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Purpose: To describe the preoperative characteristics, intraoperative details, management, and postoperative in patients with bilateral epithelial defects after laser in situ keratomileusis (LASIK)., Methods: Retrospective non-comparative case series., Results: Six patients with bilateral epithelial defects after LASIK were part of a cohort of 605 patients undergoing bilateral LASIK at our center from December 2001 to April 2003. The mean age of the patients (5M:1F) was 28.5 +/- 7.9 years, and the average pretreatment myopic spherical equivalent (SE) refraction was 7.3 +/- 0.7 D (-4, -12.25D). An epithelial flap was present in 6 eyes and an epithelial defect with a mean diameter of 3 mm (2mm, 6mm) was seen in 6 eyes. In four patients the epithelial disturbance was bilaterally similar. All defects occurred in the inferior cornea and the epithelial flaps had the hinge positioned superiorly. None of the patients had ocular or systemic risk factors that could have resulted in this complication. A bandage contact lens was used in 6 eyes. At last follow-up of 5.5 +/- 9.5 months (0.25, 21 months), unaided visual acuity was 6/9 or better in 10 eyes. Best spectacle-corrected visual acuity (BSCVA) was maintained in 8 eyes, while 4 eyes lost one line of BSCVA. Recurrent corneal erosions were not reported in the follow-up period., Conclusions: These patients represent a hitherto unrecognised group of individuals who appear to have a subclinical weakness of adhesion of the corneal epithelium to the underlying structures, which is not evident on clinical examination. This results in bilateral epithelial disturbances after LASIK. Appropriate management results in satisfactory clinical outcomes. Other options for treatment of the fellow eye of such patients include the use of a different microkeratome, release of suction during the reverse pass of the Hansatome microkeratome, and photorefractive keratectomy if the refractive error is low.

Two patients developed free flaps intraoperatively during laser in situ keratomileusis. After excimer laser treatment was performed, the free flap was replaced, maintaining proper alignment. Interrupted sutures were placed superiorly at the intended hinge site to secure the free flap. The uncorrected visual acuity was 20/30 in the affected eyes of both patients after treatment. At the 6-month follow-up, there were no flap-related complications and there was no loss of best corrected visual acuity.

A case of unilateral interface keratitis due to Mycobacterium fortuitum following simultaneous bilateral LASIK procedure for low myopia is reported. Excimer phototherapeutic keratectomy was performed to the stromal bed to reduce the infective load. Intensive topical therapy with topical amikacin and ciprofloxacin resulted in resolution of the keratitis.

We report 2 patients who experienced progressive blurring of vision following myopic laser in situ keratomileusis (LASIK) in 1 eye (Case 1) and bilaterally (Case 2). High against-the-rule astigmatism, associated with perilimbal thinning inferiorly, was seen on refraction in all eyes. Regional corneal pachymetry confirmed the peripheral corneal thinning inferiorly. Corneal topography revealed the typical features of pellucid marginal corneal degeneration (PMCD) in the untreated eye of Case 1. Advanced changes were noted in the fellow eye. The corneal topography findings in Case 2 were similar to those seen in PMCD. Patients with early PMCD may present to the refractive surgeon with a stable refraction, normal corrected visual acuity, and adequate central corneal thickness. Corneal topography data along with regional corneal pachymetry must be interpreted carefully to detect these cases. Laser in situ keratomileusis can lead to a rapid progression of PMCD.

Purpose: To report results of smaller diameter corneal flap of original thickness in the management of partial flap during laser in situ keratomileusis (LASIK)., Methods: Retrospective review of the case records of three patients (3 eyes) who had a partial corneal flap during LASIK., Results: Retreatment was performed using an 8.5-mm-diameter corneal flap, which was smaller than the original partial flap of 9.5-mm diameter. The recut depth was maintained as the original cut depth of 160 microm. No intraoperative or postoperative complications were noted. At follow-up 4 weeks later, two patients had an uncorrected visual acuity of 20/20. One patient had uncorrected visual acuity of 20/40 that improved to preoperative best spectacle-corrected visual acuity of 20/30 with a correction of +0.50 -1.25 x 170 degrees., Conclusion: A smaller diameter corneal flap of original thickness can be used for retreatment of partial flap during LASIK. A thicker posterior stromal bed after laser ablation may be retained with this technique, compared to retreatment using a corneal flap of greater thickness.

We report a case in which raised intraocular pressure (IOP) was associated with interface fluid after uneventful bilateral laser in situ keratomileusis (LASIK). The patient presented with diffuse lamellar keratitis in both eyes 3 weeks postoperatively that was treated aggressively with topical corticosteroids. A steroid-induced rise in IOP resulted in interface fluid accumulation and microcystic edema. Measurements with the Goldmann tonometer revealed an IOP of 3.0 mm Hg in both eyes. However, Schiotz tonometry recorded a pressure of 54.7 mm Hg in both eyes. Reduction in the dosage of topical corticosteroid and medical treatment of the raised IOP resulted in resolution of the microcystic edema and interface fluid accumulation. This case highlights the inaccuracies of IOP measurement after LASIK and the resulting complications.