J Cataract Refract Surg. 2001 May;27(5):781-3.
Traumatic flap displacement and subsequent diffuse lamellar keratitis after laser in situ keratomileusis.
Schwartz GS, Park DH, Schloff S, Lane SS.
Late Traumatic Flap Dislocations After LASIK
J Cataract Refract Surg Vol 22, May 2006
Excerpts from the full text:
A number of cases of late onset traumatic LASIK flap dislocations have been reported, raising questions about the strength of the adhesion between the flap and the stromal bed.
In this series, we report three cases of late onset traumatic LASIK flap displacement and their management. One patient presented 7 years after the initial surgery, which, to our knowledge, is the longest duration reported.
A 23-year-old man with bilateral uncomplicated LASIK 7 years prior presented 2 days after sustaining a left eye injury by another person’s fingernail in a fight.
A 33-year-old woman underwent LASIK and presented after sustaining a broomstick injury 1 year postoperatively.
A 38-year-old woman with a history of uncomplicated bilateral LASIK 2 years before sustained a right eye injury when a folder fell from a shelf.
The creation of a lamellar flap results in a potential plane of weakness in the cornea in which shearing forces can produce flap displacement. Recent histological and confocal studies have shown a central hypocellular primitive scar in the interface, allowing easy lifting of the flap in trauma.
The fact that this potential plane can be disrupted many years after LASIK (7 years after the initial surgery in patient 1) indicates that corneal integrity is compromised by the surgical procedure and takes a long time, if ever, to restore.