Photorefractive keratectomy with mitomycin C for the management of a LASIK flap complication following a penetrating keratoplasty

Objective: To evaluate the safety and efficacy of photorefractive keratectomy (PRK) with mitomycin C (MMC) following a buttonhole secondary to attempted laser in situ keratomileusis (LASIK) in an eye that had undergone a prior penetrating keratoplasty (PKP). Methods: Case report and review of the literature. A 26-year-old man underwent PRK with MMC following a buttonhole flap complication after LASIK in an eye that had undergone a PKP for keratoconus. Results: Three months following the procedure, the patient demonstrated a clear cornea and a best-corrected visual acuity of 20/20. Conclusion: To our knowledge, this is the first case report of buttonhole during LASIK following a PKP and the use of PRK to treat a LASIK flap complication following a successful PKP. In addition, this is the first case report of prophylactic use of MMC to prevent corneal haze with PRK following PKP. A buttonhole is a rare complication following LASIK for residual refractive error following PKP, which can be successfully managed with PRK and prophylactic MMC.