Flap Buttonhole in Thin-Flap Laser In Situ Keratomileusis: Case Series and Review
Why this work is in the frame
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Bibliographic record
Abstract
PURPOSE: To analyze the clinical features and the risk factors leading to formation of flap buttonhole during laser in situ keratomileusis (LASIK) and the postablation visual outcome. METHODS: Medical records of all eyes that developed flap buttonhole during LASIK were retrospectively reviewed. Pre-LASIK measurements and intraoperative parameters were analyzed to predict the risk factors. RESULTS: A total of 944 eyes underwent LASIK during the study duration. Four eyes (0.42%) developed partial thickness flap buttonhole. Thin-flap LASIK (flap thickness < or =90 microm) was performed in 230 eyes. The incidence of buttonholes in thin-flap LASIK cases was 1.7% (4 of 230). LASIK procedures were performed at a tertiary eye institute between October 2006 and December 2008. The mean age was 31 +/- 8.7 years. Preablation mean spherical refractive error in the affected left eye was -7.8 +/- 1.2 diopters (D), mean steeper axis keratometry was 44.0 +/- 1.56 D, and the mean pachymetry was 520 +/- 16 microm. Buttonholing in the flap occurred in the second (left) eye of all 4 cases. All cases had undergone thin-flap LASIK with 90-microm blade using the Moria M2 microkeratome. Flap diameter was +2/7.5 and 0/8.0 for 2 eyes each. Twelve weeks after the initial procedure, transepithelial phototherapeutic keratectomy/photorefractive keratectomy was performed in all 4 eyes. Postablation visual outcome was 20/20 and 20/25 in 2 eyes each. One patient had a faint subepithelial scar at the last 1-year follow-up. CONCLUSIONS: Formation of flap buttonhole is significantly more common in the second eye and with the usage of Moria M2 microkeratome and 90-microm blade. In thin-flap LASIK, the practice of using the same microkeratome blade for the fellow eye, as is commonly followed at many refractive surgery centres, should be abandoned. Intraoperative subtraction pachymetry may be helpful in predicting the risk of buttonhole in the second eye. These precautions are especially mandatory in thin-flap LASIK irrespective of the other associated risk factors.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it