title: Traumatic dislocation of LASIK flaps 4 and 9 years after surgery.
abstract: OBJECTIVE
  To report two patients who developed a corneal flap dehiscence 4 years and 9 years after LASIK, respectively, following trauma during routine domestic activities.
  
  
  METHODS
  Retrospective chart review of two patients. Clinical presentation, mechanism of injury, treatment, complications, and outcome were studied. A review of published cases in the English literature on late onset flap dislocation was performed.
  
  
  RESULTS
  Case 1 involved a 30-year-old man who presented 4 years after LASIK, after his eye was struck with a piece of wood from a window trim. Examination showed uncorrected visual acuity (UCVA) of 20/25 and flap displacement, creating a fold at the superior edge. Because the injury involved the periphery of the flap, the patient was treated medically only. Final UCVA was 20/20(-1) with a persistent fold. Case 2 involved a 29-year-old man who dislocated his flap after being hit with a dog's paw 9 years after LASIK. Uncorrected visual acuity was count fingers, and a complete flap dislocation that was folded at the hinge with 30% epithelial ingrowth was noted. Immediate surgical removal of the epithelium from the stromal bed was completed and a bandage contact lens was used along with topical medication. Final UCVA was 20/25, with no complications.
  
  
  CONCLUSIONS
  Flap dehiscence is a rare, late complication of LASIK. Case 1 is the second report of flap dislocation treated medically only and case 2 is the latest report. Tangential force applied to the flap during routine activities of life can result in flap displacement for up to 9 years after LASIK.
authors.affiliation: University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
authors.forename: Hyunjin Jane
authors.initials: HJ
authors.lastname: Kim
authors.forename: Cary M
authors.initials: CM
authors.lastname: Silverman
mesh_terms: D000062:Accidents, Occupational; D000328:Adult; D000818:Animals; D003319:Corneal Stroma / Q000293:injuries*; D004285:Dogs / Q000293:injuries; D005131:Eye Injuries / Q000209:etiology* / Q000601:surgery; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D008297:Male; D012189:Retrospective Studies; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000601:surgery; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology; D014949:Wounds, Nonpenetrating / Q000209:etiology* / Q000601:surgery