Lamellar sliver: devastating complication of recutting after LASIK

A lamellar sliver is a devastating complication resulting from recutting flaps during LASIK enhancement procedures, saidJonathan Song, MD, from the Doheny Eye Institute, Los Angeles.

Re-treatment, he noted, is needed in 3% to 10% of patients who under go LASIK. Initially, after LASIK was introducedrecutting was advised after 6 months; later relifting was advised after 1 year and then after 2 years. However, a seriouscomplication, lamellar sliver, which is tissue missing from the flap as a result of recutting, was reported to have causedirregular astigmatism and decreased visual acuity. Twelve patients were found to have this complication after proceduresperformed by nine experienced surgeons; all patients had irregular astigmatism, significant loss of best-corrected visualacuity, and very high subjective visual difficulties.

To prevent the lamellar sliver, Dr. Song advised surgeons to relift all flaps if possible-relifting can be done up to 10years using a needle or a depression technique.

"The technique that I prefer in patients with a relatively new flap the edge of the edge of the flap can be depressed and ablunt instrument used to go inside the edge," he said. "A spatula can be used to loosen any adhesion."

After re-treatment, the edges should be clean and any loose epithelium removed. A bandage contact lens can be considered. Ifthe flap is difficult to lift, he suggested converting to surface ablation with mitomycin C.