Y. MD, PhD

Journal of Cataract & Refractive Surgery: March 2018 - Volume 44 - Issue 3 - p 410-411
doi: 10.1016/j.jcrs.2018.03.009
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A 52-year-old man had laser in situ keratomileusis (LASIK) elsewhere in both eyes 17 years ago to correct myopia of approximately −6.5 diopters (D). For the past 2 months, the patient has experienced redness and irritation in the left eye. Over the years, he has had 7 epithelial flap lifts and/or scrapings, the last time in 2003.

The uncorrected (UDVA) and corrected (CDVA) distance visual acuities in both eyes were 20/25. Biomicroscopy of the left eye (Figure 1) showed a noninflamed eye with extensive gray debris extending for 3.5 mm from 5 o'clock to 11 o'clock at the LASIK flap border toward the corneal center. The flap edge appeared thinned at the border at 9 o'clock. Anterior segment optical coherence tomography (AS-OCT) (Carl Zeiss Meditec AG) showed the extension of the interlamellar ingrowth (Figure 2). Scheimpflug tomography (Pentacam HR, Oculus Optikgeräte GmbH) of the left eye showed a topographic astigmatism of 4.0 D at 120 degrees (Figure 3). In the right eye, an unremarkable LASIK flap was visible. The Schirmer tear test was 20.0 mm for both eyes. In the past, the patient used artificial tears with no improvement in the symptoms. At present, the patient does not use any eyedrops.

Figure 1.
Figure 1.:
Slitlamp photography of the left eye.
Figure 2.
Figure 2.:
High-resolution AS-OCT of the left eye (AS-OCT = anterior segment optical coherence tomography).
Figure 3.
Figure 3.:
Scheimpflug tomography of the left eye.

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