Bowman strip complications during routine LASIK: Two cases demonstrating the clinical advantage of using Mitomicyn C in such cases

Bowman strip is the term used to describe a portion of Bowman’s layer that remains exposed at the posterior surface of the flap. The incidence of intraoperative complications related to flap creation during LASIK is between 0.19% and 21.2%. Several explanations have been proposed to account for Bowman strip or ‘‘buttonhole’’ complications such as: steep corneas, partially opened eyes, microkeratome deficits such as blade defect and, insufficient synchronization between the movement of the blade and microkeratome translational movement. High astigmatism, or conjunctival entrapment may also lead to Bowman strip or buttonhole flap. Treatment options for Bowman strip appear to depend on the severity of the complications encountered. Some authors recommend waiting three months, relifting the flap, bathing the bed with Mitomicyn C (MMC) followed by surface ablation. In more severe profound cases it is recommended to wait six months, relift the flap, apply of topical MMC, close the flap and re-cutting a new flap. We report our experience of two cases where, the same type of microkeratome and laser platform were used for routine LASIK surgery. In both cases, Bowman strip was encountered with thin strip of epithelium and photo ablation was completed during the two individual surgical events. The only difference was that in one case we applied topical 0.02% Mitomycin C, while in the other the procedure was completed without any additional medications or intervention. Scientific letter