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.

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.

Causes of the Lower Uncorrected Visual Acuity than 20/40 after LASIK

PURPOSE: To evaluate the causes of low uncorrected visual acuity below 20/40 after LASIK (laser in situ keratomileusis). METHODS: 289 eyes (more -6.0 D myopia) that had LASIK between July 1997 and December 1999 by one surgeon were observed for at least 6 months. We evaluated their uncorrected visual acuity and ocular state. RESULTS: 51 eyes (17.64%) of 289 eyes have lower uncorrected visual acuity than 20/40 after LASIK. The causes were myopic regression (22/51), decentering (10/51), undercorrection of myopia (5/51), corneal ectasia (5/51), undercorrection of astigmatism (4/51), central island (2/51), free flap (1/51), postoperative flap displacement (1/51) and incomplete keratome pass (1/51). CONCLUSION: Although LASIK is a safe and effective procedure, many patients had lower uncorrected visual acuity less than 20/40 after LASIK. We must be able to manage correctable factors among the causes above.