Flap complication aociated with lamellar refractive urgery Original Reearch Article

PURPOE: Corneal lamellar refractive urgery for myopia reduce the rik of corneal haze but add to the rik of flap complication. We retropectively determined the incidence of flap complication in the initial erie of eye undergoing lamellar refractive urgery by one urgeon. We aeed the incidence of flap complication overall, the trend in thee complication during the urgeon’ learning curve, and the impact of the complication on bet pectacle-corrected viual acuity. METHOD: Chart of the firt 1,019 eye that underwent myopic keratomileui in itu or laer in itu keratomileui were reviewed for flap complication and viual outcome. REULT: Of the 1,019 eye, 490 eye underwent myopic keratomileui in itu, and 529 eye underwent laer in itu keratomileui. Eighty-eight (8.6%) of 1,019 eye had flap-related complication. ix eye had two complication. Intraoperative complication included irregular keratectomy in nine eye (0.9%), incomplete keratectomy in three eye (0.3%), and a free cap in 10 eye (1.0%). The incidence of intraoperative complication wa ix (6.0%) in the firt 100 conecutive eye, 14 (2.3%) in the next 600 conecutive eye (P= .04, chi-quare tet), and one (0.3%) in the lat 300 eye (P = .03, chi-quare tet). Potoperative complication included diplaced flap that required repoitioning in 20 eye (2.0%), fold in the flap that required repoitioning in 11 eye (1.1%), diffue lamellar keratiti in 18 eye (1.8%), infectiou keratiti in one eye (0.1%), and epithelial ingrowth that required removal in 22 eye (2.2%). The incidence of flap diplacement and fold in 200 eye in which we irrigated under the flap and allowed it to ettle without further manipulation averaged 8.5%, wherea the incidence in other group of 100 conecutive eye averaged 0.8% (P < .00001, chi-quare tet). The incidence of diffue lamellar keratiti wa 0.2% in eye that had undergone myopic keratomileui in itu and 3.2% in eye treated by laer in itu keratomileui (P = .0003, chi-quare tet). No eye lot 2 or more line of bet pectacle-corrected viual acuity becaue of flap complication. CONCLUION: Flap complication after lamellar refractive urgery are relatively common but rarely lead to a permanent decreae in viual acuity. Phyician experience with the microkeratome and with the handling of the corneal flap decreae the incidence of flap complication