Introduction:

Laser-assisted in situ keratomileusis (LASIK) is a widely performed refractive surgery to correct myopia, hyperopia, and astigmatism. While it is generally a safe and effective procedure, flap striae can sometimes occur as a postoperative complication. This article explores the causes, clinical features, management, and prevention of flap striae after LASIK.

What are Flap Striae?

Flap striae are wrinkling or irregularities that develop in the corneal flap created during LASIK surgery. The corneal flap is lifted to reshape the cornea and improve vision. In some cases, this flap may not adhere smoothly back to the underlying stroma, resulting in striae formation.

Causes:

Flap striae can be caused by various factors, including:

• Surgical Technique: Improper flap creation or inadequate hydration of the stromal bed during surgery can lead to striae.
• Intraoperative Dehydration: Inadequate irrigation or excessive drying of the stromal bed during the procedure can contribute to striae formation.
• Eye Rubbing: Vigorous eye rubbing after surgery can disrupt the flap and cause striae.
• Eye Pressure: Increased intraocular pressure or external pressure on the eye can also contribute to flap striae.

Clinical Features:

Patients with flap striae may present with the following symptoms:

• Blurred Vision: Irregularities in the corneal surface can cause distorted vision.
• Ghosting or Double Vision: Striae can lead to multiple images or halos around lights.
• Dryness and Discomfort: Some patients may experience dry eye symptoms.

Management:

Management of flap striae depends on the severity and timing of the complication:

• Immediate Postoperative: Early detection and management are crucial. The surgeon may attempt to reposition the flap immediately after surgery.
• Delayed Presentation: If striae are detected days or weeks after surgery, the patient may be advised to use lubricating eye drops to reduce dryness and promote healing.
• Lifting and Repositioning: In cases of persistent striae, the surgeon may need to lift and reposition the flap to achieve a smoother corneal surface.
• Pressure Patching: Applying a pressure patch to the eye can aid in flattening the flap and improving adherence.
• Topical Steroids: Steroid eye drops may be prescribed to reduce inflammation and promote healing.

Prevention:

Preventing flap striae is essential for a successful LASIK outcome:

• Surgeon Experience: Choose an experienced LASIK surgeon who uses precise surgical techniques.
• Intraoperative Hydration: Ensuring adequate hydration of the stromal bed during surgery can reduce the risk of striae.
• Avoid Eye Rubbing: Patients should avoid rubbing their eyes after LASIK to protect the flap.

Conclusion:

Flap striae after LASIK can cause visual disturbances and discomfort for patients. Early detection and appropriate management are crucial for achieving optimal visual outcomes. Surgeon expertise and patient compliance with postoperative care play pivotal roles in preventing and managing this postoperative complication.

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