Therapeutic flap amputation for atypical LASIK flap and interface abnormalities.

PURPOSE To describe LASIK flap amputation as a therapeutic option for patients with atypical refractory flap complications. METHODS Case series and literature review. RESULTS Seven eyes of 6 patients underwent flap amputation for various atypical indications, including non-infectious flap/interface opacity (3 patients), irregular astigmatism on the flap surface (3 patients), and chronic pain (concurrent in 2 patients with irregular astigmatism). In each case, conservative measures were ineffective. All patients had symptomatic improvement and improved corrected visual function after amputation; however, uncorrected distance visual acuity worsened in 2 patients, manifest refraction worsened in 3 patients, and irregular astigmatism increased in 2 patients. CONCLUSIONS Flap amputation is a reasonable alternative to improve corrected acuity in select cases with significant flap opacities or irregular astigmatism unresponsive to conservative measures, but uncorrected acuity and irregular astigmatism may worsen and should be discussed during the informed consent process.