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

Miri Na; Sung Kun Chung; Kyu Hong Pak; Jin Seok Choi

doi:10.3341/jkos.2018.59.5.484

Journal List > J Korean Ophthalmol Soc > v.59(5) > 1010908

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Na, Chung, Pak, and Choi: Repositioning of a Free Cap after Laser-assisted in situ Keratomileusis

Case Report

J Korean Ophthalmol Soc 2018;59(5):484-490.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.5.484

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

Miri Na, MD, Sung Kun Chung, MD, PhD, Kyu Hong Pak, MD, Jin Seok Choi, MD, PhD

Saevit Eye Hospital, Goyang, Korea

Address reprint requests to Jin Seok Choi, MD, PhD Saevit Eye Hospital, #1065 Jungang-ro, Ilsandong-gu, Goyang 10447, Korea Tel: 82-31-900-7700, Fax: 82-31-900-7777 E-mail: zenith716@gmail.com

Received 23 November 2017 Revised 21 February 2018 Accepted 30 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Flap rotation, Free cap, Laser-assisted in situ keratomileusis (LASIK)

References

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Figure 1.

Topography measured before laser-assisted in situ keratomileusis (LASIK). (A) Preoperative Pentacam®, front sagittal curvature maps of both eyes show with the rule astigmatism. (B) Preoperative Orbscan. Anterior elevation maps of both eyes show with the rule astigmatism. OD = oculus dexter; OS = oculus sinister; Sim K = simulated keratometry; Astig = astigmatism; T = temporal; N = nasal.

Figure 2.

Topography measured after laser-assisted in situ keratomileusis (LASIK). (A) Pentacam® measured 3 months after LASIK of both eyes and before flap reposition of right eye, frontal corneal astigmatism is −3.2 D on right eye. (B) Orbscan measured 3 months after LASIK of both eyes and before flap reposition of right eye, front sagittal curvature maps of both eyes show with the rule astigmatism. OD = oculus dexter; OS = oculus sinister; Sim K = simulated keratometry; Astig = astigmatism; T = temporal; N = nasal.

Figure 3.

The schematic figure of reposition procedures. (A) Detachment of prepositioned free cap and dialing 100 degrees clockwise. (B) Reposition of free cap. In both figures, ‘T’ represents the temporal side of eye and ‘N’ represents the nasal side of eye. The red star on (A) and (B) represents marking for same location of flap. The red arrow on (A) represents degrees of flap rotation.

Figure 4.

Topography measured before and after flap reposition. (A) Pentacam® measured after laser-assisted in situ keratomileusis (LASIK) (before flap reposition) of right eye, frontal corneal astigmatism is −3.2 D on right eye. (B) Pentacam® measured 1 month after flap reposition of right eye, frontal corneal astigmatism is −1.3 D on right eye. OD = oculus dexter; Astig = astigmatism; T = temporal.

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