Management of irregular astigmatism following rotationally disoriented free cap after LASIK

Virginia Miraldi Utz, Ronald R. Krueger

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


PURPOSE: To illustrate the challenges associated with a misaligned free flap (cap) and to report the outcome of applying wavefront-guided customized photorefractive keratectomy (PRK) followed by conventional PRK ablation to correct residual refractive error and aberrations after LASIK free cap complications. METHODS: The clinical course and surgical interventions of two patients with free cap complications from LASIK surgery were reviewed. The first patient underwent a total of six interventions after the initial LASIK procedure, and the second patient underwent a total of five interventions. Interventions included cap lift, cap rotation, custom PRK, and conventional PRK enhancement with prophylactic topical mitomycin C (MMC). RESULTS: Customized PRK treatment and subsequent enhancements with prophylactic topical MMC led to the recovery of best spectacle-corrected visual acuity (BSCVA), neutralization of higher and lower order aberrations, and astigmatic neutrality. Symptoms related to higher order aberrations resolved in both patients. CONCLUSIONS: Wavefront-guided custom PRK for higher order aberrations followed by conventional PRK enhancement for residual lower order aberrations, both with topical MMC application, represents an efficacious strategy for treating patients with loss of BSCVA and visual symptoms due to LASIK free cap complications.

Original languageEnglish (US)
Pages (from-to)383-391
Number of pages9
JournalJournal of Refractive Surgery
Issue number4
StatePublished - Apr 2008
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Ophthalmology


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