Incidence of femtosecond laser-assisted LASIK flap complications: A Systematic Review.

Authors

Abu Bakar Butt, Angelica Hanna, Minoo Tohidi Kaloorazi, Sara KamaliZonouzi, Melody Hanna, Brendan K Tao, Joshua C Teichman

Published in

Journal of cataract and refractive surgery. Aug 11, 2026. Epub Aug 11, 2026.

Abstract

This review evaluated the incidence and visual significance of flap-related complications in femtosecond LASIK.
Femtosecond laser-assisted LASIK has largely replaced mechanical microkeratomes for flap creation due to improved precision and safety. Understanding the incidence and clinical consequences of flap-related complications is essential for patient counseling and surgical planning.
A systematic search of Ovid MEDLINE, Embase, and CINAHL was conducted from database inception to October 10, 2024 including English-language clinical reports of patients undergoing femtosecond LASIK that reported flap-related complications. Small case series (<5 patients), secondary articles, conference abstracts, and cost-analysis studies were excluded. Study screening and data extraction were performed independently by two reviewers. The primary outcome was the incidence of LASIK flap complications stratified by femtosecond laser platform; secondary outcomes included postoperative visual acuity. Risk of bias was assessed at the outcome level using RoB 2 for randomized clinical trials and ROBINS-I for observational studies. Findings were synthesized narratively with descriptive summary of incidence proportions; no meta-analysis was performed due to heterogeneity in study designs and laser platforms. The review was registered in PROSPERO (CRD42024608238) with no post-submission amendments.
Twenty-seven studies published between 1997 and 2024 were included, comprising 28,531 eyes across multiple countries. The most frequently reported intraoperative event was opaque bubble layer, occurring in 19.7% of eyes (range 2.0-56.4%). Diffuse lamellar keratitis was reported in 6.3% of eyes and typically resolved without long-term visual impact. Epithelial ingrowth (2.1%), microstriae (1.6%), and incomplete flaps (0.17%) were uncommon. Other flap-related events, including buttonholes, free caps, epithelial defects, and traumatic flap injuries, were rare (<1%).
Femtosecond LASIK is associated with low rates of clinically significant flap-related complications, with excellent visual outcomes in most cases. Standardized reporting and longer-term prospective studies are needed to further refine complication benchmarks across femtosecond platforms.

PMID:
42592790
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.