title: Incidence, management, and visual outcomes of buttonholed laser in situ keratomileusis flaps.
abstract: OBJECTIVE
  To describe the incidence, management, and visual outcomes of buttonholed laser in situ keratomileusis (LASIK) flaps.
  
  
  METHODS
  Private practice, Riyadh, Saudi Arabia.
  
  
  METHODS
  This retrospective review identified eyes that developed buttonholed flaps during LASIK. Preoperative, intraoperative, and postoperative data were obtained to identify factors predictive of this complication.
  
  
  RESULTS
  Of 4250 primary LASIK procedures, 17 eyes (0.4%) with buttonholed flaps were identified. Buttonholes occurred with the Hansatome microkeratome in 64.7% of eyes and with the Moria microkeratome in 35.3% of eyes, the incidence of buttonholed flaps was 0.62% and 0.19%, respectively (P = .03). Laser ablation was performed at the same time as buttonhole formation in 8 eyes (47.1%) and was aborted in the other eyes. Retreatment was performed in 10 eyes (58.8%); of retreated eyes, 6 had repeat LASIK and 3 had surface ablation. The final spherical equivalent refraction was -0.38 diopter +/- 0.79 (SD). Two eyes had a final loss of more than 2 lines of best corrected visual acuity (BCVA). The mean loss of BCVA lines was 0.72 in eyes that had complete LASIK, 0.62 in eyes that had aborted LASIK followed by retreatment with repeat LASIK, and 0.80 in eyes that had aborted LASIK followed by retreatment with surface ablation.
  
  
  CONCLUSIONS
  Buttonholed flaps occurred more frequently in the second of 2 consecutively treated eyes. Microkeratomes that produce a larger diameter flap were more likely to produce flap buttonholes. The least loss of BCVA was achieved when LASIK was aborted and then repeated after refractive stability.
authors.affiliation: Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. almez2001@hotmail.com
authors.forename: Hani S
authors.initials: HS
authors.lastname: Al-Mezaine
authors.forename: Saleh A
authors.initials: SA
authors.lastname: Al-Amro
authors.forename: Saleh
authors.initials: S
authors.lastname: Al-Obeidan
mesh_terms: D000293:Adolescent; D000328:Adult; D003319:Corneal Stroma / Q000293:injuries*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D012029:Refraction, Ocular / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture; D013524:Surgical Flaps; D014792:Visual Acuity / Q000502:physiology*; D014945:Wound Healing; D055815:Young Adult