Inadvertent stromal dissection during mechanical separation of the corneal epithelium using an epikeratome.

Epithelial flap complications occurred in 2 patients during epithelial separation using a Centurion SES epikeratome (Norwood Eye Care) in epi-laser in situ keratomileusis (LASIK). The complications consisted of stromal dissection at the margin of the pupil and an epithelial free cap including the superficial stroma. The epithelial flaps were repositioned without laser ablation. Three months postoperatively, the best corrected visual acuity in both patients was 20/20 and neither complained of visual discomfort. Slitlamp biomicroscopic examination showed that both corneas were completely healed with trace opacity, and topographic examinations revealed that irregularities in the stromal cutting sites were decreased. The patients had successful photorefractive keratectomy after complete healing of the dissected stroma. Stromal dissection during mechanical separation of the epithelium with an epikeratome is a potential complication of the epi-LASIK procedure, but proper management can result in good recovery without severe visual impairment.