Intraoperative flap complications in laser in situ keratomileusis with two types of microkeratomes

To determine the incidence and types of intraoperative flap complications in laser in situ keratomileusis [LASIK] encountered with the Hansatome microkeratome and the Moria microkeratome. In this retrospective case series, all patients with intraoperative flap complications who were treated between June 1999 and July 2008 at the Eye Consultants Center in Riyadh, Saudi Arabia, were identified and reviewed. Of the 4352 subjects who underwent bilateral primary LASIK procedure, intraoperative microkeratome complications were detected in 89 eyes of 83 patients. The overall incidence of flap complications was 89/8704 [1.00%]: incomplete flaps occurred in 53 eyes [0.60%], followed by buttonhole flaps in 17 eyes [0.19%], free complete flaps in 10 eyes [0.11%], free partial flaps in 6 eyes [0.07%], sluffed epithelium in 2 eyes [0.023%], and a splitted flap [vertical flap cut] in 1 eye [0.01%]. The incidence rates of intraoperative flap complications with the Hansatome microkeratome and the Moria microkeratome were 1.21% [41/3378] and 0.90% [48/5326], respectively [P = 0.19]. There was a statistically significant difference between the two microkeratomes with regard to the incidence of buttonhole flaps: 0.33% [11/3378] for the Hansatome microkeratome versus 0.11% [6/5326] for the Moria microkeratome [P = 0.04]. Generally, the incidence rates of intraoperative flap complications with the Hansatome microkeratome and the Moria microkeratome were similar. However, buttonhole flaps occurred more often with the Hansatome microkeratome [a type of microkeratome that produces larger flaps]. The commonest complication encountered was the incomplete flap, followed by the buttonhole flap and free flap

Outcomes of retreatment after aborted laser In Situ keratomileusis due to flap complications

To determine the refractive outcomes and complications of retreatment after aborted primary laser in situ keratomileusis [LASIK] due to flap complications. This retrospective study evaluated 50 retreated eyes that had flap complications during primary LASIK at the Eye Consultants Center in Riyadh, Saudi Arabia. Data were analyzed for patients with at least 3 months follow-up post retreatment. Thirty-three eyes of 31 consecutive patients with 3 months follow-up or later post retreatment were included. The primary LASIK was aborted due to incomplete flaps in 22 eyes [66.7%], buttonhole flaps in 7 eyes [21.2%], free partial flaps in 3 eyes [9.1%], and a free complete flap in 1 eye [3.0%]. Twenty-two eyes [66.7%] were retreated with LASIK, and 11 eyes [33.3%] were retreated with surface ablation. The mean spherical equivalent [SE] was ?0.23 +/- 0.72 D, the mean astigmatism was ?0.65 +/- 0.89 D, and the mean loss of the best corrected visual acuity [BCVA] was 0.78 lines at the final postoperative visit. At the last postoperative visit, 20/30 or better BCVA was achieved in 90.1% of eyes that underwent retreatment with LASIK and in 91% of eyes that were retreated with surface ablation. There was no statistical difference in postoperative SE between eyes retreated with LASIK and eyes retreated with surface ablation [P=0.610]. There was no statistical difference in postoperative BCVA between eyes retreated with LASIK and those retreated with surface ablation [P=0.756]. There were no intraoperative complications and no eyes required a second retreatment. Creation of a flap after a previous intraoperative flap complication was not associated with any complications. The refractive outcomes of retreatment with LASIK or surface ablation were comparable and reasonably favorable

Misdiagnosis of spasm of the near reflex

Spasm of the near reflex is characterized by intermittent attacks of convergence, accommodation, and miosis. It typically affects young adults and is frequently psychogenic. The author describes the case of a 17-year-old female with spasm of the near reflex manifesting with headache, diplopia, reduced vision, esotropia, and limitation of abduction. The condition had been misdiagnosed as myasthenia gravis following a positive Tensilon test. This case re-emphasizes the importance of considering spasm of the near reflex in the differential diagnosis of any patient with esotropia associated with headache and reduced vision