Incidence, indications, and outcomes of eyes needing early flap lifting after LASIK

Purpose: To analyze the incidence, indications, and outcomes associated with early flap relifting after uncomplicated laser in situ keratomileusis (LASIK). Methods: All LASIK cases from a single surgical center between 2007 and 2015 were reviewed. Early postoperative flap lift cases (, 15 d after surgery) were identified. Results: Overall, 25, 712 eyes were included, of which 366 (1.42%) underwent early postoperative flap lifting. There was a significant reduction in early postoperative flap lifting rates from 2006 (2.46%) to 2015 (0.92%) (P = 0.001). Reasons for early flap lifting included striae (n = 301, 1.17%), diffuse lamellar keratitis (n = 62, 0.24%), flap dislocation (n = 20, 0.08%), epithelial ingrowth (n = 18, 0.07%), and interface debris (n = 15, 0.06%). There was a significant difference in rates and outcomes of flap relifting among high-volume surgeons (P, 0.001). The flap lift group had a significantly lower final safety index (0.95 6 0.16 vs. 1.01 6 0.15, P, 0.001), efficacy index (0.85 6 0.26 vs. 0.94 6 0.26, P, 0.001), and a higher distance from target refraction (0.39 6 0.61 vs. 0.21 6 0.46 D). In unilateral cases, the study eye had a lower safety index (P, 0.001), efficacy index (P, 0.001), and greater distance from target refraction (P = 0.003) compared with the fellow eye. After intervention, 81.1% of cases achieved full resolution, 10.1% achieved partial resolution, 4.1% required additional flap relifting, and 4.7% were nonresolved by the end of follow-up. Conclusions: The main indication for early flap relifting after LASIK was striae, and most cases achieved full resolution. Although refractive and visual outcomes are lower in this group, they are, nevertheless, satisfactory.