During LASIK, the microkeratome creates an incomplete flap with a central buttonhole. The correct immediate course of action is:
- A Complete the cut manually and proceed with ablation
- B Convert the case to PRK on the same day
- C Reposition the flap, abort the ablation, and defer surgery by several months ✓
- D Increase suction and recut a deeper flap immediately
Correct answer: C. Reposition the flap, abort the ablation, and defer surgery by several months
Explanation
A buttonholed flap must be repositioned without ablation and the eye allowed to heal for at least three months before any retreatment. Proceeding risks irregular astigmatism, epithelial ingrowth through the defect, and scarring. Immediate recutting doubles the flap complication rate, and same-day conversion to surface ablation over an irregular stromal bed gives unpredictable results. Flat or steep corneas and thin flaps are recognised risk factors for buttonholes.
Reference: Yanoff and Duker Ophthalmology, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.