Editorial Manager(tm) for Cornea Manuscript Draft Manuscript Number: CORNEA-D-06-00395R1 Title: COMPLICATED FLAP CREATION WITH FEMTOSECOND LASER AFTER RADIAL KERATOTOMY

Purpose: To report a case of LASIK using Intralase® due to residual myopic astigmatism, 14 years after radial keratotomy. Methods: Thirty-nine years-old male patient who had undergone bilateral RK operation for myopic correction was admitted to Turkiye Hospital, for the correction of the residual refractive error in his left eye. The manifest refraction was -1.25(-3.00@175), UCVA was 20/50 and BCVA was 20/20 on left eye. The keratometric measurements were 38.40D@92o, 35.40D@2o. The central and thinnest pachymetry measurements by Orbscan were 582μ and 576μ, respectively. LASIK operation with femtosecond laser flap formation was planned for the left eye. Results: Intralase® lost suction during flap formation. After device control, flap could be formed at the same intracorneal plane. During flap lifting, RK incisions were separated and one of them progressed to the corneal center with the force applied by the blunt spatula. No sectoral piece separated completely from the flap. Excimer laser treatment and flap re-positioning could be done without any problem. Postoperatively, all RK incisions appeared to be well aligned. The iron deposits around the radial incision at the central cornea spared the optic axis. There was no haze or epithelial in-growth. Conclusions: This case showed that Intralase® does not have unique benefit as opposed to the mechanical keratome for post-RK eyes. We recommend that femtosecond laser flap formation should be regarded with great caution in post-RK eyes. The suction performance of the device should be checked before the procedure and flap lifting maneuvers should be very cautious. * Copyright Transfer Form Click here to download high resolution image * Copyright Transfer Form Click here to download high resolution image