title: Laser in situ keratomileusis buttonhole: classification and management algorithm.
abstract: OBJECTIVE
  To report the classification, management, and visual outcomes after laser in situ keratomileusis (LASIK) flap buttonhole caused by a microkeratome cut.
  
  
  METHODS
  Private practice, Boston, Massachusetts, USA.
  
  
  METHODS
  This retrospective observational case series comprised 15 patients with an intraoperative LASIK flap buttonhole or near buttonhole. In all cases, the flap was left in place or repositioned without excimer laser treatment. Buttonholes were classified by stage, and a treatment algorithm based on the stage was devised to determine the timing and type of intervention. The uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and complications associated with the laser vision correction surgery were reported.
  
  
  RESULTS
  Postoperative follow-up ranged from 1 week to 23 months. All 9 patients who were retreated had a postoperative UCVA of 20/25 or better. No retreated patient lost BSCVA. Before retreatment, the median UCVA was 20/80 (range 20/40(-1) to counting fingers), the median BSCVA was 20/20(-2) (range 20/15(-1) to 20/70), and the spherical equivalent (SE) refractive errors ranged from -1.00 to -6.62 diopters (D). After retreatment, the median UCVA was 20/20(-2) (range 20/15(-1) to 20/25(-1)), the median BSCVA was 20/20 (range 20/15 to 20/20(-3)), and the SE refractive errors ranged from +0.50 to -0.75 D. Complications after laser correction treatment included overcorrection in 3 patients and corneal haze in 2 patients.
  
  
  CONCLUSIONS
  Classification of buttonholes was helpful in guiding treatment. Good UCVA and BSCVA were achieved by following a simple treatment algorithm based on surface ablation.
authors.affiliation: Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Mona
authors.initials: M
authors.lastname: Harissi-Dagher
authors.forename: Amit
authors.initials: A
authors.lastname: Todani
authors.forename: Samir A
authors.initials: SA
authors.lastname: Melki
mesh_terms: D000328:Adult; D000465:Algorithms; D003316:Corneal Diseases / Q000145:classification* / Q000209:etiology / Q000628:therapy*; D003319:Corneal Stroma / Q000473:pathology; D019781:Corneal Topography; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000473:pathology*; D014792:Visual Acuity