Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents

Purpose: To report the rate of flap‑related complications in LASIK surgery performed by in‑training ophthalmology residents and to analyze the risk factors for these complications. Methods: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap‑related complications were noted. Comparison between both groups with and without complications was performed with an independent Student’s t‑test and relative risks were calculated. Results: There were 19 flap‑related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free‑cap (n = 5; 1.83%), and flap‑buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white‑to‑white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K‑min (P = 0.01), and K‑max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap‑related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon’s flap‑related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. Conclusion: Flap‑related complications are common intraoperative event during LASIK surgery performed by in‑training ophthalmologists. Keratometries and surgeon’s first procedure represent a higher probability for flap related complications than some other biometric parameters of patient’s eye.