LASIK flap stability after severe ocular injury
The flap produced in LASIK creates the potential for additional complications from trauma, even years after the procedure. The risk of these LASIK flap complications has led some authors to conclude that LASIK is not safe in populations that are at high risk of traumatic injuries, such as those in the military.

A 39-year-old active duty Marine with a manifest refraction of +5.00–2.75 × 022 in the right eye and +2.00–0.50 × 160 in the left eye and a BCVA of 20/25 in the right eye and 20/15 in the left eye underwent uneventful bilateral femtosecond wavefront-guided LASIK utilizing the iFS femtosecond laser and VISX Star S4 excimer laser. The LASIK flaps were programmed for a depth of 100 μm, a diameter of 9.5 mm, and a non-beveled side cut angle of 90°. The post-operative course was uncomplicated and he had an UCVA of 20/25–1 in the right eye and 20/15–1 in the left eye after the procedure.

Four years later he was struck in the left eye with a softball resulting in an open globe injury as well as frontal and maxillary bone fractures. He was not wearing eye protection at the time. He was stabilized and repaired at an outside facility prior to presentation to our clinic one month after the injury. Examination revealed a 12 mm full-thickness corneoscleral laceration from the limbus at 7 o'clock extending just past the limbus at the 2 o'clock position with 10–0 nylon sutures in place. The LASIK flap was not displaced. The lens and iris were not well visualized. Visual acuity was light perception. Five months after injury he underwent penetrating keratoplasty and vitrectomy at an outside institution, vision remained light perception. At ten months post-injury, the eye became phthisical and visual acuity was no light perception.

In conclusion, LASIK flaps can be traumatically dislocated, but the incidence of such injuries is extremely low. In the rare event that an isolated LASIK flap dislocation or flap amputation occurs, visual outcomes are often excellent. Additionally, this case report demonstrates that the presence of a LASIK flap may not further complicate repair in cases of severe ocular injury. The potential benefits of corneal refractive surgery therefore far outweigh the risks in populations that are at high risk of traumatic injury.