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Case Reports and Small Case Series
March 2001

Late Dislocation of a LASIK Flap Caused by a Fingernail

Arch Ophthalmol. 2001;119(3):447-449. doi:

This report of a delayed traumatic dislocation of a laser in situ keratomileusis (LASIK) corneal cap highlights the long-term dangers of the procedure. Recommendations are made on how to approach repair of a dislocated LASIK cap.

A 28-year-old white woman came to our casualty service following uncomplicated, bilateral LASIK performed elsewhere. Preoperative refraction was −2.25 diopters (D)OD and −3.75 DOS. Postoperatively she achieved an unaided visual acuity of 20/20 OU. Ten months after surgery, her fingernail brushed the left eye while she was removing a sweater, resulting in painful displacement of the corneal cap.

The cap was repositioned using topical (0.5% tetracaine hydrochloride) and sub-Tenon (2% lignocaine hydrochloride) anesthesia. Operative manipulation suggested that the cap had everted, the lower edge of its nasal hinge had torn, it had twisted about the residual hinge, and one of its edges had folded over (Figure 1 A). The stromal bed and cap were debrided. Three 10-0 interrupted nylon sutures were used to secure the cap and the patient was discharged receiving preservative-free topical antibiotics and tear supplements.