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To report an uncommon refractive incident where a patient was scheduled for a routine Femto LASIK procedure using Intralasae IFS and excimer ablation with Wave Light® Allegretto Wave® Eye-Q machines, and an unfortunate technical error of the Allegretto machine delayed the ablation for two days after successful flap creation with the Intralasae with no flap raising at the incident.
A 27 year old male myopic patient came to the clinic seeking refractive surgery. Full opthalmological examination was done for him, which was all normal. He had BCVA 20/200U corrected with refraction of-3.25/-2.50*250D and -2.00/-2.25*160S. Corneal assessement with Pentacam was performed revealing a prolate normal cornea, upon which the decision was for a Femtolasik procedure for refractive correction was decided, and for a wavefront optimized Excimer Laser ablation using the Allegretto machine .
The procedure started with a successful complete bilateral femto flap creation of 100um thickness using the INTRALASE IFS machine. Proceeding to the excimer ablation, an unexpected sudden technical error, due to administrative misreporting about it, occurred to the Allegretto machine before starting .After asking for technical support, and tremendous efforts from the maintenance team to fix the problem for three hours with no thread of hope to solve the problem that day ,the decision was taken to postpone the case for another day. Two days later, the problem was totally solved, and the machine was ready to use. The patient was informed and consented to continue the procedure. The patient was examined on the slit lamp before the procedure to determine the flap borders .
The procedure was performed in right eye first by entering the flap elevator from the edge of the flap obliquely to make an opening point, then circumfrentially opening the gutter 270 degrees. Afterwards, the superior hinge flap was totally elevated with the elevator smoothly, and wave front optimized excimer laser ablation was applied, returning the flap at the end. The procedure was successively repeated in the left eye as well. Topical antibiotics, steroids and lubricant eye drops were prescribed postoperatively .
Succesful femtoflap creation makes flap lifting possible even after two days of its creation. The potential space created is still there, and facilitated flap elevation and continuation of the procedure with no mentioned difficulty. The question that arises to be further evaluated is the maximum duration primary f lap elevation can be done after flap creation without facing wound healing issues.