Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Operative Management of a Cortisone-abuse-induced Bilateral Flap Complication Following LASIK

Daniel J., Walkow T.
CENTRO Klinik Oberhausen

Purpose: We report on a flap complication due to excessive topical use of cortisone. A 42 year old man underwent uneventful bilateral LASIK surgery for -2,50 -0,50 x 170 at OD and -2,25 -0,25 x 11 at OS. We aimed at emetropia at both eyes. Ablation was performed with the LADARVISION 4000 excimer laser. Postoperatively, both eyes were protected with shields and Isopto Max eye drops were administered. Uncorrected vision was 20/20 in both eyes at the first postop day. At 1 week, we found severe epithelial ingrowth in the interface. The patient reported to have the Isopto Max eye drops administered 8-10 times daily.
Method: We decided to proceed immediately surgically. Both lenticules could be lifted easily. The epithelium was instable. Using an rough I/A cannula we thoroughly performed cleaning of flap an cornea. Subsequently, three 10x0 nylon sutures and thereafter a single running suture were placed. Postoperatively, we administered topical antibiotics without using any cortisone.
Results: At the first postop day, uncorrected visual acuity reached 20/25 OD and 20/40 OS. Uncorrected visual acuity further improved to 20/20 OD and 20/25 OS over the next three months. The single sutures were removed after 2 weeks and the running sutures after 3 months.
Conclusions: Excessive cortisone abuse after LASIK may result in severe flap complications which may be managed if intervention is immediately performed.

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