Management of traumatic macrostriae in an undisplaced LASIK Flap.

Purpose: To present a case of traumatic late macrostriae of Laser in situ keratomileusis (LASIK) flap managed by flap lifting, stretching, and polishing.

Material and method: A patient presented with a history of defective vision in his right eye following trauma with a rubber ball 10 days ago. He had undergone an uneventful LASIK surgery 4 years ago. Ocular examination showed visual acuity of 20/200, multiple parallel radiating folds in an undisplaced LASIK flap in the inferonasal quadrant, and sphincter tear. This case required an urgent surgical intervention. Epithelial debridement, flap lifting, gentle stretching, and irrigation were performed to smooth out the striae. A bandage contact lens was applied to ensure proper wound apposition.

Results: The postoperative period was without complications, and the patient achieved a final visual acuity of 20/20.

Discussions: The insufficient wound healing of the LASIK flap results in a cornea with compromised biomechanical strength. They remain susceptible to trauma for a long duration after surgery. Traumatic injury to these eyes can lead to late macrostriae formation, which results in visual deterioration. Cases of macrostriae presenting late require surgical debridement of epithelium, which keeps these folds fixed. It should be followed by flap irrigation and stretching to smooth these striae.

Conclusions: Since LASIK wound healing is always incomplete, it is crucial to inform patients about the potential risk of trauma. Any traumatic flap injury requires thorough examination and proper management of these cases results in excellent visual gain.