Topography-guided neutralization technique for the management of flap complication in laser in situ keratomileusis

A 29-year-old male was referred following a flap loss after the creation of a thin, irregular flap with a visual acuity of logMAR0.1 with -2.0 DS-2.75 DC x 175 degrees. Corneal topography and anterior segment optical coherence tomography revealed an irregular corneal curvature and epithelial profile. Phototherapeutic keratectomy (PTK) followed by Topography - Guided Custom Ablation Treatment (TCAT), as a modification of the topographic neutralization technique protocol, was planned to regularize the corneal surface and treat the residual refractive error. Postoperatively, the patient showed a best-corrected visual acuity of logMAR 0 with a refractive error of -1 DC x 90 degrees. Regularization of topography and epithelial thickness was seen along with a reduction in astigmatism and higher order aberrations. We report the use of PTK followed by TCAT as a novel method to treat a case of intraoperative flap loss during laser in situ keratomileusis.