Lamellar sliver: devastating complication of recutting after LASIK

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

Retreatment, he noted, is needed in 3–10% of patients who undergo LASIK. After LASIK was initially introduced, recutting was advised after six months; later, relifting was advised after one year and then after two years. However, a serious complication, lamellar sliver, which is tissue missing from the flap as a result of recutting, was reported to have caused irregular astigmatism and decreased visual acuity. Twelve patients were found to have this complication after procedures performed by nine experienced surgeons; all patients had irregular astigmatism, significant loss of best-corrected visual acuity, 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 10 years using a needle or a depression technique.

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

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