JUNIPER
PUBLISHERS- JOJ Ophthalmology
Purpose
To report an uncommon refractive incident where a
patient was scheduled for a routine Femto LASIK procedure using
Intralasae IFS and excimer ablation with Wave Light® Allegretto Wave®
Eye-Q machines, and an unfortunate technical error of the Allegretto
machine delayed the ablation for two days after successful flap creation
with the Intralasae with no flap raising at the incident.
Method
A 27 year old male myopic patient came to the clinic
seeking refractive surgery. Full opthalmological examination was done
for him, which was all normal. He had BCVA 20/200U corrected with
refraction of-3.25/-2.50*250D and -2.00/-2.25*160S. Corneal assessement
with Pentacam was performed revealing a prolate normal cornea, upon
which the decision was for a Femtolasik procedure for refractive
correction was decided, and for a wavefront optimized Excimer Laser
ablation using the Allegretto machine [1].
The procedure started with a successful complete
bilateral femto flap creation of 100um thickness using the INTRALASE IFS
machine. Proceeding to the excimer ablation, an unexpected sudden
technical error, due to administrative misreporting about it, occurred
to the Allegretto machine before starting .After asking for technical
support, and tremendous efforts from the maintenance team to fix the
problem for three hours with no thread of hope to solve the problem that
day ,the decision was taken to postpone the case for another day. Two
days later, the problem was totally solved, and the machine was ready to
use. The patient was informed and consented to continue the procedure.
The patient was examined on the slit lamp before the procedure to
determine the flap borders [2].
The procedure was performed in right eye first by
entering the flap elevator from the edge of the flap obliquely to make
an opening point, then circumfrentially opening the gutter 270 degrees.
Afterwards, the superior hinge flap was totally elevated with the
elevator smoothly, and wave front optimized excimer laser ablation was
applied, returning the flap at the end. The procedure was successively
repeated in the left eye as well. Topical antibiotics, steroids and
lubricant eye drops were prescribed postoperatively [3].
Results
First day postoperative the patient was examined. The
flaps were coapted and cornea clear both eyes, and mild subconjuntival
hemorrhage. One month later postoperative UCVA was 20/20 OU.
Conclusion
Succesful femtoflap creation makes flap lifting
possible even after two days of its creation. The potential space
created is still there, and facilitated flap elevation and continuation
of the procedure with no mentioned difficulty. The question that arises
to be further evaluated is the maximum duration primary f lap elevation
can be done after flap creation without facing wound healing issues.
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