Delayed Lasik Flap Repositioning After Accidental Trauma In A 15 Year Old Lasik Flap.

To report a case of an accidental trauma in an eye with a 15 year old LASIK flap that received surgical management and demonstrated a favorable visual outcome. The patient was operated 4 days after the insult with flap lifting, stretching, debridement, irrigation and flap repositioning. Six months after the procedure, the uncorrected visual acuity on the affected eye was 1.25, the cornea was clear and no adverse effects were observed.

The patient was initially seen at the emergency department of the Jules Gonin Eye Hospital in Lausanne, Switzerland and was subsequently managed by the cornea service of the hospital.

A 46-year-old male presented to the emergency department of our hospital one day after an accidental trauma with a tree branch in his right eye. His past ocular history was only significant for LASIK vision correction 15 years prior. The patient described difficulty to open his eye, mild photosensitivity, a foreign body sensation, mild secretions and a subjective visual decline. His best corrected visual acuity was 0.8 on the affected eye. On slit lamp examination, flap dislocation with a fold, 3 macrostriae, along with anterior stromal thickening and a fluorescein positive epithelial defect in the same area were visible in the infratemporal quadrant of the affected cornea. The patient was operated under regional anesthesia.  The surgical management included hydration of the flap with BSS, unfolding of the fold, lifting the flap, extensive irrigation and debridement of the flap and underlying stroma, flap stretching and subsequent flap repositioning. Six months after the procedure, the uncorrected visual acuity was 1.25, the cornea was clear and no adverse effects were observed.

This case is a good reminder that LASIK flaps can dislocate even 15 years after surgery and can successfully be managed by meticulous attention to debridement and repositioning.  While a few similar cases have been described in the literature, this case demonstrates that even delayed intervention when combined with proper surgical technique and prompt postoperative monitoring of the affected eye may be equally effective in helping the patient regain the pre-insult visual acuity.