"Lasik flap won't stick, ENDOTHELIAL reaction" Posted by William - Fort Wayne, IN on 16:27:03 9/09/2000
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I am an ophthalmologist and performed lasik on a 46yo female this week, VISX laser and Nidek keratome. preop about -5.00 + 3.50 x 90 OU. Lasik went fine until she was rechecked half an hour later. With minimal blinking, both flaps wrinkled. They were refloated, SCL placed, and the same thing happened two hours later. They were refloated again and the left has stayed in good position. The right was refloated with 5% NaCl and air dried for 45 minutes. The flap is now in good position, but in addition to significant debris under the flap, THERE IS A COURSE MATERIAL ON THE ENDOTHELIUM OR BOWMAN'S. It looks clear like fine KP, but the deposits or reflections are much too course to be KP. The eye is quiet, best corrected about 20/40, but very hazy.
HELP!!!! Has anyone seen anything like this before? Bill Argus, Fort Wayne. 219.436.5600 or pager 219.429.0577. I would like to speak to you if you think that you can help this person.
There are many causes of Sands of the Sahara (SOS). The end result is an inflammatory reaction in the flap interface.
The course material you are seeing may be the inflammatory infiltrate within the flap interface.
The treatment of SOS depends on the degree of the inflammatory reaction. Mild to moderate cases can be treated with hourly steroid drops. However, more severe cases may require lifting the flap and flushing out the inflammatory reaction.
Obviously, after the flap has slipped twice, one would be reluctant to lift the flap unless absolutely necessary. Of course, perhaps there was a cause for the flap slippage. As you may have heard, there are recent reports that the use of Alphagan drops at the time of LASIK can increase the risk of flap slippages. So if this was the cause, then the flap would probably be more "sticky" after a few days.
Please feel free to call me tomorrow in my office if you would like to discuss the case
