Surgical flap amputation for central flap necrosis after laser in situ keratomileusis

A 52-year-old man had uneventful bilateral myopic laser in situ keratomileusis (LASIK) with planned monovision. Three months later, the left eye was retreated to improve the near vision. On postoperative day 1, the uncorrected distance visual acuity (UDVA) was 0.95 and the patient reported mild ocular pain. Stage 2 diffuse lamellar keratitis was observed. Despite hourly prednisolone instillation, the UDVA decreased to 0.1 and central flap necrosis syndrome was diagnosed. The flap was lifted and stromal bed irrigation performed. One month later, the UDVA was 0.05 with a hyperopic shift of +3.25 diopters and the flap, which had central haze and several striae, was amputated. Four months later, the UDVA was 0.05 with residual irregular astigmatism. Customized transepithelial photorefractive keratectomy (PRK) was performed; there were no postoperative complications. Three months after PRK, the UDVA was 0.8 with no refractive defect.