Accidental activation of excimer laser fluence test during LASIK: A case report

To report a case of unintended fluence test laser activation during planned laser-assisted in situ keratomileusis (LASIK) and its refractive and visual consequences. A 49-year-old female presented for elective LASIK surgery. Her ophthalmic and systemic history were unremarkable. Treatment refraction was -3.75 -0.50×85° in the right eye and -3.25 -1.00×75° in the left, with 20/20 best corrected visual acuity (BCVA) in both eyes. Preoperative workup confirmed she was a suitable candidate. The patient opted for sequential surgery, beginning with the right eye. Following uneventful flap creation, the excimer laser was inadvertently activated in fluence test mode instead of performing the programmed ablation. Post–fluence test refraction in the right eye was −4.00 −1.50 × 75°, with BCVA of 1.0. Corneal tomography demonstrated a 7 μm reduction in central corneal thickness and localized superior thinning of up to 22 μm, consistent with the fluence test pattern. The patient remained asymptomatic. After disclosure of the event, LASIK was subsequently performed in the same eye. Postoperative refraction was plano, with uncorrected visual acuity of 1.0. This case underscores the critical importance of procedural verification in refractive surgery and illustrates the safety margins of excimer laser platforms in the event of unintended laser activation, while emphasizing the need for transparent disclosure and comprehensive postoperative assessment after unexpected intraoperative events. • Procedural checks are critical to avoid unintended laser treatment complications. • Inadvertent LASIK fluence test activation may not cause significant structural or visual harm. • Modern excimer platforms demonstrate high safety in error scenarios. • Transparency in reporting errors contributes to surgical safety culture. • While rare, fluence misfire cases suggest that excellent outcomes remain possible with LASIK.