One of the questions people sometimes ask before LASIK is, ""Are there problems I should know about or worry about?"" The fear that something could go wrong, which might be bad or unrecoverable, is indeed a powerful factor that keeps some people from having LASIK.
Complications in creation of the flap are extremely rare, but can happen with any keratome and in the hands of the best of surgeons. When such a problem occurs, it can be recognized immediately by the surgeon. Examples might include an imperfectly shaped flap (not round, but ""D"" shaped), a ""short flap"" (can arise if the keratome stops or gets stuck before completing the excursion), or a ""buttonhole"" flap (wherein the keratome passes over a slightly buckled corneal surface, causing a central hole in the flap). Flap complications such as this are very rare, occuring about once in every 3,000 cases.
The best thing to do if this happens is to cancel the laser treatment and replace the flap. After the flap has healed (about 12 weeks), a new flap can safely be created.
Nothing about Steve's exam or prior history suggested he was at any increased risk for flap creation problems. The surgery went perfectly in his right eye (June, '02), and a buttonhole flap occured when performing surgery on the left eye. Needless to say, Steve was very disappointed, but I promised him that this was a completely recoverable condition, and that I would fix it as soon as it was safe to do so.
We waited 3 months for the tissue to adequately heal. During that time, Steve was a real trooper. In early October, we were able to successfully create a perfect flap on the left side, and do the laser treatment. He again has 'balanced' vision (now that both eyes are corrected!) and is very pleased with the final outcome.
I wanted to include Steve's profile here for two reasons: First, to acknowledge that not everyone gets the "fairy-tale" result, even with all the meticulous precautions taken by myself and my staff. Second, I wanted to present a candid discussion of flap problems as a type of significant surgical complication that, with proper care, could be repaired and result in optimum restoration of vision.