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- Medically Reviewed by Mr Mfazo Hove Consultant Ophthalmologist
- Author: Chris Dunnington
- Published: December 30, 2024
Laser eye surgery has revolutionised vision correction, offering millions of people the opportunity to reduce or eliminate their dependence on glasses and contact lenses. Whilst most procedures are successful, it’s crucial to understand potential risks, including flap complications. At Blue Fin Vision®, our expert ophthalmologists in London’s Harley Street are committed to providing comprehensive information about laser eye surgery, ensuring our patients are well-informed and confident in their decision.
Understanding Laser Eye Surgery
Before delving into flap complications, let’s briefly review the most common types of laser eye surgery:
LASIK (Laser-Assisted In Situ Keratomileusis): The most popular form of laser eye surgery, involving the creation of a thin corneal flap.
LASEK (Laser-Assisted Sub-Epithelial Keratectomy): A surface treatment that doesn’t require a corneal flap.
PRK (Photorefractive Keratectomy): Like LASEK, this procedure removes the epithelium entirely.
SMILE (Small Incision Lenticule Extraction): A newer technique that creates a small incision rather than a flap.
Flap complications are primarily associated with LASIK, as it’s the only procedure that creates a corneal flap. However, understanding these complications is valuable for anyone considering laser eye surgery.
What Is the Corneal Flap?
In LASIK surgery, a thin flap is created within the cornea, beneath the epithelium and into the corneal stroma. The epithelium is approximately 50 μm thick, and the typical flap is 90-120 μm thick, extending well into the stroma beneath Bowman’s layer. This flap is then lifted to allow the laser to reshape the underlying corneal tissue. After the reshaping is complete, the flap is repositioned to act as a natural bandage.
Types of Laser Eye Surgery Flap Complications
Flap complications can occur during or after the LASIK procedure. While rare, especially when performed by experienced surgeons using advanced technology, it’s important to be aware of these potential issues:
- Flap Dislocation
Cause: Poor adhesion of the flap after surgery, often due to eye rubbing or trauma.
Symptoms:
- Sudden decrease in vision
- Foreign body sensation
- Eye discomfort or pain
Treatment: The surgeon will carefully reposition the flap and may use a bandage contact lens to promote healing.
- Flap Folds or Striae
Cause: Improper repositioning of the flap during surgery or shifting of the flap post-surgery through patients rubbing their eyes.
Symptoms:
- Blurred or distorted vision
- Increased glare or halos around lights
Treatment: In minor cases, the folds may resolve on their own. For significant folds affecting vision, the surgeon may need to lift and reposition the flap.
- Epithelial Ingrowth
Cause: Epithelial cells from the surface of the eye grow underneath the flap.
Symptoms:
- Blurred or distorted vision
- Discomfort or irritation
- Visible line or haze at the edge of the flap
Treatment: In mild cases, observation may be sufficient. More severe cases may require lifting the flap and removing the ingrown cells.
- Diffuse Lamellar Keratitis (DLK)
Cause: Inflammation beneath the corneal flap, often called “Sands of the Sahara” due to its appearance.
Symptoms:
- Blurred vision
- Light sensitivity
- Eye discomfort
Treatment: Typically managed with topical steroid eye drops. In severe cases, the flap may need to be lifted, and the interface cleaned.
- Irregular Astigmatism
Cause: Uneven healing of the corneal flap or irregularities in the corneal surface.
Symptoms:
- Blurred or distorted vision
- Difficulty focusing
Treatment: May require additional laser treatment or, in rare cases, a corneal transplant.
- Flap Buttonholes
Cause: May be caused by scars in the corneal stroma and occurs when separating the flap from the stroma.
Symptoms:
- Glare and halos around lights
- Diplopia (double vision)
- Light sensitivity
Treatment: Treatment typically involves immediate flap repositioning, allowing for corneal healing, and potentially considering surface PRK or topography-guided treatment after a sufficient healing period, with regular follow-ups to monitor progress.
Note: Much less common with femtosecond laser-created flaps, which is the advanced technology we use at Blue Fin Vision®.
Preventing Laser Eye Surgery Flap Complications
While the risk of flap complications is low, there are several steps that both surgeons and patients can take to minimise these risks:
For Surgeons:
- Utilise advanced laser technology for precise flap creation
- Conduct thorough pre-operative assessments
- Ensure proper flap alignment during surgery
- Provide comprehensive post-operative care and follow-up
For Patients:
- Follow all pre-operative and post-operative instructions carefully
- Avoid rubbing your eyes after surgery
- Wear protective eyewear as directed
- Attend all follow-up appointments
- Report any unusual symptoms promptly
Treatment of Laser Eye Surgery Flap Complications
The treatment of flap complications depends on the specific issue and its severity. In many cases, prompt intervention can resolve the problem without long-term effects on vision. Treatments may include:
- Repositioning of the flap
- Additional laser treatment
- Use of topical medications
- In rare cases, more extensive surgical intervention
Choosing a Reputable Eye Clinic
The risk of flap complications can be significantly reduced by choosing a reputable eye clinic with experienced surgeons. At Blue Fin Vision®, our Harley Street clinic in London is equipped with state-of-the-art technology and staffed by highly skilled ophthalmologists specialising in laser eye surgery.
When selecting an eye clinic, consider the following:
- Surgeon’s qualifications and experience
- Clinic’s track record and patient testimonials
- Use of advanced laser technology
- Comprehensive pre-operative assessment process
- Quality of aftercare and follow-up
The Importance of Informed Consent
Before undergoing laser eye surgery, it’s crucial to have a thorough discussion with your surgeon about potential risks and complications. This process, known as informed consent, ensures that you’re fully aware of both the benefits and risks of the procedure.
At Blue Fin Vision®, we believe in empowering our patients with knowledge. Our surgeons take the time to explain the procedure in detail, discuss potential complications, and answer any questions you may have.
Advanced Technology at Blue Fin Vision®
At Blue Fin Vision®, we exclusively use femtosecond laser technology to create corneal flaps. This advanced technique offers several advantages:
- Reduces the incidence of flap complications
- Creates uniform flaps of predictable thickness
- Considered the gold standard in LASIK surgery
Post-Operative Care
To ensure optimal healing and minimise the risk of complications, we implement the following measures:
- Day 1 Check: All patients undergo a thorough examination 24 hours after surgery to ensure proper flap positioning and address any issues promptly.
- Flap Adherence: We emphasise the importance of avoiding eye rubbing in the first 24 hours to allow proper flap adherence.
- Debris and DLK Check: During the follow-up, we carefully examine for any debris beneath the flap and signs of Diffuse Lamellar Keratitis (DLK).
Conclusion
Flap complications, while rare, are a potential risk of LASIK surgery. Understanding these risks is an important part of making an informed decision about laser eye surgery. With advancements in technology and surgical techniques, the incidence of flap complications has significantly decreased over the years.
At Blue Fin Vision®, our commitment to excellence in laser eye surgery extends from our state-of-the-art Harley Street clinic in London to our team of expert ophthalmologists. We prioritise patient safety and satisfaction, ensuring that everyone receives personalised care and achieves the best possible outcome.
If you’re considering laser eye surgery and have concerns about potential complications, we invite you to schedule a consultation at our London eye clinic. Our team will provide you with comprehensive information, assess your suitability for the procedure, and address any questions or concerns you may have. With proper care and expertise, you can join the millions who have benefited from this life-changing procedure.
