What is a buttonhole flap?

A buttonhole flap is a small tear, cut or hole in the flap, occurring during LASIK.

What causes a buttonhole flap and which surgery(-ies) is it associated with? (posted: jan 2005)

Buttonholes are a complication of LASIK.

A buttonhole can occur while the microkeratome is cutting the flap, or while the flap is being lifted, or while it is being laid back down after the ablation, but most typically it will appear while the flap is being cut. This can be due to malfunction of the microkeratome, poor selection of microkeratome for the particular patient, or poor placement or inadequate suction.

There are anatomical features which are known to place patients at higher risk for buttonholes. These include deep set eyes, small eyes, unusually steep corneas and unusually flat corneas.

What are the potential results of a buttonhole flap? (Posted: Jan 2005)

The main risk with a buttonhole is scarring. If the hole is central, and scarring develops, it could significantly impair vision.

How is a buttonhole flap diagnosed? (posted: jan 2005)

Flap complications are generally visible during slit-lamp examination.

How is a buttonhole flap treated? (posted: jan 2005)

Good surgical skills are essential in preventing further damage when a buttonhole occurs. If it occurs before the ablation, the flap should be set back down and no ablation should be attempted. Many surgeons are comfortable with replacing the flap and having the patient wait some months and then try again.

In cases where the buttonhole is central and impairing vision, sometimes surgeons undertake a PTK treatmentto smooth the cornea.

Where can I get more information about buttonhole flaps?

Click here for our Encyclopedia listing for buttonhole flaps.