Part 2 book “LASIK emergencies – A video primer” has contents: Incomplete flaps, irregular flaps, epithelial defect, thin and thick flaps, decentered flaps, subconjunctival hemorrhage and bleeding, special considerations, management of postoperative complications. | 8 Incomplete Flaps ETIOLOGY AND INCIDENCE OF INCOMPLETE FLAPS Femtosecond LASIK An incomplete flap may happen with femtosecond LASIK if suction proves to be unsuccessful, despite repeated attempts after an initial aborted pass. It may also occur if the tear meniscus, debris, ink marks, or epithelial defect shields an area of the flap from the laser ablation. The incidence of incomplete flaps with femtosecond LASIK is approximately Microkeratome LASIK Incomplete flaps may occur with microkeratome LASIK after loss of suction. Microkeratome jamming due to either electrical failure or mechanical obstacles may also result in incomplete flaps. Lashes, drape, loose epithelium, and precipitated salt from the irrigating solution have been recognized as possible impediments to smooth keratome head progression. Incomplete flaps also occur when the gear advancement mechanism jams or is inadequate. The incidence of incomplete flaps with microkeratome LASIK varies between and 83 Melki SA, Fadlallah A. LASIK Emergencies: A Video Primer (pp 83-104). © 2018 SLACK Incorporated. 84 Chapter 8 Figure 8-1. Initial surgery resulted in a suction loss during the raster cut. The raster and side cuts were not repeated in this case. FEMTOSECOND LASIK COMPLICATIONS AND IMMEDIATE SOLUTIONS Complication #1: Incomplete Flap (Unable to Lift) Video section: 0 minutes 6 seconds Platform: IntraLase FS60 kilohertz (kHz) (Abbott Medical Optics) Flap diameter: mm Flap target depth: 100 microns (μm) The initial surgery resulted in a partial suction loss. Laser treatment was continued. Adherence was found during dissection at the place where suction was lost (video 8; time: 0 minutes 6 seconds; Figures 8-1 and 8-2). Some practical measures are as follows: • Discontinue the laser treatment immediately and repeat the raster cut. • Start the mechanical flap dissection in front of and behind the suspected uncut zone (place where suction was lost during the first raster .
