Article
Laser flap enhancement 5 to 9 years and 10 or more years after laser in situ keratomileusis: Safety and efficacy

https://doi.org/10.1016/j.jcrs.2019.05.030Get rights and content

Purpose

To study the safety and efficacy of refractive enhancement by flap lifting 5 and 10 years after laser in situ keratomileusis (LASIK).

Setting

Vissum Alicante, Spain.

Design

Retrospective case series.

Methods

Eyes with a flap lift at least 5 years after primary LASIK with a 3-month follow-up were evaluated. The primary outcome measures were safety and the complication rate. Moderate epithelial ingrowth was managed with Nd:YAG laser treatment.

Results

The primary LASIK procedure was myopic in 45 eyes, hyperopic in 22 eyes, and presbyopic in 3 eyes. The mean time from primary LASIK to the flap lift was 12.3 years ± 3.45 (SD). In 57 eyes, the primary LASIK flap was created at least 10 years before the enhancement. The mean pre-lift spherical equivalent was −1.29 ± 1.23 diopters (D) in the myopia group and +0.65 ± 1.72 D in the hyperopia group. Three months later, 88% of eyes and 74% of eyes, respectively, had an uncorrected distance visual acuity of 20/20 or better; 100% achieved at least 20/25. No eye lost 2 lines or more of corrected distance visual acuity. In the myopia group, the efficacy index was 0.94 and the safety index was 0.98 at 6 months. Mild epithelial ingrowth developed in 31.43% of eyes and clinically significant epithelial ingrowth in 11.42% of eyes; 4.28% required a relift for severe epithelial ingrowth.

Conclusions

Late flap lift for refractive enhancement 10 years or more after LASIK provided good efficacy and safety with fast visual recovery. The rate of surgical intervention for significant postoperative epithelial ingrowth was low.

Section snippets

Patients and methods

In this retrospective case series we evaluated the outcomes of flap lifting for refractive correction performed between 2012 and 2018 at Vissum Alicante, Spain; the time from the primary procedure to the enhancement was at least 5 years. The study was approved by the institution's ethical board committee and followed the tenets of the Declaration of Helsinki.

Only eyes with at least a 3-month follow-up after the enhancement were included. Excluded were eyes that had refractive surgery other than

Results

Seventy eyes of 48 patients matched the inclusion criteria and were included in the study; 24 patients (50.0%) were men. Primary LASIK was performed between 1997 and 2012. Of the 70 primary LASIK treatments, 45 (66.18%) were myopic (myopia group), 22 (32.35%) were hyperopic (hyperopia group), and 3 (4.41%) were presbyopic (presbyopia group). The mean age at the time of primary LASIK was 27.17 years ± 6.88 (SD) in the myopia group and 36.88 ± 10.04 years in the hyperopia group. The mean

Discussion

Refractive enhancements for refractive errors occurring years after LASIK are a common problem faced by refractive surgeons.1, 2 In general, the well-documented risk for epithelial ingrowth after late flap lifting has discouraged surgeons from performing this procedure for refractive enhancement, and surface ablation treatments are usually used in such cases.6 Although surface treatments over LASIK flaps are safe and effective, they are associated with a long visual recovery (up to 6 months), a

First author:

Jorge L. Alió del Barrio, MD, PhD, FEBOS-CR

Cornea, Cataract and Refractive Surgery Unit, Vissum Alicante, Spain

References (12)

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First author:

Jorge L. Alió del Barrio, MD, PhD, FEBOS-CR

Cornea, Cataract and Refractive Surgery Unit, Vissum Alicante, Spain

This study was performed in the framework of the Red Temática de Investigación Cooperativa en Salud (RETICS), reference RD12/0034/0007 and RD16/0008/0012.

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© 2019 ASCRS and ESCRS Published by Elsevier Inc.