Incomplete flap - now what?

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Incomplete flap - now what?

Postby DoneInJan » Wed May 16, 2007 3:18 am

My husband had custom LASIK this morning. I was watching the surgery as it happened on a TV behind the surgeon. First eye (the right) went flawlessly.

During the left eye flap cut, I noticed that there was a small pause before the blade retracted. When the surgeon went to open the flap, it wouldn't remove all the way. The surgeon smoothed it down and then tried again on the other side - same thing. After that, he smoothed the flap for the final time, applied all the antibiotic drops and the surgery was over.

I had LASIK from this same surgeon this January and I now have 20/15 vision, so I have full confidence in him. Which is why I recommended my husband go to him. The surgeon said that this was a machinery malfunction, which from what I've researched is incredibly rare.

Surgeon suggested that in 3 months my husband should come back and that they would take care of it. Obviously we have a lot of questions and we go in tomorrow morning for the first post-op visit.

There are a couple of tricky items that I don't know how we should navigate...
1. My husband was at a [national chain] center. The surgeon uses their equipment, but does not work there. The pre-op exams were done by [the national chain] personnel - and tomorrow we'll be seeing a different doctor - not the surgeon.
2. [The national chain] wants to refund my husband for the one eye that was not completed. I'm not so sure we should let them... Will they still be on the hook if they do that?
3. And what about doing a second surgery on the same eye? We're thinking of insisting on Intralase instead of LASIK. I know that it's supposed to be more reliable, but are there risks we should know about?

Any pointers are appeciated. Thanks!

Note: This post was edited to remove a clinic's name.
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Re: Incomplete flap - now what?

Postby LasikExpert » Wed May 16, 2007 3:47 am

DoneInJan wrote:1. My husband was at a [national chain] center. The surgeon uses their equipment, but does not work there. The pre-op exams were done by [national chain] personnel - and tomorrow we'll be seeing a different doctor - not the surgeon.


The use of a facility for surgery is very common. An OB/Gyn does not own the hospital where a child is delivered. It is common for a Lasik surgeon to use a facility that s/he does not own for the laser, microkeratome, and support staff.

No matter whose staff completed tests, the final responsibility is virtually always on the surgeon.

DoneInJan wrote:2. [The national chain] wants to refund my husband for the one eye that was not completed. I'm not so sure we should let them... Will they still be on the hook if they do that?


I guess that depends upon which hook you mean. If your husband wants to have surgery by the same doctor at the same facility at a later time, then a refund may not even be appropriate. Your doctor and the facility may make different and separate offers. Be sure you understand who is offering what and the consequences/advantages of any offer. You will need to discuss what is being offered and see if that is consistent with what you desire. You don’t need to make a decision now, and ignore any manufactured timeline.

DoneInJan wrote:3. And what about doing a second surgery on the same eye?


Letting an incomplete flap heal for three months, cutting a new flap, and continuing with the procedure is relatively common in situations like this. Whether or not it is appropriate will really not be known until after healing for three months or so.

DoneInJan wrote:We're thinking of insisting on Intralase instead of LASIK.


There are really two issues here. The narrow issue is whether or not you should have a new flap made with a femtosecond laser (IntraLasik, All-Laser Lasik). Depending upon where the second flap would be created, the nature of the incomplete flap, and many other factors, a second flap with a femtosecond laser may be okay or downright dangerous, which leads us to the second and wider issue.

If you think you need to dictate a treatment plan to your doctor, you are either with the wrong doctor or do not have the level of trust that is necessary to proceed with any doctor. Your doctor needs to be advising you what is available and appropriate, and then allow you to decide what you prefer. Not the other way around.

It is certainly okay to ask about a potential treatment method like a femtosecond laser for the second flap (such discussions are highly encouraged), but asking and telling are quite different.

If in three months you are still don’t have the requisite trust of your surgeon’s ability, get a second opinion.
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Postby DoneInJan » Wed May 16, 2007 5:21 am

Thank you very much for your speedy and professional response. My husband is (understandably, I think) very upset and wants to make sure that he doesn't have long-lasting effects. If I have any additional questions (or answers!) after the post-op tomorrom AM, I'll check back in here.

Thank you again!
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Postby LasikExpert » Wed May 16, 2007 6:33 am

Incomplete flaps are not exactly common, but there have been more than enough to know that they most often are not a long-term problem. You did not mention any vision degradation. How is your husband's vision now?
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Postby DoneInJan » Wed May 16, 2007 4:06 pm

Interesting that you ask about his vision... Yesterday while he was home resting, I went to his regular eye doctor and requested that a 'dummy' lens be put into his glasses for his right eye since surgery for that eye was completed. Left eye was left as-is since the surgery was stopped due to the flap issue & correction wasn't performed.

After showering this morning, he put his glasses on. His vision is pretty much the same out of his left eye. We were told to expect some blurriness due to swelling at the incision site, so it's not something we're concerned about.

He noticed his right eye was pretty blurry as well though. When he switched the glasses around and looked with his right eye through the lens for his left eye, everything came into focus.

So now we're wondering if they also had the Rx switched for both eyes? If that's the case, then it's probably a very good thing the microkeratome stopped when it did because before surgery his vision was worse in his right eye than his left and they would have overcorrected his left eye.

We head in for the post-op appt in an hour, so we'll see what information we can glean from the meeting...
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Postby LasikExpert » Wed May 16, 2007 4:32 pm

If the left eye is affected by edema (swelling), then he would become more myopic (nearsighted, shortsighted) in that eye. The refractive error has probably changed slightly, but what is most important is that the quality is good and vision can be corrected with lenses.
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I am not a doctor.
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