Achieving functional recovery without anatomical repositioning: A case of corneal flap inversion trauma post femtosecond laser-assisted in situ keratomileusis surgery

Abstract

Post femtosecond laser-assisted in situ keratomileusis corneal flap inversion trauma is an exceptionally rare and challenging complication in ophthalmology, highlighted by a case involving a 29-year-old woman who suffered an eye injury from ice chips 10 months after undergoing bilateral femtosecond laser-assisted in situ keratomileusis surgery. The injury led to a corneal flap inversion and melting, exacerbated by a delay in seeking treatment due to the pandemic. When she finally presented for medical attention, her vision was severely compromised, with dense epithelial ingrowth obstructing the visual axis or blocking the pupillary entrance. Despite these complications, medical interventions to remove the epithelial cells and attempts to reposition the corneal flap were carried out. Although the flap could not be fully anatomically restored due to scarring and stromal melt, the patient experienced a remarkable recovery in vision, achieving 20/17 visual acuity 6 months post-surgery. This case illustrates that satisfactory visual outcomes can be achieved even when perfect anatomical restoration is not possible. It challenges the traditional focus on anatomical perfection in corneal surgery and highlights the potential for functional recovery to take precedence over anatomical correction, reducing the need for further risky procedures. The outcome stresses the importance of tailored patient management and careful assessment of the risks and benefits in complex surgical cases.