Results of late flap removal after complicated laser in situ keratomileusis

Purpose: To evaluate the effect of flap removal on complications after laser in situ keratomileusis (LASIK). Setting: Three university-based referral centers and 1 private practice. Methods: This retrospective interventional case series comprised 6 eyes of 6 patients at 4 centers. Flap removal occurred 2 to 41 weeks after the LASIK procedure. The corneal flaps were excised by 2 methods: In 2 eyes, the flap was lifted and excised manually. In 4 eyes, the thin flap was removed by excimer ablation using phototherapeutic keratectomy and/or photorefractive keratectomy. Postoperative measurements included uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, slitlamp evaluation, and computerized videokeratography. All patients had an 8-month or longer convalescence to assess visual recovery. Results: After the initial flap complication, the BSCVA decreased in all 6 eyes (mean loss 3.0 lines +/- 1.5 [SD]). After flap removal, it improved in all eyes (mean gain 2.2 +/- 1.2 lines). All patients reported a reduction in or elimination of visual symptoms. Despite the improvements, a minor loss of BSCVA (mean -0.8 lines [range 0 to 2 lines]) remained in 4 patients. Conclusion: In carefully selected patients, flap removal is a viable surgical option to improve visual function.