|Arrows show a Lasik buttonhole flap in front of patient's
pupil and made visible with special illumination.
A buttonhole flap is a relatively
rare but known complication of Lasik or Bladeless Lasik caused when the microkeratome passes through the top of the cornea while creating
a flap of corneal tissue.
The first step of Lasik is the creation of a thin flap of corneal
tissue. A microkeratome is affixed to the eye with suction and a
blade or laser energy passes underneath to create the Lasik flap.
If the microkeratome blade or laser energy cuts too thin, the flap
is incomplete with a "hole" in the center that often resembles a
Loss of Suction
Buttonhole flaps are most often caused by loss of suction of
the ring that holds the microkeratome to the eye. The usual response
is to stop the surgery, replace the flap, protect the flap with
a bandage contact lens for a few days, then if all heals well about
three months later do the surgery again. The vast majority of people
who have buttonhole flaps have no long-term problems and are able
to have Lasik, PRK, or LASEK after the flap has sufficiently healed. While healing
the doctor will monitor the flap to watch for epithelial ingrowth or other concerns.
A flat cornea and eyes with small orbits tend to be more prone to buttonhole flaps, however buttonhole
flaps are possible with any Lasik or Bladeless Lasik - even if the
probability is low. If the probability of a buttonhole flap is elevated,
the doctor may recommend PRK, LASEK, or Epi-Lasik as an alternative.
Mechanical v Laser Flap
Conventional Lasik with a mechanical microkeratome may be more likely
to create a buttonhole flap than Bladeless Lasik with a laser microkeratome.
The more planar shape of the Lasik flap created with a femtosecond
laser may be more appropriate, as determined by a surgeon.
Looking For Best Lasik Surgeon?
If you are ready to choose a doctor to be evaluated for conventional
or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization.
Locate a USAEyes Evaluated & Certified Lasik Doctor.
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