Resumen de Buttonholes in 315,259 LASIK procedures
Fernando Llovet Osuna, Julio Ortega Usobiaga, Massimo Notaro, Toam Katz, J. Beltran-Sanz, Julio Baviera Sabater
PURPOSE: We aimed to determine the incidence of buttonhole after laser in situ keratomileusis (LASIK). We also evaluated possible risk factors, treatment strategies and visual outcome.
SETTING: multicentric, including several international clinics.
METHODS: : In this comparative case series we reviewed the medical records of 164,603 patients (315,259 eyes) that underwent LASIK from January 2003 to December 2011 to identify cases of buttonhole. All surgeries were performed by means of a manual microkeratome. The main outcome measures were incidence of buttonhole after LASIK, response to treatment and visual outcome. Possible risk factors, clinical course, days to retreatment and surgical treatment were recorded.
RESULTS: Buttonhole was found in 137 eyes in 134 patients (105 myopes and 32 hyperopes). Age, preoperative refraction and keratometric power were not statistically significant independent risk factors. Buttonholes appeared in thinner corneas. Patients were retreated with a new flap or with surface ablation. Safety and efficacy were better with recutting than with surface ablation, although statistically significant differences were found for efficacy in the myopic group only.
CONCLUSIONS: The incidence of buttonhole after LASIK was 0.043%. Buttonhole is a potentially sight-threatening complication. Proper management can preserve useful vision in most cases.
