Sandor asked this question on Lasik flap healing:

Dear Dave,
Is it true that corneal flaps never heal completely after Intralasik? What is the chance of dislocation during the rest of the patients life?
Thank you in advance, Sandor

Sandor, it’s an important question. It is true that thicker (e.g. blade, keratome) flaps never fully heal. They can be surgically lifted many years after. However, thin flaps such as are created with femtosecond lasers (around 100-110 microns) appear to heal significantly more strongly.

The healing in the uppermost layers of the cornea is different from deeper down. Collagen fibres are more wavy and heal much better when cut with a thin flap. I have found a couple of patients where I have tried to lift femtosecond flaps, and they were fully bonded down and impossible to lift after a year post-op. This has never been the case with keratome blade cut flaps which I have always been able to lift, even many years later.

IntraLasik is just the brand name for flaps made with the Intralase American made femtosecond laser. Using the Swiss Ziemer laser it is called Z-LASIK.

The key question first is the depth at which a flap was cut. One of the major reasons why many clinics have invested in femtosecond lasers over the much cheaper keratomes (10x more expensive for a femtosecond) is being able to cut predictable accurate thin flaps, with their better healing.

If it was a thin flap, e.g from a femtosecond laser (Ziemer, Intralase, Visumax, Femtec), I expect the lifetime chance of dislocation will be zero.