Management of late traumatic LASIK flap dislocation related to dog scratch 16 Years postoperatively

PURPOSE: This report details a case of an unusual late dislocation of a laser in situ keratomileusis (LASIK) flap due to animal-related trauma 16 years after the initial surgery. OBSERVATIONS: A 59-year-old woman with history of LASIK surgery on both eyes 16 years prior, and uncomplicated cataract surgery on the left eye (oculus sinister; OS) 3 years prior, arrived at our institution with sudden painful visual loss 3 hours after receiving a scratch on OS from her dog. Corneal examination revealed a completely displaced nasally hinged LASIK flap folded irregularly over the hinge, with multiple creases over its entire thickness. The flap was intact but edematous and opaque, with detritus present both on the flap surface and stromal face. Treatment was initiated with topical moxifloxacin and oral clindamycin. The next morning, the flap was refloated, and debris was removed from both sides of the flap while irrigating with preservative-free moxifloxacin. The flap was repositioned and a bandage contact lens placed. Postoperative topical medication included moxifloxacin, prednisolone acetate, and sodium hyaluronate. At the final follow-up visit, the patient was asymptomatic, with a measured uncorrected distance visual acuity (UDVA) of 20/25 OS. CONCLUSION AND IMPORTANCE: This uncommon case highlights the longest reported interval—16 years— between initial surgery and traumatic LASIK flap displacement, caused by animal-related trauma. Patients experiencing LASIK surgery complications, including contaminated trauma many years after the original ablation, can still recover excellent visual acuity when managed appropriately and in a timely fashion.