Table - 1.
Review of literature: FB status post LASIK.
| Authors | History of trauma | Eye affected | Gender | Type of FB | Duration after LASIK | Flap dislo-dged | Interface/underlying stromal bed | Location of FB | Imaging investigations | Management | Complications |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Weisenthal et al.28 (2000) | Yes Noticed irritation while fixing sink | OS | M | Metallic | 6 months | No | Clear | Metallic FB in the inferotemporal cornea in OS overlying the LASIK flap | Nil | FB was removed without disruption of the flap and minimal disruption of the epithelium leaving a small residual rust ring. | DLK (24 hours) (managed with topical steroids) |
| Porges et al.15(2001) [8 patients] |
Yes(4) No (4) |
M-7 F-1 |
Mostly metallic FB | 1 day to 18 months | No | – | Corneal FB | Nil | CFB removal was carried out with a 27-gauge needle | Corneal hyposensitivity leading to delayed diagnosis in 3 patients. | |
| Cosar et al.3 (2002) | Yes Penetrating trauma to the OD while hammering |
OD | M | Metallic FB | 17 months | No | Full-thickness peripheral corneal laceration at 11-o'clock in OD extending over the edge of the previous LASIK flap. | Partially embedded in the superior iris | Nil | FB removed in OT by kelmanforcep through scleral tunnel | No |
| Crowther et al.1 (2005) | NO | OU | M | Ferrous FB | 18 months | Flap lifted | Interface debris | OD had a LASIK flap scar with debris in the interface. | Nil | FB removed with needle bevel | (1) Flap lift on attempted removal, thus rust ring was left behind (2) High astigmatism (3) corneal hyposensitivity leading to multiple incidents of OU FB |
| OS had central rust ring and debris within | |||||||||||
| the interface, extending from the rust-ring | |||||||||||
| position to the peripheral rim inferotemporally. | |||||||||||
| 2 scars were present from previous corneal FBs | |||||||||||
| Cheung et al.10 (2006) | Yes Gouging by a seagull claw |
OD | M | Organic material | 34 months | Flap dehiscence | Flap dislocation | Interface organic fb debris | Microbiological work up showed enterrobacter species | Flap reflected, fb debride from flap and stromal bed, irrigation done, flap repositioned | Enterobacter keratitis |
| Jin et al.16 (2006) [2 patients] |
1.Yes With construction material while cutting vinyl board in OD 2.Yes Hit in OS by a wood chip when using an axe to break up particleboard |
1-OD 2-OS |
M (both) | 1.Debris from construction site in 2. Wooden FB |
(1)7 years (2)4 years |
1.Flap laceration 2.Flap displaced |
1. Interface foreign debris 2.FB trapped in wound |
1. Triangular linear flap laceration with some interface foreign debris 2. Displaced flap at 9 o'clock with a curvilinear laceration and a superficial laceration of the stromal bed Vertical macrofolds were seen. A small wood fragment was trapped in the wound. |
1.Nil 2. Nil |
1.surgical removal of epithelial ingrowth and fb 2.The corneal flap was surgically lifted, debrided, the striae stretched out, and tissue fragments carefully repositioned |
1.Epithelial ingrowth (pre-operative) 2. Mild DLK (pod-1), astigmatism |
| Pan et al.14 (2007) | No | OD | M | Eyelash | 5 weeks | No | Epithelial ingrowth | Eyelash lodged under the lower half of an oedematous LASIK flap in OD with mild surrounding infiltrates | Nil | Flap lifted, FB removed, epithelial cells curetted, flap repositioned | Epithelial ingrowth (preoperative), Mild DLK (pod-1) |
| Maeda et al.26 (2008) | Yes Accidental trauma with patients own hand while applying eye shadow powder in OS |
OS | F | Eye shadow particles | 6.5 years | Yes | Interface had few infiltrates and no FB reaction. | Displaced LASIK flap at 6 o'clock with eye-shadow powder deposited under the lower quarter of the flap | Nil | Flap was partially lifted sparring VA, eye-shadow deposits were copiously irrigated | Mild DLK (pod-1) |
| Lin et al.17(2011) | Yes Bee sting while riding scooters or motorcycles |
OD | M | Stinger of bee in OD | 2 years | No | Adjacent stromal infiltration | Periphery of the cornea penetrated through the LASIK flap, tearing the flap. | Nil | Stinger was removed and the lacerated conjunctiva and corneal flap were repaired | Epithelial ingrowth (post-operative) |
| Choi et al.18 (2012) | Yes OD scratched by a tree spring during recreational mountain climbing. |
OD | F | Crystalline material | 4 years | No | Stromal infiltrate at interface | Interface and under flap | Microbiological work up revealed Staphylococcus epidermidis | Flap lifted, crystalline foreign bodies grasped from the stromal bed and undersurface of the lamellar flap with fine corneal forceps Topicals for staphylococcal infection |
Staphylococcal keratitis |
| Prakash et al.12 (2012) |
No | OS | F | Cotton fibre | 10 days | No | Clear | Cotton fiber was noticed in the intralamellar space, inferotemporal to the pupillary axis | Nil | Conservative Spontaneous dissolution of FB was noted |
Nil |
| Huang et al.30 (2012) |
Yes With plastic pole to OS |
OS | M | Fb debris | 5 years | Yes Flap dislocated |
Fb debris present on exposed stromal bed | Dislocated Lasik flap misdiagnosed as corneal epithelial defect and foreign body material over the lesion | Nil | dislocated flap lifted, stromal surfaces of flap and bed scraped to remove debris and epithelial cells, flap repositioned | nil |
| Baenninger et al.25 (2014) | Yes | OD | M | Concrete | 6 months post femtoLASIK | No | Preoperative- clear POD 1: diffusely distributed, white to gray granular material concentrated around the impact location of the FB |
FB within the plane of flap in OD. | Nil | FB removed without disturbing flap | Mild-moderate DLK (pod-1) |
| Boutillier et al.13 (2018) | No | OD | M | Insect larva | 6 days | No | Inflammatory reaction, with localized neovascularization in response to the insect larva | Interface | AS-OCT: hyperreflectivity of insect larvae under LASIK flap with back-shadowing | Conservative- topical antibiotics and steroids | Nil |
| Maki et al.11(2018) | Yes Tree branch injury to OD |
OD | M | Vegetative matter | 5 years | No | Well apposed full thickness laceration of stromal bed underlying an intact LASIK flap. | Large dark piece of FB at core with surrounding hypopyon in anterior chamber | AS-OCT: posterior, penetrating, corneal laceration located underneath an intact LASIK flap. | FB removed in OT through paracentesis | Mild DLK (pod-2), Epithelial ingrowth (post-operative) |
| Our study | Yes | OD | M | Metallic | 4 years | Buttonhole of flap | clear | Penetrating the flap and embedded in the anterior stroma | AS-OCT: high reflectivity in the anteriorwith back shadowing and overlying crater lesion |
FB removed with 26G needle in OT. Glue, BCL placed | Nil |
DLK: Diffuse lamellar keratitis, BCL: Bandage contact lens, FB: Foreign body, OD: right eye, OS: Left eye, VA:visual axis, POD: post operative day, ASOCT: Anterior segment optical coherence tomography, LASIK: laser insitu keratomileusis.
M: Male, F: Female.