Epithelial ingrowth under LASIK flaps: tips and tricks for preventing recurrence!

Background: LASIK for refractive error correction has become a universal surgery. Despite its popularity, the estimated prevalence of traumatic flap dislocations in post?LASIK patients is 3.9%, and it is sometimes associated with epithelial ingrowth. The prognosis in such cases depends on the rapid surgical revision of the flap with the removal of the EI and perioperative steps to prevent Epithelial ingrowth (EI) recurrence in the future. Purpose: The video aims to display the steps involved in revising the flap, removing EI, and tips to prevent its recurrence. Synopsis: A 33?year?old post? LASIK patient presented with decreased vision, photophobia, and glare during the COVID pandemic in the right eye for 2 months. The best?corrected visual acuity was reduced to 6/60. The anterior segment revealed traumatic flap dislocation along with macro fold temporally and epithelial ingrowth. She underwent a successful flap revision surgery with no recurrence of epithelial ingrowth postoperatively. Highlights: A successful revision of a 2?month? old traumatic folded flap was performed along with the complete removal of EI. It explains the step?by?step approach to avoid the recurrence of EI in each step of the surgical revision of the flap. The video is self?explanatory and guides novice surgeons too

Intraoperative optical coherence tomography-guided management of postlaser-assisted in situ keratomileusis epithelial ingrowth

We describe a modified technique of intraoperative optical coherence tomography (iOCT)?guided removal of post?laser?assisted in situ keratomileusis (LASIK) epithelial ingrowth with interface ethyl alcohol and mitomycin C application to prevent a recurrence. Epithelial ingrowth was visualized as hyperreflective deposits in the interface on iOCT, and the location and extent were noted at the beginning of the procedure. A simple dimple?down maneuver was performed to help identify the circumference of the LASIK flap. iOCT helped to delineate the flap edge and ensure dissection in the correct plane with complete removal of epithelial cell nests. Real?time visualization of the interface helped in on?table decision making regarding the extent of lifting the flap to encompass the entire region of hyperreflective epithelial ingrowth, as well as the need for additional interventions to ensure complete flap apposition at the end of surgery. All patients gained an uncorrected visual acuity of 20/20–20/25 with no recurrence

Research progress of epithelial ingrowth under corneal flap after keratorefractive surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#The epithelial ingrowth under corneal flap is one of the complications after keratorefractive surgery, of which the incidence has declined dramatically with the improvement of relevant facilities and surgical techniques. However, epithelial ingrowth results from traumatic flap displacement has been describing in the literatures from time to time. If the prompt and efficient treatment cannot be taken, the severe complications of epithelial ingrowth will occur such as the alternation of refraction and cornea keratolysis. In this article, we reviewed the research progress of epithelial ingrowth after keratorefractive surgery.

Tratamento de crescimento epitelial persistente pós-Lasik com debridamento mecânico, uso de álcool a 20% e cola de fibrina / Treatment of persistent epithelial ingrowth after Lasik with mechanical debridement, use of 20% alcohol and fibrin glue

RESUMO O Lasik é a técnica de cirurgia refrativa mais utilizada no mundo. Apesar de segura e efetiva, ela pode levar a algumas complicações. O crescimento epitelial pós-Lasik é uma complicação pós-operatória incomum, com prevalência maior em casos de retratamento. Geralmente, é um achado não progressivo e assintomático, que não requer tratamento, mas, em uma minoria de pacientes, os sintomas podem ser clinicamente significantes e variados. O tratamento é feito com debridamento mecânico do crescimento epitelial, mas alguns recursos adjuvantes também podem ser utilizados. O presente estudo consiste em um relato de caso de paciente com crescimento epitelial pós-Lasik que apresentou quatro recidivas após intervenções de debridamento epitelial, sutura de lamela corneana e ablação a laser. No quinto procedimento, o paciente foi finalmente tratado com combinação de debridamento epitelial, uso de álcool a 20% e cola de fibrina. Entretanto, a regressão do crescimento epitelial e a melhora da acuidade visual só ocorreram ao longo dos meses após a intervenção, o que mostra a importância de esperar um tempo para que ocorra a melhora da visão no pós-operatório, evitando-se reintervenções.

ABSTRACT Lasik is the most often performed laser refractive surgery worldwide. Despite its efficacy and safety, some complications may occur. Epithelial ingrowth is a rare postoperative complication of Lasik, with an increased prevalence in cases of retreatment. Epithelial ingrowth is usually a nonprogressive and asymptomatic finding, which requires no treatment; however, in a minority of cases, symptoms may be clinically significant and diverse. Treatment is done with mechanical debridement of the affected interface, and additional interventions may be required. This study reported a case of recalcitrant epithelial ingrowth after Lasik, whichrelapsed four times after mechanical debridement, flap lift and laser ablation. In the fifth intervention, the patient was finally treated with a combined scraping/use of 20% alcohol and fibrin glue. However, regression of epithelial ingrowth and better visual acuity were only observed some months after the intervention, which shows the importance of waiting for better vision in the postoperative period, thus avoiding new reinterventions.

Structural and compositional shifts in Cerrado fragments in up to 11 years monitoring

The Cerrado has a wide diversity of fauna and flora, and the knowledge of its horizontal structure, in different time intervals allows the prediction of its structural and floristic characteristics. The aim of this study was to evaluate the changes in structure and composition of tree community in three fragments of Cerrado with low anthropization, in an interval of 11 years at Minas Gerais state. Rectangular plots of fixed size were sampled, measuring stem diameter and height of all living arboreal individuals with diameter at 1.30 meters above ground (DBH) ≥ 5 cm. The tree vegetation dynamics study of the areas was performed, as well as the floristic analysis and the diametric structure. Considering all fragments and years of measurement, the recruitment of trees surpassed its mortality. The basal area varied between 3.67 and 13.07 m².ha-1. The studied areas, considering all fragments and years of measurement, showed a Shannon diversity index (H') from 3.43 to 3.87 nat.ind-1 and Pielou equitability index (J') ranged an interval between 0.77 and 0.82. The similarity calculated by the Jaccard index (J), when performed per plot considering the three fragments, showed a value of 0.2653. Also, related to the development and growth of the study areas, it can be inferred that all fragments and their respective years of measurement had a J-inverse pattern. In conclusion, it can be inferred that the three fragments maintained a representative growth in number of individuals and basal area.

Uso de adhesivo tisular de fibrina en el tratamiento de endocrecimiento epitelial severo posterior a Lasik. Reporte de caso / Use of fibrin tissue adhesive in the treatment of severe epithelial ingrowth after LASIK. Case Report

Objetivo: Describir el uso de adhesivo tisular de fibrina para el sellamiento del flap en el tratamiento de un paciente con endocrecimiento epitelial severo posterior a Laser In Situ Keratomileusis (LASIK). Diseño: Reporte de caso. Metodología: Reporte de Caso retrospectivo, mediante la recopilación de datos clínicos, imágenes, video y valoraciones postoperatorias. Resultado: Se reporta el uso de adhesivo tisular para el sellamiento del flap en el tratamiento de un paciente con endocrecimiento epitelial severo bilateral posterior a LASIK. Se documenta la recuperación de la agudeza visual en el ojo izquierdo (el ojo tratado) posterior a el uso de adhesivo tisular de fibrina para el sellamiento del flap en el tratamiento del endocrecimiento epitelial severo posterior a LASIK, llegando a una visión mejor corregida de 20/30. Conclusión: Se han descrito varias opciones de manejo: remoción mecánica junto con adhesión del flap mediante sutura, cianoacrilato, adhesivo tisular de fibrina o hidrogel. En la literatura mundial hay publicaciones de casos sobre el uso de adhesivo tisular de fibrina con buenos resultados, hasta la fecha este es el primer caso reportado en nuestro país, siendo demostrativo de buenos resultados, en cuanto a la tasa de recidiva y agudeza visual.

Purpose: To describe the use of fibrin adhesive for flap sealing in the treatment of a patient with severe epithelial ingrowth following Laser In Situ Keratomileusis (LASIK). Design: Case Report. Methods: Retrospective Case Report study, was performed by collecting clinical data, images, video and postoperative evaluations. Results: The use of tissue adhesive for flap sealing is reported in the treatment of a patient with severe bilateral epithelial ingrowth post-LASIK Subsequent recovery of the visual acuity in the left eye (treated eye) after the use of fibrin adhesive for fl ap sealing in the treatment of severe epithelial post-LASIK epithelial ingrowth, reaching a better-corrected vision of 20/30. Conclusion: Several management options have been described: mechanical removal along with flap adhesion by suture, cyanoacrylate, fibrin adhesive or hydrogel. In the world literature there are case reports on the use of fibrin adhesive with good results, to date this is the fi rst case reported in our country, demonstrating good results in terms of relapse rate and visual acuity.

Treatment of corneal epithelial ingrowth after LASlK / 国际眼科杂志(Guoji Yanke Zazhi)

? AlM: To analyze the reason of corneal epithelial implantation and ingrowth after laser in situ keratomileusis ( LASlK ) , and summarize the treatment experiences. ?METHODS: The clinical data of postoperative corneal epithelial ingrowth on 18 cases (30 eyes) from 1 256 cases (2 256 eyes) after LASlK were retrospectively analyzed in our hospital from January 2008 to December 2012. After the treatment of all eyes, patients’ general visual quality scores before and after treatment were analyzed. ?RESULTS:There were 18 cases ( 30 eyes ) with corneal epithelial implantation and ingrowth after LASlK, and the incidence rate was 1. 3%. ln the 18 cases (30 eyes), there were 12 eyes corneal flap epithelial ingrowth caused by postoperative trauma, 12 eyes caused by multiple corneal flap flush, 2 eyes caused by intraoperative irregular corneal flap, and nothing special for 4 eyes. The classification of corneal epithelial ingrowth of 30 eyes:grade I, 11 cases (18 eyes);gradeII, 4 cases (8 eyes);grade Ⅲ, 3 cases ( 4 eyes ) . Grade I-II were treated with TobraDex eye drops and intraocular pressure lowering drug. Grade Ⅲ firstly were treated by drugs, otherwise by surgery if it didn’t improve. After treatment, 8 cases (13 eyes) epithelial ingrowth disappeared from 11 cases ( 18 eyes ) , 3 cases ( 5 eyes ) implanted epithelial tumor shrank in grade l;epithelial implantation of 2 cases (4 eyes) in grade II disappeared, implantation degree of 2 cases (4 eyes) reduced to grade I;2 cases (2 eyes) in grade Ⅲ had 0. 5 ~ 1mm wide flap edge shallow gray ribbon 1 mm inside the limbus, visual acuity was 0. 8 ~1. 2, 1 case ( 2 eyes ) treated with curettage corneal epithelial implantation and endophytic epithelium hadn’t relapsed in the follow-up. After the treatment, 18 cases of corneal epithelial ingrowth got lower visual quality scores than those before therapy (Hc=10. 511, P ?CONCLUSlON: Operation standardized, postoperative early detection and aggressive treatment are important for prevention and treatment of complications after LASlK.

Fast changes in seasonal forest communities due to soil moisture increase after damming / Cambios estacionales acelerados en comunidades boscosas debidos al aumento en la humedad del suelo después de la construcción de una represa

Local changes caused by dams can have drastic consequences for ecosystems, not only because they change the water regime but also the modification on lakeshore areas. Thus, this work aimed to determine the changes in soil moisture after damming, to understand the consequences of this modification on the arboreal community of dry forests, some of the most endangered systems on the planet. We studied these changes in soil moisture and the arboreal community in three dry forests in the Araguari River Basin, after two dams construction in 2005 and 2006, and the potential effects on these forests. For this, plots of 20m x10m were distributed close to the impoundment margin and perpendicular to the dam margin in two deciduous dry forests and one semi-deciduous dry forest located in Southeastern Brazil, totaling 3.6ha sampled. Besides, soil analysis were undertaken before and after impoundment at three different depths 0-10, 20-30 and 40-50cm. A tree minimum DBH of 4.77cm community inventory was made before T0 and at two T2 and four T4 years after damming. Annual dynamic rates of all communities were calculated, and statistical tests were used to determine changes in soil moisture and tree communities. The analyses confirmed soil moisture increases in all forests, especially during the dry season and at sites closer to the reservoir; besides, an increase in basal area due to the fast growth of many trees was observed. The highest turnover occurred in the first two years after impoundment, mainly due to the higher tree mortality especially of those closer to the dam margin. All forests showed reductions in dynamic rates for subsequent years T2-T4, indicating that these forests tended to stabilize after a strong initial impact. The modifications were more extensive in the deciduous forests, probably because the dry period resulted more rigorous in these forests when compared to semideciduous forest. The new shorelines created by damming increased soil moisture in the dry season, making plant growth easier. We concluded that several changes occurred in the T0-T2 period and at 0-30m to the impoundment, mainly for the deciduous forests, where this community turned into a riparian-deciduous forest with large basal area in these patches. However, unlike other transitory disturbances, damming is a permanent alteration and transforms the landscape to a different scenario, probably with major long-term consequences for the environment.

Los cambios locales provocados por las represas pueden tener consecuencias para un ecosistema, ya que no solo cambian el régimen de las aguas, sino que también modifican las áreas a la orilla de los lagos. Por lo tanto, este trabajo tuvo como objetivo observar los cambios en la humedad del suelo después de la construcción de represas, para entender las consecuencias de esta modificación a la comunidad arbórea de los bosques secos, que son uno de los sistemas más amenazados del planeta. Después de la construcción de tres represas, se estudiaron los cambios en la humedad del suelo y la comunidad arbórea en 3 bosques secos de la cuenca del río Araguari, en donde se construyeron dos represas en 2005 y 2006. Se demarcaron parcelas de 20x10m que se distribuyeron cerca y perpendicular al margen de la represa en dos bosques secos caducifolios y un bosque seco semideciduo ubicado en el sureste de Brasil, en total se muestrearon 3.6 hectáreas. Se realizó un análisis de la humedad del suelo antes y después de la construcción del embalse en tres profundidades 0-10, 20-30, 40-50cm. El inventario de la comunidad arbórea DAP de 4.77cm se realizó antes T0, dos T2 y cuatro T4 años a partir de la retención del agua. Además se calcularon las tasas anuales dinámicas de todas las comunidades, y se utilizaron pruebas estadísticas para confirmar los cambios en la humedad del suelo y las comunidades de árboles. Los análisis confirmaron aumento de humedad del suelo en todos los bosques, especialmente durante la estación seca y en los lugares más cercanos al embalse, con un aumento del área basal debido al rápido crecimiento de muchos árboles. El mayor volumen de modificaciones se produjo en los primeros dos años después de La construcción del embalse, principalmente debido a la mayor mortalidad de los árboles más cerca del margen de la represa. Sin embargo, todos los bosques mostraron reducción de las tasas dinámicas en los años siguientes T2-T4, lo que indica que estos bosques tienden a estabilizarse después de un fuerte primer impacto. Las modificaciones fueron más severas en los bosques caducifolios, probablemente debido a una estación seca más severa en estos bosques en comparación con el semideciduo. Las nuevas márgenes creadas por el embalse aumentaron la humedad del suelo en la época seca facilitando el crecimiento de muchas plantas. Se concluye que los cambios que se produjeron en el período de T0-T2 y de 0-30m del embalse, principalmente en los bosques caducifolios estan transformando estas comunidades en bosque de ribera-caducifolia con gran área basal en estos parches. Sin embargo, este impacto es diferente a otras alteraciones transitorias, así la construcción del embalse es un cambio permanente y transforma el paisaje en otro escenario, probablemente con importantes consecuencias a largo plazo para el ambiente.

Combined Mitomycin-C Assisted Photorefractive Keratectomy in the Treatment of Epithelial Ingrowth after LASIK

PURPOSE: To report 2 cases of thick, late-onset and long-standing epithelial ingrowth after laser-assisted in situ keratomilusis (LASIK) using mitomycin C-assisted photorefractive keratectomy and flap suturing. CASE SUMMARY: The first case involved a 29-year-old woman who had LASIK in both eyes in 2002. She was diagnosed with epithelial ingrowth OD after blunt ocular trauma in 2007. The second case involved a 30-year-old man who had LASIK in both eyes in 1999 followed by enhancements in 2004. Slit lamp examination showed dense epithelial ingrowth OS in a geographic pattern. Two eyes of the 2 patients with epithelial ingrowth had flap lifting followed by debridement of interface epithelial cells, photorefractive keratectomy, interface application of mitomycin C, and the placement of interrupted 10-0 nylon sutures. Two eyes regained better uncorrected visual acuity and showed reduced corneal astigmatism postoperatively. There was no evidence of residual or recurrent ingrowth throughout the follow-up period (case 1: 11 months, case 2: 1 month). CONCLUSIONS: Combined mitomycin C-assisted photorefractive keratectomy and flap suturing can be an effective and safe method for treating and preventing the recurrence of thick, late-onset and long-standing epithelial ingrowth involving the visual axis.

The Analysis of Epithelial Ingrowth after LASIK Using a Femtosecond Laser

PURPOSE: To analyze the incidence and clinical course of epithelial ingrowth after laser in situ keratomileusis (LASIK) using a femtosecond laser. METHODS: We retrospectively evaluated the results of 1158 eyes of 581 patients who received LASIK with the flap created by a femtosecond laser from February 2006 to March 2009 at our institute. We investigated the incidence and clinical course of LASIK in which the flap was created by a femtosecond laser. RESULTS: Epithelial ingrowth was first detected one week after surgery in 12 (57%) of 21 eyes and within one month in 19 eyes (90%). Epithelial ingrowth was localized most commonly near the temporal and nasal flap edge in 12 eyes (57%). In two eyes (9.5%), an isolated ingrowth mass was located in the pupillary area. The development of more than 2.0 mm of epithelial ingrowth was observed in three eyes (0.25%). Among 28 eyes with loose epithelium or epithelial detachment during surgery, epithelial ingrowth was observed in six eyes (21.4%) compared with 15 (1.32%) of 1130 eyes without loose epithelium or epithelial detachment. Therefore, epithelial detachment during surgery was significantly associated with epithelial ingrowth (p = 0.00). CONCLUSIONS: In LASIK in which the flap is created by a femtosecond laser, damage to the epithelial layer increases the chances of epithelial ingrowth. Therefore, avoiding epithelial defects with a gentle maneuver is needed to reduce the chance of epithelial ingrowth during surgery.

Effect of Zoledronic Acid on Early Osseointegration of Porous Implant in Rabbit / 대한정형외과연구학회지

PURPOSE: The purpose of this study was to determine whether intravenous injection of the zoledronic acid could promote osseointegration of the porous implant inserted into the rabbit medullary cavity. MATERIALS AND METHODS: A rabbit intramedullary osseointegration model was used. A specially designed porous nitinol implant (Bio-Smart, Sungnam, Gyeonggi-do, Korea) was inserted in the right distal femur of twenty six rabbits. They were randomized into the control or the experimental groups. In the control group, an intravenous injection of normal saline 2 ml/kg (Daihan Pharm, Seoul, Korea) was given at the end of the operation. In the experimental group, an intravenous injection of zoledronic acid 0.1 mg/kg (AclastaG(R) 2 ml/kg, Norvatis, Stein, Switzerland) was given at the end of the operation. Six weeks later, all animals were sacrificed and undecalcified histologic sections were prepared. Then, histomorphometric measurement of bone affinity index (%) and bone ingrowth area rate (%) was carried out. RESULTS: Six rabbits were excluded due to death and wound infection. Nine rabbits in the control group and eleven rabbits in the experimental group were included for the analysis. The bone affinity indices were 19.9+/-7.9% in the control group, and 28.4+/-7.2% in the experimental group. Although there was no statistical significance (p=0.056), the bone affinity index of the experimental group was higher than that of the control group. The bone ingrowth area rates were 8.7+/-3.7% in the control group, and 12.1+/-4.1% in the experimental group (p=0.046), indicating zoledronic acid had an positive effect on the promotion of bone ingrowth into the porous implant. CONCLUSION: In our rabbit intramedullary osseointegration model, intravenous injection of the zoledronic acid promoted early osseointegration of the porous implant. Zoledronic acid might be useful to promote the early osseointegration of the joint replacement implants.

The Treatment of Epithelial Ingrowth After Phacoemlusification Through Clear Cornea Incision

PURPOSE: To report a case of epithelial ingrowth treatment by surgical excision of epithelial tissues and intracameral 5-fluorouracil injection. CASE SUMMARY: A 70-year-old female patient who underwent phacoemulsification through clear cornea incision in both eyes 2 years before, was referred for her left ocular pain and corneal edema of 3 months' duration. Diffuse sheet-like epithelium grew from the clear cornea incision site to the pupil margin lesion of the iris. The epithelial tissues were excised and 5-fluorouracil was injected intracamerally. There were no recurrences for 2 months.

Delayed Epithelial Ingrowth Caused by Viral Conjunctivitis after LASIK

To report a patient who presented with epithelial ingrowth caused by viral keratoconjunctivitis 3 months after LASIK surgery. A 41-year-old man presented with decreased visual acuity in the right eye, which had developed about 3 weeks before. He had undergone LASIK surgery 3 months prior without complications. Two months after the surgery, he was treated for viral conjunctivitis. During the treatment period, filamentary keratitis developed, and a therapeutic bandage contact lens was applied for 2 weeks. Upon presentation, examination revealed a corrected visual acuity of 20/100 and irregular epithelial sheets under the edematous flap. The flap was lifted, and the in-grown epithelium was removed. The flap was repositioned with double continuous 10-0 nylon sutures. Post-operatively, the patient developed a mild diffuse lamellar keratitis that resolved rapidly with topical corticosteroid treatment. At 2 months, the corrected visual acuity was 20/20 without interface opacities. As the patient showed no complications prior to viral conjunctivitis, we suspect that the viral infection caused edema of the corneal flap, which caused epithelial ingrowth under the flap. Patients who have viral conjunctivitis after LASIK surgery should be examined carefully and managed with consideration of flap complications.

Bovine bone xenograft as orbital implants in rabbit eyes / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To assess the biocompatibility of bovine bone as orbital implants in rabbits.·METHODS: Bovine bone graft was used as an ocular implant in rabbits to determine whether it could be successfully used in the anophthalmic socket as an alternative to the expensive synthetic alloplastics. Evisceration of eyes with and without bovine bone orbital implantation was performed in the right eyes of 12 New Zealand white rabbits.Group Y (n =6) was eviscerated without implant, meanwhile Group X (n =6) was eviscerated with insertion of an orbital implant using bovine bone. Observation was carried out on day 1, day 7, day 14, day 28 and day 42. Serial clinical examination was carried out based on a few fixed criteria,which included rate of infection, implant migration, evidence of wound breakdown and any restriction of intraocular movements. The implanted eyes were then enucleated on day 42. The enucleated eyes were sent for histopathological evaluation to record the type of inflammatory reaction and rate of fibrovascular ingrowth.·RESULTS: Serial clinical examination showed presence of minimal infection in all eyes, both in Group X implanted) and Group Y (control) on first postoperative day, which responded well with antibiotics. Infection occurred in the implanted group after first postoperative day, but there was no evidence of orbital migration or extrusion of implant, wound breakdown, restriction of extraocular movement, severe infection or any physical abnormality. Histopathological examination revealed good fibrovascular ingrowth in the implanted group, with minimal rejecting reaction of rabbit eye towards bovine bone implant.·CONCLUSION: This study shows that bovine orbital implant has a good biocompatibility in rabbit eyes and its cost is acceptable.

Treatment of Epithelial Ingrowth after Laser in Situ Keratomilusis Using Amniotic Membrane Patch

PURPOSE: To present the result of a new technique for compressing the flap with amniotic membrane patch to manage epithelial ingrowth following a lacerated or microperforated flap near the visual axis during laser in situ keratomileusis (LASIK) surgery. METHODS: Four patients having epithelial ingrowth involving the visual axis were treated as follows: Under a surgical microscope, 3~5 landmark sutures were located at the margin of the flap and the flap was lifted carefully. After removing epithelial cells, preplaced corneal sutures were tied to fix the flap and a prepared amniotic membrane patch was tightly sutured to the sclera to compress the entire cornea. The amniotic membrane overlay was maintained for about a week and then removed. RESULTS: All four eyes achieved a best corrected visual acuity of 20/25 or better and no eyes have shown signs of recurrence within 3 months. CONCLUSIONS: Amniotic membrane patch can be a useful way to secure the flap in the treatment of epithelial ingrowth threatening the visual axis, especially when direct sutures are deemed difficult.

Treatment of Epithelial Ingrowth after Laser in Situ Keratomilusis Using Amniotic Membrane Patch

PURPOSE: To present the result of a new technique for compressing the flap with amniotic membrane patch to manage epithelial ingrowth following a lacerated or microperforated flap near the visual axis during laser in situ keratomileusis (LASIK) surgery. METHODS: Four patients having epithelial ingrowth involving the visual axis were treated as follows: Under a surgical microscope, 3~5 landmark sutures were located at the margin of the flap and the flap was lifted carefully. After removing epithelial cells, preplaced corneal sutures were tied to fix the flap and a prepared amniotic membrane patch was tightly sutured to the sclera to compress the entire cornea. The amniotic membrane overlay was maintained for about a week and then removed. RESULTS: All four eyes achieved a best corrected visual acuity of 20/25 or better and no eyes have shown signs of recurrence within 3 months. CONCLUSIONS: Amniotic membrane patch can be a useful way to secure the flap in the treatment of epithelial ingrowth threatening the visual axis, especially when direct sutures are deemed difficult.

Bone Ingrowth into Harris-Galante Porous-coated Acetabular Cup Retrieved during Revision

Purpose: To investigate the extent of bone ingrowth into the porous-coated acetabular cups as well as the factors that correlated with bone ingrowth in total hip arthroplasty. Materials and Methods: Thirty six Harris-Galante porous-coated acetabular cups that were retrieved through revision surgery were examined in this study. Acetabular cups retrieved due to infection or severely destroyed cups (ed note: severe what?) were excluded. The extent of bone ingrowth into the acetabular cups was grossly measured, and its correlation with the variables including age, gender, weight, height, the duration of fixation, size, number of screws, inclination and anteversion was statistically analyzed. Results: The mean proportion of bone ingrowth was 52.9 21.9%(2~90%) and less than 30% in three cups(8.3%). The pattern and the location of bone ingrowth were not consistent. There was no correlation between the extent of bone ingrowth and age, gender, weight, height, the duration of fixation, cup size, number of screws, size, inclination and anteversion. Conclusion: Harris-Galante porous-coated acetabular cups showed satisfactory bone ingrowth regardless of the variables associated with the demographic or surgical conditions. Surface treatments with a fiber-metal porouscoating appears to be suitable for cementless acetabular cups in terms of the long term results.

Effect of Basic Fibroblast Growth Factor on Fibrovascular Ingrowth into Porous Polyethylene Anophthalmic Socket Implants

To investigate the effect of basic Fibroblast Growth Factor (bFGF) on fibrovascular ingrowth into porous polyethylene orbital implants (Medpor (R) ) and to investigate any differences according to the method of administration. For the treated groups, after evisceration and Medpor (R) implantation, bFGF was administered by soaking Medpor (R) in the bFGF solution, and/or by injecting bFGF into the Medpor (R) 1 week after the operation. Implants were removed 4 weeks after the operation and examined for the degrees of fibrovascular ingrowth by light microscopy. The percentages of the cross-sectional area of the implant occupied by fibrovascular ingrowth and the numbers of proliferated vessels were significantly higher in the bFGF-treated groups (Mann Whitney test, p 0.05). bFGF promoted fibrovascular ingrowth into porous polyethylene orbital implants regardless of the route of administration. Therefore, bFGF might be helpful to prevent complications such as implant exposure.

The Effect of the Synthetic Bone Glass on the Fibrovascularization into Porous Polyethylene Orbital Implant

PURPOSE: To evaluate the effect of the synthetic bone glass particulate (BG) on the fibrovascular ingrowth into porous polyethylene orbital implant (PP). METHODS: Forty eight rabbits were divided into 4 groups according to the surgical techniques and implanted materials. One eye was enucleated one eye and PP was implanted in group 1, was eviscerated and PP was implanted in group 2, was enucleated and BG, containing 30% by weight synthetic bone glass particulate, was implanted in group 3, and was eviscerated and BG was implanted in group 4. All implants of each group were assessed by histologic study at the first, second, fourth, and eighth weeks postoperatively. The area of fibrovascular ingrowth was calculated by histologic examination. RESULTS: There were no statistically significant differences in the fibrovascular ingrowth among these groups. A greater number of vessels per unit area and matured fibrous tissue was found in the more outer zone at longer time after implantation, but there was not statistically significant difference among the four groups. CONCLUSIONS: On the basis of this study, the synthetic bone glass particulate did not significantly increase the rate of fibrovascular ingrowth into porous polyethylene orbital implant in rabbits.

The effect of polyethylene orbital implant(Medpor(R)) pretreated with autogenous fibrovascular tissues in rabbits

PURPOSE: The purpose of this study is to determine whether partially neovascularized Medpor(R) by preplacement of implant to buttock area for one month before secondary orbital insertion demonstrates earlier refibrovascular ingrowth into implant than that in primary orbital placement. METHODS: Thirty-five rabbits were divided into two groups: Group A (15 rabbits) ; primary orbital implantation of Medpor(R)(nonvascularized) after enucleation, Group B (15 rabbits) ; secondary orbital implantation of implant (vascularized) after enucleation after harvesting implants from buttock area, inserted for one month prior to orbital implantation. Five neovascularized implants by preplacement of implant to buttock area for one month were sectioned and investigated for the fibrovascular ingrowth, expression of bFGF, and CD-31 to evaluate the influence of pretreatment. Implants from group A and B were harvested from the orbit at 1, 2, 4, 6, and 8 weeks postoperatively. The implants were sectioned and studied grossly and histopathologically. Immunohistochemical study on bFGF and CD-31 were conducted to detect the angiogenetic factor and degree of angiogenesis in both group A and B. RESULTS: The fibrovascular ingrowth and expression of bFGF and degree of angiogenesis in group B were higher than those in group A. The degrees of angiogenesis were well correlated with bFGF expression. CONCLUSIONS: This animal model may provide the basis for the future investigation of agents and structural modifications directed towards optimization of fibrovascular ingrowth into porous anophthalmic socket implants and clinically apply to enucleation for the vascular compromised patients such as in the settings of postirradiation, diabetes.