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PURPOSE: To report the clinical features and outcome of eyes with flap buttonhole during LASIK. METHODS: A retrospective review was performed to identify eyes that developed flap buttonhole during Hansatome microkeratome translation. Pre-, intra-, and postoperative data were obtained to identify factors predictive of buttonhole. RESULTS: Five patients with buttonhole were identified from June 2001 through September 2002 (5 [0.06%] eyes of 7672 primary LASIK procedures). Mean patient age was 49.2±11.3 years (range: 37 to 66 years). Mean preoperative spherical equivalent refraction was -4.92±2.90 diopters (D) (range: -2.25 to -9.50 D). Mean keratometry was 45.59±1.15 D (range: 43.90 to 47.60 D). All 5 flap buttonholes occurred in the second of 2 consecutively treated eyes (P=.03). Buttonhole occurred in 2 (0.26%) of 778 eyes where the 160-µm microkeratome plate was used, and 3 (0.06%) of 4350 eyes where the 180-µm plate was used (P=.16). Two eyes received laser ablation at the time of buttonhole formation. In the untreated cases, the buttonhole flap itself caused a myopic spherical change of -0.50 D and 0.70 D of astigmatism. One of 5 eyes lost 2 lines of best spectacle-corrected visual acuity; this eye received laser ablation immediately after buttonhole formation. CONCLUSIONS: Buttonholes are significantly more likely to occur in the second of two consecutively treated eyes. A new blade for the second eye when the flap in the first eye appears to be thin should be considered. Caution should be exercised when considering laser ablation immediately following buttonhole formation. [J Refract Surg. 2007;23:472-476.]

No abstract

Visual aberrations such as glare and halo have been well documented after laser in-situ keratomileusis (LASIK). These are more likely in patients with higher refractive errors and large pupil diameters. We present a patient with good Snellen acuity but functional impairment by visual aberrations after LASIK. These symptoms resolved after an InterWave-guided LASIK multipass, multistage enhancement treatment to correct spherical aberrations.

PURPOSE: To describe the indications and technique for repositioning the laser in situ keratomileusis (LASIK) flap at the slit lamp. METHODS: We present a description of patients with striae or slippage of the flap who had repositioning of the flap at the slit lamp. RESULTS: Indications for repositioning at the slit lamp are mostly flap striae. However, it can also be done for a displaced flap and small amounts of debridement. This procedure is not recommended for taking cultures, irrigation of diffuse lamellar keratitis, suturing the flap, or epithelial ingrowth. Repositioning the flap is done by finding the edge of the flap with the cannula, lifting the flap, sweeping the cannula to release the entire wound, and infusing balanced salt solution under the entire flap. We did not encounter infection or recurrent epithelial erosion in these patients. CONCLUSIONS: Repositioning the LASIK flap at the slit lamp was effective and safe in the treatment of striae or flap slippage. It saved time, money, and, anxiety for the patient. [J Refract Surg 2004;20:166-169]