Corneal Flap Dislocation

Seven years after uneventful laser in situ keratomileusis (LASIK), a 48yearold woman presented one week after being hit with an iron cord with blurry vision, pain, and irritation The injury resulted in traumatic flap dislocation, epithelial ingrowth, and macrostriae Following epithelial removal, the flap was refloated and repositioned Nine interrupted sutures were used to secure the flap.

Corneal flap dislocation. A grossly displaced flap with macrostriae will exhibit an enlarged gutter peripheral to the area of trauma and requires urgent intervention Microstriae will present with "negative" staining over the striae as the areas where the flap has been disrupted rise above the fluorescein pool This phenomenon is best seen in retroillumination. Microkeratomerelated flap complications Flap Buttonhole caused by buckling of the cornea during flap creation, occurs predominantly in steep corneas Other risk factors include loss of suction, defective blade, abnormal advancement of blade Management Do not perform laser ablation, recut the flap and ablate a minimum of 3 months later Free Cap. Purpose To report the management and outcome of late onset traumatic dislocation of LASIK flaps Methods This retrospective, interventional case series presents three patients with late onset LASIK flap dislocation following mechanical trauma 1 to 7 years postoperatively Results In all cases, the flap was surgically repositioned.

Late flap dislocations are always associated with ocular trauma, though most ocular trauma does not cause a dislocation, thus accounting for their significantly reduced frequency compared to early dislocations The LASIK flap actually consists of two wounds (1) the planar interface between the flap and the underlying corneal stroma and (2) the. Two interventional case reports of patients with lateonset LASIK corneal flap dislocation after ocular trauma occurring at 7 and 26 months after surgery, respectively The flaps were lifted. The flap dislocation in our case was caused by a twig 10 years after the LASIK procedure Epithelial ingrowth into the interface between the flap and stromal bed is a complication of LASIK flap dislocation Epithelial ingrowth with direct communication and supply from peripheral regenerating epithelium could lead to progressive ingrowth under.

The pictures of the corneal flap dislocation in our patient showed a larger upper portion of the corneal flap compared to the lower portion Furthermore, there was a part of the upper portion cornea folding between the stromal bed and cornea itself Besides, the patient had multiple lacerations over upper eyelids. Traumatic corneal flap dislocation one to six years after LASIK in nine eyes with favorable outcome Print J Refract Surg 06 Nov;22(9)49 Landau D, Levy J, Solomon A, Lifshitz T, Orucov F, Strassman E, FruchtPery J. Corneal flap displacement within 1 to 2 days following LASIK is a wellrecognized complication1–3However, stability of the flap remains largely unknown as flap dehiscence has been reported as late.

During LASIK, a small flap is created in the topmost layer of the corneal, which is known as the epithelium By moving this top layer of the cornea back, a LASIK surgeon can then reshape and recontour the corneal surface and improve the passage of light through the eye Once the corneal reshaping is commplete, the flap is set back down. Flap wound never heals completely, said Dr Schocket, who’s experienced a dislocation twice In fact, studies have shown that the strength of the healed wound margin is on average only 28% of the normal cornea1 This can lead to flap dislocation during retina surgery “I’ve learned to specifically ask patients. With each dislocation the flap and be prone to develope wrinkling it striae which can reduce quality of vision Placement of sutures is appropriate after the second dislocation but I woukd be concerned about any underlying corneal issues that might be in play with your eye.

Corneal flap displacement with the flap being folded in the superior and inferior portion In addition, the bare stroma was exposed The connection between the nasal hinge of the corneal flap and the cornea was still intact (Figure 1) Surgical intervention was performed 12 hours after injury. REFRACTIVE LENTICULE EXTRACTION • ReLex is a relatively long technique that uses a femtosecond laser to cut a lensshaped piece of corneal tissue with the intact cornea • Then removed via a LASIKstyle flap or using a minimally invasive 4mm incision • Advantages include Less marked biochemical and neurological corneal disturbance than LASIK Surface disturbance is minimal in comparison to surface ablation procedures. The precise cause of flap dislocation is unclear, but wrinkling or dislodgment may result from poor adherence of the corneal flap to the stromal bed because of overhydration of the stromal bed or the flap, eye rubbing, excessive blinking, and eye squeezing from pain, photophobia, or other discomfort in the postoperative period.

There have been cases of striae reported without corneal flap dislocation following trauma years after the initial surgery It is important to consider the formation of striae when examining LASIK patients with ocular trauma even in the absence of flap slippage, subluxation, or dislocation Fluorescein dye can be helpful to detect flap folds. However, this may result in significant irregular astigmatism 7. The precise cause of flap dislocation is unclear, but wrinkling or dislodgment may result from poor adherence of the corneal flap to the stromal bed because of overhydration of the stromal bed or.

A, B, C color photograph of a dislocated laser in situ keratomileusis flap 24 days after surgery secondary to a “finger flick” to the right eye (patient 2) Note the severe folds across the visual axis (B) as well as the coverage of the exposed stroma by corneal epithelium (C) within 10 hours of the injury. This technique reduces the risk of corneal edema because it requires no irrigation under the flap;. Specifically, the corneal flap created during LASIK can become dislocated following minor physical trauma, such as a finger or object striking the eye If the flap becomes dislocated, the patient would require further medical or surgical intervention to correct the dislocation and protect the patients vision1.

Rationale Traumatic flap dislocation might occur anytime after laser in situ keratomileusis (LASIK), but it is rarely concomitantly complicated with epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis altogether Here we report a case of traumatic LASIK flap inversion with epithelial ingrowth, Propionibacterium acnes infection, and diffuse lamellar keratitis. Dislocated intraocular lens (IOL) is a rare, yet serious complication whereby the intraocular lens moves out of its normal position in the eye IOL dislocation has been reported at a rate of 02% to 3% 14 It may occur as a result an early or late complication of cataract surgery, prior vitreoretinal surgery, trauma, or an inherent pathological process or connective tissue disorders. Delayed diagnosis and management of flap dislocation after corneal trauma may potentially increase the risk of epithelial ingrowth, recalcitrant flap striae and visual impairment The presence of lateonset epithelial ingrowth in patients with previous LASIK mandates careful examination for occult flap displacement.

Flap dislocation is extremely rare with LASIK even with very powerful injuries including car accidents, sports injuries, and even air big inflation However, the absence of a flap with SMILE makes this an impossibility that may make some people more comfortable with this procedure. Edema increases the risk of the flap's not fitting well into the stromal bed and of epithelial defects, both of which are associated with striae, flap dislocation, and DLK. As described earlier, the flapstromal interface is vulnerable given the limited healing that occurs While flap dislocation or penetrating cornea trauma introduces an entrance into this potential space for foreign body debris, another possible mechanism involves sharp ocular trauma that may leave foreign body debris in the LASIK interface.

A flap dislocation would cause notable pain, discomfort, excessive watering in the eye, and/or blurred vision The vast majority of flap dislocation incidents happen in the first few days after the LASIK procedure as a result of not wearing eye protection and being hit or bumped in the eye. Late LASIK flap dislocation cases have been reported up to 14 years after surgery 2 Although a rare event, with enough force a LASIK corneal flap may be completely avulsed, and sometimes loss Searching the MEDLINE literature database through PubMed interface we found that only 12 cases have been reported in the English literature ( Table 1 ) 3 , 4 , 5 , 6 , 7 , 8 , 9. The Lasik flap dislocation is a separation between layers of collagen within the cornea and it does adhere back to the underlying collagen after few weeks of surgery especially the flaps made by using femtosecond laser In simple terms, it actually adheres quite well if the surgery is performed with the use of modern technology.

Before repositioning the dislocated flap, the ophthalmologist will evaluate the stromal surfaces of the flap and the corneal stroma should be scraped to remove any debris and epithelial cells In the event of a lost flap, the epithelium is simply allowed to heal;. 2 Flap Related Complication If the corneal flap is not made correctly with mechanical microkeratome, its adherence to the corneal bed will not be good in which it might get wrinkled, folded or dislocated Flap dislocation in this case can occur spontaneously or after minor trauma or eye rubbing Treatment of it should be surgical. Flap dislocations are rare complications of laserassisted in situ keratomileusis (LASIK) A study of army service members who had refractive surgery found the incidence of flap dislocation to be 0085% (1/1174 eyes) The Wills Eye Institute reported a higher incidence of 275% (3/109 patients) in referrals of patients dissatisfied with LASIK.

Here’s a general rule to live by with regard to corneal flap dislocation If you’re not sure whether or not your corneal flap has moved, then your corneal flap has not moved In the very unlikely event of corneal flap dislocation, patients will feel immediate pain and should seek emergency treatment. I have an article published in this month's Journal of Refractive Surgery titled Traumatic Dislocation of LASIK Flaps 4 and 9 Years After Surgery With the help of UMDNJ ophthalmology resident, H Jane Kim, we published two cases of traumatic flap dislocation following LASIK One of the cases occurred 9 years following LASIK, making it the longest reported case medical literature. These observations clearly illustrate that corneal integrity is never fully restored after creation of a LASIK flap The basis for this inherent weakness has recently been reported in a rabbit model of LASIK in which irregular corneal stromal regeneration was observed at the wound margin 5 Flap dislocation as a potential late complication.

Many cases have been reported regarding late onset flap dislocation and related problems 13 To our knowledge, however, this is the first case report of interfacecaptured foreign bodies after a mild corneal scratch without any sign of flap displacement The foreign bodies were associated with Staphylococcal keratitis. Traumatic corneal flap dislocation one to six years after LASIK in nine eyes with a favorable outcome Landau D, Levy J, Solomon A, Lifshitz T, Orucov F, Strassman E, FruchtPery J J Refract Surg, (9)48 MED. Sometimes the dislocated area is covered by epithelium.

Corneal transplant LASIK permanently thins and thereby weakens the cornea This can lead to the need for a cornea transplant, despite a LASIK surgery being deemed “successful” Corneal flap dislocation The corneal flap is altered during every LASIK surgery However, in some cases, this eventually leads to a dislocated corneal flap. Microkeratomerelated flap complications Flap Buttonhole caused by buckling of the cornea during flap creation, occurs predominantly in steep corneas Other risk factors include loss of suction, defective blade, abnormal advancement of blade Management Do not perform laser ablation, recut the flap and ablate a minimum of 3 months later Free Cap. Specifically, the corneal flap created during LASIK can become dislocated following minor physical trauma, such as a finger or object striking the eye If the flap becomes dislocated, the patient would require further medical or surgical intervention to correct the dislocation and protect the patients vision1.

Despite changes in surgical technique that reduce risk, retina specialists still encounter corneal defects with vitrectomy and intravitreal injectionsRetinal Physician editor in chief Peter K Kaiser, MD, leads a discussion with retina specialists Carl D Regillo, MD, FACS, and Thomas A Albini, MD, and cornea specialists Marguerite McDonald, MD, FACS, and Francis S Mah, MD, to try to reach. The healed flap is stable and unlikely to dislodge with eye rubbing Significant eye trauma could potentially dislocate the flap, however, such instances are rare Flap creation making use of the femtosecond laser provides for even greater stability and reduced chances of flap movement or dislocation This has been one of the greatest advances in LASIK surgery. With each dislocation the flap and be prone to develope wrinkling it striae which can reduce quality of vision Placement of sutures is appropriate after the second dislocation but I woukd be concerned about any underlying corneal issues that might be in play with your eye.

The flap does not dislocate as the very edge is not cut through (making it a flap) The surgeon smooths the corneal flap down after the correction is completed It then adheres and heals in a short amount of time if the corneal flap dislocates after the procedure it can be felt by the patient and is quite uncomfortable. The precise cause of flap dislocation is unclear, but wrinkling or dislodgment may result from poor adherence of the corneal flap to the stromal bed because of overhydration of the stromal bed or the flap, eye rubbing, excessive blinking, and eye squeezing from pain, photophobia, or other discomfort in the postoperative period. A LASIK flap wound never heals completely, said Dr Schocket, who’s experienced a dislocation twice In fact, studies have shown that the strength of the healed wound margin is on average only 28% of the normal cornea 1 This can lead to flap dislocation during retina surgery “I’ve learned to specifically ask patients multiple times whether they’ve had LASIK, not just eye surgery,” she said, “because many don’t think of it as a surgical procedure” (See “Dislocation of a.

Corneal flap displacement within 1 to 2 days following LASIK is a wellrecognized complication 1–3 However, stability of the flap remains largely unknown as flap dehiscence has been reported as. Late flap dislocations are always associated with ocular trauma, though most ocular trauma does not cause a dislocation, thus accounting for their significantly reduced frequency compared to early dislocations The LASIK flap actually consists of two wounds (1) the planar interface between the flap and the underlying corneal stroma and (2) the. Corneal flap dislocation The corneal flap is altered during every LASIK surgery However, in some cases, this eventually leads to a dislocated corneal flap Although these problems certainly deserve very serious consideration, fortunately there are a number of treatments to remedy them.

The flap dislocation in our case was caused by a twig 10 years after the LASIK procedure Epithelial ingrowth into the interface between the flap and stromal bed is a complication of LASIK flap dislocation Epithelial ingrowth with direct communication and supply from peripheral regenerating epithelium could lead to progressive ingrowth under. The microkeratome or IntraLase then creates a flap leaving a small hinge to keep the flap partially attached to the rest of the cornea Research suggests the incidence of LASIK complications with flaps is about 02 percent (0002) of all LASIK surgeries (Study of Corneal flap complications from Codet Aris Vision Institute). This is usually performed with a surgical tool called a microkeratome or a laser called IntraLase A ring is placed on the surface of the cornea and is held in place with suction The microkeratome or IntraLase then creates a flap leaving a small hinge to keep the flap partially attached to the rest of the cornea.

Here’s a general rule to live by with regard to corneal flap dislocation If you’re not sure whether or not your corneal flap has moved, then your corneal flap has not moved In the very unlikely event of corneal flap dislocation, patients will feel immediate pain and should seek emergency treatment. The precise cause of flap dislocation is unclear, but wrinkling or dislodgment may result from poor adherence of the corneal flap to the stromal bed because of overhydration of the stromal bed or. A superiorhinged corneal flap was created using the Moria M2 microkeratome (Moria SA, Antony, France) and the surgery was uneventful Ten years later, partial flap dislocation was diagnosed after mild trauma This case suggests that flap dislocations can occur during recreational activities up to 10 years after surgery.