Tsai Tsung-Han, Peng Kai-Ling, Lin Chien-Jen
Department of Ophthalmology.
Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan.
Int Med Case Rep J. 2017 Apr 19;10:143-148. doi: 10.2147/IMCRJ.S128637. eCollection 2017.
Laser in situ keratomileusis (LASIK) is the most common and popular procedure performed for the correction of refractive errors in the last two decades. We report a case of traumatic flap displacement with flap folding which occurred 3 years after LASIK was performed. Previous literature suggests that vision prognosis would be closely related to proper and prompt management of traumatic flap displacement with flap folding 3 years after LASIK.
A 23-year-old female presented to our hospital who had undergone uneventful LASIK in both eyes 3 years prior. Unfortunately, she had suffered a blunt trauma in her right eye in a car accident. A late onset of corneal flap displacement was found with upper and lower portion of the flap being folded inside the corneal bed. Surgical intervention for debridement with subsequent reposition of corneal flap was performed as soon as possible in the operating room. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. Two days after the operation, the displaced corneal flap was found to be well attached smoothly on the corneal bed without folds. The best-corrected visual acuity was 6/6 with refraction of -0.75 D to 1.0 D ×175° in her right eye 1 month later.
We reviewed a total of 19 published cases of late-onset traumatic flap dislocations or displacements after LASIK with complete data from 2000 to 2014.
Traumatic displacement of corneal flaps after LASIK may occur after blunt injury with specific direction of force to the flap margin, especially tangential one. According to the previous literature, late-onset traumatic flap displacement may happen at any time after LASIK and be caused by various types of injuries. Fortunately, good visual function could mostly be restored with immediate and proper management.
准分子原位角膜磨镶术（LASIK）是过去二十年来最常见且最受欢迎的屈光不正矫正手术。我们报告一例LASIK术后3年发生的伴有瓣折叠的外伤性瓣移位病例。既往文献表明，LASIK术后3年外伤性瓣移位伴瓣折叠的恰当及时处理与视力预后密切相关。
一名23岁女性前来我院就诊，她3年前双眼LASIK手术过程顺利。不幸的是，她在一次车祸中右眼遭受钝挫伤。发现角膜瓣延迟出现移位，瓣的上下部分折叠在角膜床内。在手术室尽快进行清创手术干预，随后重新定位角膜瓣。术后放置绷带式隐形眼镜，并给予局部抗生素和皮质类固醇。术后两天，发现移位的角膜瓣顺利良好地附着在角膜床上，无褶皱。1个月后，右眼最佳矫正视力为6/6，屈光度为-0.75 D至1.0 D×175°。
我们回顾了2000年至2014年共19例已发表的LASIK术后迟发性外伤性瓣脱位或移位病例，数据完整。
LASIK术后角膜瓣外伤性移位可能在钝性损伤后，外力以特定方向作用于瓣边缘时发生，尤其是切线方向。根据既往文献，迟发性外伤性瓣移位可能在LASIK术后任何时间发生，且由各种类型的损伤引起。幸运的是，通过及时恰当的处理，大多可恢复良好的视觉功能。
