Results of phototherapeutic keratectomy in the management of flap striae after LASIK before and after developing a standardized protocol: long-term follow-up of an expanded patient population.

OBJECTIVE To evaluate the efficacy and safety of phototherapeutic keratectomy (PTK) for treatment of striae in LASIK flaps. DESIGN Retrospective consecutive series. PARTICIPANTS Forty-seven eyes of 44 patients with flap striae after LASIK with reduced best-corrected visual acuity (VA) or visual symptoms with at least 3 months' follow-up (consecutive cases from January 2001 to May 2004). INTERVENTION Transepithelial PTK. MAIN OUTCOME MEASURES Uncorrected VA (UCVA), best spectacle-corrected VA (BSCVA), resolution or reduction of preoperative symptoms, and corneal haze. RESULTS Mean UCVA and BSCVA improved from 20/43 and 20/29 to 20/33 and 20/23, respectively. Five eyes (10%) developed 1+ haze and 14 eyes (30%) developed trace haze, generally peaking at 1 to 2 months postoperatively. No visual symptoms or loss of acuity were attributable to haze. A mean hyperopic shift of +0.80 diopters (D) occurred after PTK treatment. Development of a standardized protocol significantly reduced the variability of the refractive shift after PTK (P = 0.003). Results were stable in up to 2 years of follow-up. CONCLUSIONS Phototherapeutic keratectomy treatment of LASIK flaps is well tolerated, with stable outcomes and minimal complications. A standardized treatment protocol reduced postoperative refractive variability.