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    Circumnavigating Minivectors: A Biomechanically Safer Technique to Lift LASIK Flaps in Cases With Keratitis

    AAO 2023 Video Program
    Femtosecond Laser Surgery, Refractive Mgmt/Intervention

    Infective keratitis involving an eye with a LASIK flap can be challenging. LASIK flap amputation is often performed to improve the penetration of antimicrobials, decrease the infective load and remove the potential interface space. If the necrosis/infection involves both the flap and the stroma (especially deep stroma), traditional flap lift techniques can lead to dislodgement of the flap-abscess complex, leading to chamber collapse and need for urgent procedures. In this video, we demonstrate a biomechanically safe method of necrotic flap lift that produces minimal tension on the flap-abscess complex. This is achieved by creating circumnavigating minivectors with very little uncompensated torque, which essentially avoids unbalanced forces near the flap-abscess complex. We also discuss variations and other modifications needed to lift these flaps with minimal collateral damage. This simple technique does not have a steep learning curve, and even though different from a conventional flap lift technique, it can be adopted quickly by a cornea specialist.