Video Presentation - VT33

Flap on the Loose: When Lasik Takes an Unexpected Turn

We report 2 cases of free flap during blade LASIK,showing different management strategies.
27 y/o had a free flap during blade LASIK in RE.Free flap was repositioned and BCL was put.POD1,RE flap was edematous and loosely attached.Repositioning was attempted but failed due to edema,so flap was secured with sutures.But,flap remained edematous with stromal haze.3 weeks later,edematous flap was dislodged with epithelization of undersurface,so flap was amputated.Follow up showed BCVA 6/9 with stable cornea and no ectasia.
22 y/o had a RE free flap on POD1 which was displaced under the BCL.During repositioning,flap was dissected from BCL and unfolded.After flap positioning,botropase glue was applied over the edges.On follow up,flap was well apposed, with clear compact stroma and a BCVA 6/6.
Here we show varied approaches to free flap management.While suturing remains effective in unstable flaps,botropase glue is a simple and innovative method for flap stabilization with good visual outcomes.