Biomechanical Changes to the Cornea from LASIK Flap Creation Resulting in Inaccurate Ablations and Suboptimal Refractive Outcomes with Topographic-Guided Ablation

PURPOSE: This study documents a biomechanical corneal change related to corneal flap creation in certain patients leading to an irregular ablation pattern and an inaccurate refractive outcome. METHODS: This retrospective study included consecutive eyes treated with primary LASIK Contoura using the LYRA Protocol. All LASIK procedures were performed on the WaveLight EX500 excimer laser. Flaps were created with either the Alcon WaveLight FS200 femtosecond laser or the Moria M2 microkeratome. Eyes that were off by greater than or equal to 0.50 diopters (D) sphere or cylinder from the targeted goal within 3 months after surgery were identified. Topographical, higher order aberration, and epithelial maps were created. Of these eyes, approximately 10% of eyes were found to have undergone a biomechanical change upon flap creation that led to an inaccurate outcome. RESULTS: Six representative cases are presented that demonstrate the biomechanical change, outcomes, and treatment. All patients demonstrated an elliptical, irregular ablation pattern on post-operative topography, lateralized the thinnest point of the cornea relative to the corneal apex on Pentacam pachymetry maps, and irregular corneal epithelial thickening at the periphery of the elliptical ablation. CONCLUSION: A biomechanical change during flap creation can occur in certain types of corneas during LASIK flap creation and subsequent treatment with topographic-guided ablation leading to an irregular ablation and suboptimal refractive outcomes.