Repositioning of a Free Cap after Laser-assisted in situ Keratomileusis

PURPOSE: To report a case of irregular astigmatism caused by a free flap during laser-assisted in situ keratomileusis (LASIK) surgery that was treated with a flap rotation based on postoperative topography. CASE SUMMARY: A 21-year-old female underwent LASIK, which was complicated by a free cap on her right eye. Because the gentian violet markings were no longer present, the exact orientation of the cap was unknown. At 3 months after surgery, the astigmatism of the right eye was −3.00 diopters (D) with an uncorrected visual acuity (UCVA) of 0.4, and the astigmatism of the left eye was −0.75 D with an UCVA of 1.0. The corneal topography was analyzed in order to return to the existing position. Free cap repositioning was performed and irregular astigmatism was corrected to improve the UCVA to 1.0. CONCLUSIONS: If the preoperative markings cannot be identified on a free flap during LASIK, secondary postoperative corneal topographic analysis can be performed to restore the corneal free flap to its original position to minimize astigmatism with good visual outcomes.

A Case of Conversion to PRK Due to Lost-Free Cap in LASIK

PURPOSE: LASIK has several advantages over PRK such as less postoperative pain, quicker visual recovery, virtually no corneal haze and low incidence of myopic regression. But the primary disadvantage of LASIK is that flap-related complications rarely can occur. METHODS: In the LASIK procedure of a 30-year-old woman, we experienced the crescent form lost-free cap which developed in the direction of 4~7 clock hours and then we converted to PRK. RESULTS: Postoperative visual acuity showed 1.0 . On slit-lamp biomicroscopic examination we were able to find the completely healed cornea including lost-free cap site epithelium. On topography, we were able to find the improvement in the irregular surface of lost-free cap site. CONCLUSIONS: Intraoperative flap complications of LASIK are relatively uncommon, but we should consider the possibility of those complications. And though it may occur, proper management will result in good surgical outcomes without severe visual impairment.