DEAR DOCTORS,
I HAD LASIK SURGERY 2+ YEARS AGO, WHEREIN THE DOCTOR SAID THAT SUCTION WAS LOST, CAUSING A THIN, AND COMPLETELY FREE FLAP. THE DOCTOR CONTINUED WITH THE PROCEDURE, STITCHING THE EYE, AND PLACING A CONTACT OVER IT FOR A WEEK. THE END RESULT HAS BEEN A TERRIBLY WRINKLED CORNEA THAT DOES NOT EVEN ALLOW ME TO WEAR A CONTACT. AFTER 4 SECOND OPINIONS, IT SEEMS THAT A CORNEAL TRANSPLANT IS MOST LIKELY, ALTHOUGH I PLAN TO WAIT AND SEE IF ANY NEW TECHNOLOGY COMES ABOUT IN THE NEXT COUPLE YEARS. CAN YOU TELL ME IF IT IS TYPICAL PRACTICE TO ABORT THE PROCEDURE AND TRY AGAIN LATER WHEN THERE ARE FLAP COMPLICATIONS, AS IT SEEMS FROM READING OTHERS' ACCOUNTS THAT THIS IS WHAT THEIR DOCTORS TYPICALLY DID. ALSO, MY DOCTOR TOLD ME THAT IT IS POSSILE THAT MY VISION MAY ACTUALLY BE FINE IN THE PROBLEM EYE IF THE FLAP WERE COMPLETELY REMOVED?? HAVE YOU ANY INFO OR EXPERIENCE IN REFERENCE TO THIS SITUATION? ALSO, DO YOU KNOW HOW SUCCESSFUL CORNEAL TRANSPLANT IS IN THIS TYPE OF SITUATION? I WOULD BE VERY GRATEFUL FOR ANY INFO. THIS IS AN EXCELLENT AND INFORMATIVE SITE DOCTORS! THANK YOU IN ADVANCE. DAVE

If a person has a severely wrinkled flap that was left in place for a long period of time, it is likely that a flap lift with suture would not be successful. But this is probably the least risky procedure, since if it does not work, you would just be in the same situation.
Following this, one would next consider removing the flap. Removal of the flap in cases of severe flap problems can result in an improvement in the quality of vision. Again, this is a less-risky step then proceeding straigt to a corneal transplant.
After removal of the flap, the most common problem is astigmatism - which may respond to additional suface laser treatment. As well, a contact lens at this point might be succesful.
Finally, if all else failed, one could consider a corneal transplant. Transplants are a common procedure, but you should see a cornea specialist for this. The success rate is high, but many patients do end up requiring contact lenses after transplants to see crisply. Finally, there is a risk of corneal transplant failure (rejection) - which is why it is best to try other, less invasive procedures first.

Best of luck

Bill Trattler, MD
Miami, FL