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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.
Patel CK, Hanson R, McDonald B, Cox N. Late Dislocation of a LASIK Flap Caused by a Fingernail. Arch Ophthalmol. 2001;119(3):447–449. doi:
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