Persistent Subepithelial Haze in Thin - fl ap

PURPOSE: To report persistent subepithelial haze in two patients following femtosecond LASIK associated with creation of a thin fl ap. METHODS: Subepithelial haze was assessed by slit-lamp photography, high-resolution Scheimpfl ug imaging, and corneal confocal microscopy. RESULTS: Two patients showed distinct subepithelial haze and reduced corrected distance visual acuity at 3 months after LASIK with a thin-fl ap generated by a femtosecond laser. The extent of haze was documented, and haze was treated topically with steroids for up to 12 weeks. The haze was localized approximately 20 to 40 μm below Bowman’s layer and dissolved slowly during the 3 months of treatment. At 6 months after surgery, uncorrected visual acuity was 20/20. CONCLUSIONS: Subepithelial haze formation represents a new potential complication in thin-fl ap LASIK. [J Refract Surg. 2010;26:222-225.] doi:10.3928/1081597X-20090930-02 Increasing evidence demonstrates that fl ap thickness in LASIK plays an important role in corneal biomechanics. Accordingly, many surgeons have returned to the safety of advanced surface ablation despite the longer healing time and slower visual recovery.1,2 There is evidence that ultra-thin fl aps (90to 100-μm thickness), when cut with a femtosecond laser, have a lesser impact on corneal biomechanics than thicker fl aps1,2 (also J. Marshall, MD, unpublished data, 2008). For some surgeons, thin-fl ap LASIK or so-called sub-Bowman keratomileusis of !110-μm fl ap thickness3 might represent a combination of the advantages of LASIK (quick visual recovery and minimal pain) and advanced surface ablation (less risk for ectasia, better visual outcome). In this study, we report the occurrence of a thin-fl ap LASIK complication in two patients in whom subepithelial haze compromised vision for up to 6 months after the procedure. CASE REPORTS