title: Refractive outcomes of laser in situ keratomileusis after flap complications.
abstract: OBJECTIVE
  To study the refractive and visual outcomes, including surgically induced astigmatism, of laser in situ keratomileusis (LASIK) after flap buttonholes and incomplete flaps.
  
  
  METHODS
  Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
  
  
  METHODS
  This was a retrospective case series of 15 patients (15 eyes) who had LASIK after flap complications (6 eyes with buttonholes and 9 with incomplete flaps). The second surgery was performed after the refraction was stable for 2 months. The refractive and visual outcomes were studied.
  
  
  RESULTS
  After the flap complication, the spheroequivalent did not change significantly (P = .78) but the mean pachymetry changed from 523.6 microm +/- 23.14 (SD) to 530.4 +/- 23.96 microm (P = .04) and the mean absolute cylinder changed from 0.63 +/- 1.01 diopter (D) to 0.88 +/- 0.87 D (P = .026). The second surgery was performed at a mean interval of 6.2 months (range 3 to 17 months). Two eyes had flap complications (irregular flaps) again after the second surgery. At the 6-month follow-up, the mean spheroequivalent was -0.34 +/- 0.65 D and the mean cylinder was 0.15 +/- 0.19 D x 83.6. Thirteen eyes (86.66%) were within 0.5 D of the attempted correction. Post-LASIK complications included diffuse lamellar keratitis (1 eye), epithelial ingrowth (1 eye), and flap striae (2 eyes). After the flap complication, no eye lost 2 or more lines of best spectacle-corrected visual acuity (BSCVA); but after the second surgery at 6 months, 1 eye had lost 2 lines of BSCVA. Six months postoperatively, all eyes had a BSCVA of 20/40 or better.
  
  
  CONCLUSIONS
  Laser in situ keratomileusis after flap complications is associated with good refractive and visual outcomes; however, there is a higher risk for intraoperative and postoperative complications after the second surgery.
authors.affiliation: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
authors.forename: Deepta
authors.initials: D
authors.lastname: Ghate
authors.forename: Tushar
authors.initials: T
authors.lastname: Agarwal
authors.forename: Rasik B
authors.initials: RB
authors.lastname: Vajpayee
mesh_terms: D000328:Adult; D003316:Corneal Diseases / Q000209:etiology*; D003319:Corneal Stroma / Q000473:pathology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D020731:Keratomileusis, Laser In Situ; D008297:Male; D009216:Myopia / Q000601:surgery; D012029:Refraction, Ocular / Q000502:physiology*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000009:adverse effects*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*