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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
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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
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@#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.
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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.
Subject(s)
Humans , Male , Middle Aged , Postoperative Complications/therapy , Epithelium, Corneal/surgery , Epithelium, Corneal/pathology , Corneal Diseases/etiology , Corneal Diseases/therapy , Keratomileusis, Laser In Situ/adverse effects , Recurrence , Reoperation , Fibrin Tissue Adhesive , Combined Modality Therapy , Debridement , Ethanol/administration & dosageABSTRACT
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.
Subject(s)
Corneal Diseases , Eye Diseases , Laser Therapy , Ophthalmologic Surgical ProceduresABSTRACT
? 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.
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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.
Subject(s)
Adult , Female , Humans , Astigmatism , Axis, Cervical Vertebra , Debridement , Epithelial Cells , Eye , Follow-Up Studies , Keratomileusis, Laser In Situ , Lifting , Mitomycin , Nylons , Photorefractive Keratectomy , Recurrence , Sutures , Visual AcuityABSTRACT
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.
Subject(s)
Humans , Epithelium , Eye , Incidence , Keratomileusis, Laser In Situ , Retrospective StudiesABSTRACT
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.
Subject(s)
Aged , Female , Humans , Cornea , Corneal Edema , Epithelium , Eye , Fluorouracil , Iris , Phacoemulsification , Pupil , RecurrenceABSTRACT
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.
Subject(s)
Adult , Humans , Male , Cell Proliferation , Conjunctivitis, Viral/etiology , Epithelial Cells/pathology , Keratomileusis, Laser In Situ/adverse effectsABSTRACT
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.
Subject(s)
Humans , Amnion , Axis, Cervical Vertebra , Cornea , Epithelial Cells , Keratomileusis, Laser In Situ , Recurrence , Sclera , Sutures , Visual AcuityABSTRACT
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.
Subject(s)
Humans , Amnion , Axis, Cervical Vertebra , Cornea , Epithelial Cells , Keratomileusis, Laser In Situ , Recurrence , Sclera , Sutures , Visual AcuityABSTRACT
LASIK is an effective and exact procedure to correct myopic refractive error but fatal complication may be happened during making corneal flap using microkeratome. We report a patient who developed acute central stomal melting following LASIK on postoperative day 4. This complication was treated by lifting the flap and scraping the interface of corneal flap & central stroma with a metal blade. After 4 months, overcorrected hyperopic refractive error was retreated with excimer laser ablation and patient recovered successful visual acuity. The pathogenesis of this case is not completely understood. Corneal endothelium and central cornea stroma may be mechanically damaged due to excessive suction ring application during LASIK procedure. Interface epithelial ingrowth may be associated with early postoperative inflammation and infection of corneal flap may produce proteinase which melts corneal flap. If corneal flap melting happens after LASIK procedure, early surgical debridement of melting stroma and proper reattachment of the flap may be needed.
Subject(s)
Humans , Cornea , Debridement , Endothelium, Corneal , Freezing , Inflammation , Keratomileusis, Laser In Situ , Lasers, Excimer , Lifting , Refractive Errors , Suction , Visual AcuityABSTRACT
The purpose of this study is to demonstrate a method of how to remove epithelium grown beneath the hinge area after laser in situ keratomileusis (LASIK) without affecting the refractive part of the lenticule. In three cases, an incision was made at the base of the hinge by RK diamond knife to free the lenticule from the stroma. The lenticule was lifted from the nasal edge. The epithelium grown along the interface beneath the hinge area was removed with a Bard-Parker No. 15 knife. The lenticular flap was repositioned with interrupted sutures using 10-0 nylon. No further epithelial ingrowth was observed. The central cornea remained clear leaving a peripheral ring-shaped opacity without affecting the preoperative naked visual acuity. In conclusion, epithelial ingrowth along the interface after LASIK can be removed safely without affecting the refractive part by the incision of the hinge area with a RK diamond knife, removal of the epithelium, and suturing of the lenticule to the stromal bed.
Subject(s)
Adult , Female , Humans , Male , Epithelium, Corneal/surgery , Epithelium, Corneal/pathology , Photorefractive Keratectomy/adverse effects , Reoperation , Suture Techniques , Treatment Outcome , Visual Acuity/physiologyABSTRACT
Detachment of a keratomileusis lenticule or extensive epithelial ingrowth is a difficult complication to amnage. Seven cases of extensive interfacial epithelial ingrowth were occurred following in situ keratomileusis or laser in situ keratoileusis. After the removal of epithelial ingrowth, we tried to reattach the lenticule to the stromal bed by drying the cap with air, or by suturing using interrupted sutures or double running sutures. Three detached cases were applied with air dry, only one case was reattached. Two other cases were failed due to epithelial ingrowth along the interface. In spite of the interupted sutures, the epithelial ingrowth along the interface recurred. In one of them, the edge of the lenticule was burried into the stroma and the lenticule was attached to the cornea leaving a ring-shaped opacity peripherally. In the other four cases, the lenticule was attached to the cornea successfully without epithelial ingrowth along the interface with double running sutures. Detached lenticules with extensive epithelial ingrowth following keratomileusis can be managed successfully by double running suture technique.