title: Subtarsal flap dislocation after superior hinge laser in situ keratomileusis in a patient with borderline mental illness.
abstract: OBJECTIVE
  To report a case of complete subtarsal flap dislocation after uncomplicated superior hinge laser in situ keratomileusis (LASIK).
  
  
  METHODS
  Flap dislodgement resulted from eye rubbing in a patient with a past medical history of mental illness and epilepsy. The dislocated cap, which was also folded in half, was refloated, profusely irrigated, and ironed to eliminate flap wrinkles. Particular care was taken to avoid flap misalignment.
  
  
  RESULTS
  Despite the above mentioned intervention, a prominent epithelial mark corresponding to the line of previous folding persisted for 3 additional days. Eventually, a perfectly aligned lenticule without wrinkles and an otherwise normal postoperative course occurred.
  
  
  CONCLUSIONS
  Although superior hinge LASIK may reduce the likelihood of flap displacement, mechanical forces can generate complete flap dislocation. When a flap has been folded in half, an epithelial mark corresponding to the line of folding may persist. Patients with psychiatric disorders may be at higher risk of postoperative flap-related complications.
authors.affiliation: Department of Ophthalmology, University Clinic, Pamplona, Navarra, Spain. mjmaldonado@unav.es
authors.forename: Miguel J
authors.initials: MJ
authors.lastname: Maldonado
authors.forename: José R
authors.initials: JR
authors.lastname: Juberías
mesh_terms: D003319:Corneal Stroma / Q000473:pathology* / Q000601:surgery; D004827:Epilepsy / Q000150:complications; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D008297:Male; D008405:Massage / Q000009:adverse effects*; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D009216:Myopia / Q000601:surgery; D012086:Reoperation; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome; D014792:Visual Acuity