title: Intraoperative flap complications in laser in situ keratomileusis with two types of microkeratomes.
abstract: OBJECTIVE
  To determine the incidence and types of intraoperative flap complications in laser in situ keratomileusis (LASIK) encountered with the Hansatome microkeratome and the Moria microkeratome.
  
  
  METHODS
  In this retrospective case series, all patients with intraoperative flap complications who were treated between June 1999 and July 2008 at the Eye Consultants Center in Riyadh, Saudi Arabia, were identified and reviewed.
  
  
  RESULTS
  Of the 4352 subjects who underwent bilateral primary LASIK procedure, intraoperative microkeratome complications were detected in 89 eyes of 83 patients. The overall incidence of flap complications was 89/8704 (1.00%): incomplete flaps occurred in 53 eyes (0.60%), followed by buttonhole flaps in 17 eyes (0.19%), free complete flaps in 10 eyes (0.11%), free partial flaps in 6 eyes (0.07%), sluffed epithelium in 2 eyes (0.023%), and a splitted flap (vertical flap cut) in 1 eye (0.01%). The incidence rates of intraoperative flap complications with the Hansatome microkeratome and the Moria microkeratome were 1.21% (41/3378) and 0.90% (48/5326), respectively (P = 0.19). There was a statistically significant difference between the two microkeratomes with regard to the incidence of buttonhole flaps: 0.33% (11/3378) for the Hansatome microkeratome versus 0.11% (6/5326) for the Moria microkeratome (P = 0.04).
  
  
  CONCLUSIONS
  Generally, the incidence rates of intraoperative flap complications with the Hansatome microkeratome and the Moria microkeratome were similar. However, buttonhole flaps occurred more often with the Hansatome microkeratome (a type of microkeratome that produces larger flaps). The commonest complication encountered was the incomplete flap, followed by the buttonhole flap and free flap.
authors: Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors: Hani S
authors: HS
authors: Al-Mezaine
authors: Saleh A
authors: SA
authors: Al-Amro
authors: Saleh
authors: S
authors: Al-Obeidan
keywords: Flap complication; Hansatome; LASIK; Microkeratome; Moria
references: J Cataract Refract Surg. 2000 Mar;26(3):358-62
references: 10713229
references: Ophthalmology. 1999 Aug;106(8):1461-7; discussion 1467-8
references: 10442889
references: J Cataract Refract Surg. 2009 May;35(5):839-45
references: 19393882
references: J Cataract Refract Surg. 1998 Jul;24(7):989-1006
references: 9682123
references: J Cataract Refract Surg. 1996 Dec;22(10):1443-50
references: 9051500
references: Ophthalmology. 1999 Apr;106(4):732-8
references: 10201594
references: Ophthalmology. 1999 Jan;106(1):13-20
references: 9917775
references: Br J Ophthalmol. 2007 Oct;91(10):1373
references: 17895418
references: J Cataract Refract Surg. 1997 Jan-Feb;23(1):39-49
references: 9100106
references: J Cataract Refract Surg. 2006 Jun;32(6):962-9
references: 16814054
references: J Refract Surg. 2007 May;23(5):472-6
references: 17523508
references: J Refract Surg. 2000 Jan-Feb;16(1):79-82
references: 10693623
references: J Cataract Refract Surg. 1997 Apr;23(3):372-85
references: 9159682
references: J Refract Surg. 1996 Mar-Apr;12(3):417-21
references: 8705718
references: J Refract Surg. 2004 Sep-Oct;20(5 Suppl):S723-6
references: 15521276
references: Am J Ophthalmol. 2006 May;141(5):833-9
references: 16678504
references: J Cataract Refract Surg. 2004 Jan;30(1):26-32
references: 14967265
references: Am J Ophthalmol. 1999 Feb;127(2):129-36
references: 10030552
references: J Cataract Refract Surg. 2004 Jun;30(6):1240-7
references: 15177598
references: J Refract Surg. 2000 Jan-Feb;16(1):83-9
references: 10693624
references: Ophthalmology. 1998 Oct;105(10):1839-47; discussion 1847-8
references: 9787353
references: J Refract Surg. 1997 Sep-Oct;13(6):528-34
references: 9352481
references: J Refract Surg. 1999 Nov-Dec;15(6):648-52
references: 10590002
references: J Refract Surg. 2003 Jan-Feb;19(1):8-14
references: 12553599
references: J Refract Surg. 2002 May-Jun;18(3 Suppl):S347-51
references: 12046880
references: Am J Ophthalmol. 2000 Jan;129(1):59-67
references: 10653414
references: J Refract Surg. 1996 Jul-Aug;12(5):575-84
references: 8871858
references: Ophthalmology. 2000 May;107(5):920-4
references: 10811084
references: J Cataract Refract Surg. 2000 Sep;26(9):1270-1
references: 11183850
references: J Cataract Refract Surg. 2008 Nov;34(11):1892-9
references: 19006735
references: J Refract Surg. 1996 Jan-Feb;12(1):29-35
references: 8963815
references: J Cataract Refract Surg. 2002 Jan;28(1):23-8
references: 11777706
references: J Refract Surg. 2005 Sep-Oct;21(5 Suppl):S655-7
references: 16212299
references: J Cataract Refract Surg. 2008 May;34(5):859-63
references: 18471647
references: J Cataract Refract Surg. 1996 Jan-Feb;22(1):31-43
references: 8656358