Department of Cataract and Refractive Service, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India.
Department of Cornea Service, Shantilal Sanghvi Cornea Institute, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India.
Indian J Ophthalmol. 2024 Apr 1;72(4):489-494. doi: 10.4103/IJO.IJO_788_23. Epub 2023 Dec 26.
To evaluate the surgical and visual outcomes of flap repositioning for various post-laser-assisted in-situ keratomileusis (LASIK) flap pathologies. Retrospective review of consecutive cases between April 1, 2017 and February 28, 2022, where surgical flap repositioning was performed following LASIK for various flap-related complications. Of the 6018 eyes, 31 needed flap repositioning (0.51%). Indications were flap displacement and folds in 20 eyes (64%), flap subluxation in five eyes (16%), epithelial ingrowth and interface debris in two each, and one eye each of diffuse lamellar keratitis and incomplete flap. Final best spectacle-corrected visual acuity of ≥ 20/25 was obtained in 25/31 (80%) eyes. The efficacy index pre to post repositioning showed significant improvement (0.86 ± 0.39 vs. 0.63 ± 0.29 preop, P = 0.011). Flap repositioning incidence was significantly higher (7/602 (1.16%)) during the COVID lockdown phases compared to the non-COVID lockdown phase (24/5416 (0.44%, P = 0.019)). The COVID group had lower efficacy (0.72 ± 0.36 vs. 0.90 ± 0.39, P = 0.300) and safety indices (0.85 ± 0.24 vs. 1.06 ± 0.35, P = 0.144) compared to the non-COVID group; however, the results were not statistically significant. The flap displacement rate was statistically higher in nasal hinged (microkeratome) flaps (18/2013, 0.89%) compared to superior hinged (Femto) flaps (13/4005, 0.32%) (0.32%, P = 0.003). Our study shows that flap repositioning has a low incidence in LASIK, with the most common indication being flap displacement/folds. The outcome post flap repositioning was poorer during the lockdown period, perhaps due to the inability to follow up early. Early identification and surgical repositioning are successful in both anatomical and visual restoration.
评估各种准分子激光原位角膜磨镶术（LASIK）后瓣相关病变的瓣复位手术和视觉效果。回顾性分析 2017 年 4 月 1 日至 2022 年 2 月 28 日期间连续病例，对因各种瓣相关并发症行 LASIK 后瓣复位手术的病例进行分析。在 6018 只眼中，有 31 只眼需要瓣复位（0.51%）。适应证为 20 只眼（64%）的瓣移位和皱褶、5 只眼（16%）的瓣半脱位、2 只眼各有上皮内生长和界面碎屑、1 只眼分别有弥漫性层间角膜炎和不完全瓣。31 只眼中有 25 只眼（80%）最终获得最佳矫正视力≥20/25。复位前后的疗效指数显示明显改善（0.86±0.39 与术前 0.63±0.29，P=0.011）。与非 COVID 封锁阶段相比（24/5416，0.44%，P=0.019），COVID 封锁阶段瓣复位发生率明显更高（7/602，1.16%）。COVID 组的疗效（0.72±0.36 与 0.90±0.39，P=0.300）和安全性指数（0.85±0.24 与 1.06±0.35，P=0.144）均低于非 COVID 组，但结果无统计学意义。在鼻侧有铰链（微型角膜刀）瓣的病例中，瓣移位率明显高于在上方有铰链（飞秒）瓣的病例（18/2013，0.89%），与上方有铰链瓣相比（13/4005，0.32%）（0.32%，P=0.003）。我们的研究表明，LASIK 中瓣复位的发生率较低，最常见的适应证是瓣移位/皱褶。在封锁期间，瓣复位后的结果较差，这可能是由于无法早期随访。早期发现和手术复位在解剖和视觉恢复方面均取得成功。
