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Li X, Gu Y. Unusual visual impairment after enhancement refractive surgery. J Surg Case Rep 2024; 2024:rjae074. [PMID: 38370587 PMCID: PMC10873836 DOI: 10.1093/jscr/rjae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/26/2024] [Indexed: 02/20/2024] Open
Abstract
We reported a case of rapidly developed corneal epithelial in-growth (EI) deteriorating visual acuity (VA) within the initial postoperative day. A 37-year-old male presented with decreased VA for 2 years. He underwent LASIK surgery 13 years ago. After enhancement surgery, postoperative VA was much worse than preoperative best corrected visual acuity (BCVA) 20/20 and decreased rapidly. VA of OD was 20/40 on Day 1, and 20/70 on Day 5, OS 20/20 on Day 1, 20/25 on Day 10, and 20/50 on Day 13 postoperatively. Corneal topography and optical coherence tomography (OCT) showed distinctive features. The patient was diagnosed with corneal EI postoperatively. After scraping ectopic corneal epithelial cells, the cornea became transparent and VA improved. Despite its rarity, early postoperative EI can occur within 1 day after enhancement surgery and can progress rapidly. OCT and corneal topography provide distinctive manifestations aiding diagnosis.
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Affiliation(s)
- Xia Li
- Department of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai 200031, PR China
- Shanghai Aier Eye Institute, Shanghai 200031, PR China
| | - Yong Gu
- Department of Ophthalmology, Wu Xi Aier Eye Hospital, Wuxi, Jiangsu 214000, PR China
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2
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Rohlf D, La Nasa A, Terveen D, Shafer B, Thompson V, Berdahl J. Outcomes of LASIK vs PRK enhancement in eyes with prior cataract surgery. J Cataract Refract Surg 2023; 49:62-68. [PMID: 36026691 DOI: 10.1097/j.jcrs.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 07/20/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare postenhancement visual acuity between patients who underwent postcataract laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). SETTING A private, tertiary referral practice in Sioux Falls, South Dakota. DESIGN 3-year, retrospective chart review. METHODS Patients who underwent postcataract extraction excimer laser enhancement surgery targeted for emmetropia (±0.50 diopter). Postenhancement uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) was recorded for all available follow-ups and compared for both groups. RESULTS 822 postcataract enhanced eyes (491 LASIK; 331 PRK). For patients with at least 6-month follow-up, mean UDVA was 0.05 ± 0.13 logMAR in LASIK-enhanced patients and 0.15 ± 0.20 in PRK-enhanced patients ( P < .001). Mean absolute value MRSE was 0.22 ± 0.36 and 0.48 ± 0.62 for LASIK-enhanced and PRK-enhanced patients at or beyond 6 months, respectively ( P < .001). 330 (67%) LASIK-enhanced patients achieved 20/20 or better postenhancement UDVA, compared with 142 (43%) PRK-enhanced patients ( P < .001). Controlling for pre-enhancement UDVA, LASIK-enhanced patients showed significantly better postenhancement UDVA than PRK-enhanced patients, except in those with pre-enhancement vision of 20/20 or better, or those worse than 20/50. LASIK-enhanced virgin corneas had mean postenhancement of 0.05 ± 0.14 UDVA compared with 0.13 ± 0.19 UDVA in PRK-enhanced virgin cornea patients ( P < .001). CONCLUSIONS LASIK provides better and more predictable outcomes in UDVA than PRK in postcataract enhancement patients, even when controlling for pre-enhancement visual acuity and prior ocular procedures.
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Affiliation(s)
- Derek Rohlf
- From the University of South Dakota Sanford School of Medicine, Vermillion, South Dakota (Rohlf, La Nasa); Vance Thompson Vision, Sioux Falls, South Dakota (Terveen, Shafer, Thompson, Berdahl)
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Lázaro-Rodríguez V, Sauvageot P, Álvarez de Toledo J. Treatment of epithelial ingrowth after LASIK with partial flap lifting, mechanical debridement and sectorial flap suturing. J Fr Ophtalmol 2021; 45:e129-e131. [PMID: 34961648 DOI: 10.1016/j.jfo.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- V Lázaro-Rodríguez
- Centro de Oftalmología Barraquer, Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Muntaner 314, 08021 Barcelona, Spain.
| | - P Sauvageot
- Centro de Oftalmología Barraquer, Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Muntaner 314, 08021 Barcelona, Spain
| | - J Álvarez de Toledo
- Centro de Oftalmología Barraquer, Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Muntaner 314, 08021 Barcelona, Spain
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Singh B, Sharma S, Bharti N, Samantaray D, Bharti S. Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty as a Treatment Modality for Recalcitrant Post-Laser in situ Keratomileusis Epithelial Ingrowth. Case Rep Ophthalmol 2021; 12:831-835. [PMID: 34720985 PMCID: PMC8543360 DOI: 10.1159/000519189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
Abstract
The purpose is to present the outcomes of anterior lamellar keratoplasty for a case of post-laser in situ keratomileusis (LASIK) epithelial ingrowth. A 40-year-old male patient presented with epithelial ingrowth 14 years after primary LASIK with a microkeratome blade in the right eye following trauma. Multiple stromal bed washing was done over a period of 3 years, but recurrence of epithelial ingrowth was seen every time. Femtosecond laser-assisted anterior lamellar keratoplasty was performed in the right eye. Twelve months after the procedure, the patient's corrected distance visual acuity improved to 6/9, and no recurrence was noted. Femtosecond laser-assisted anterior lamellar keratoplasty is an effective treatment modality in cases of recurrent recalcitrant epithelial ingrowth seen after LASIK.
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Affiliation(s)
- Bhupesh Singh
- Bharti Eye Foundation and Hospital, New Delhi, India
| | | | - Neha Bharti
- Bharti Eye Foundation and Hospital, New Delhi, India
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September consultation #5. J Cataract Refract Surg 2021; 47:1244. [PMID: 34468466 DOI: 10.1097/01.j.jcrs.0000792756.92234.ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
A 27-year-old female patient came for a routine postoperative check-up, with a history of bilateral ReLEx small incision lenticule extraction (SMILE) surgery done 1.5 years back. On examination, epithelial ingrowth was noticed in the left eye at 8-9'o'clock position. Topography showed excess flattening in the area of ingrowth. Anterior Segment OCT showed hyper-reflectivity and was measured to be at a depth of 120 microns from the corneal surface. As the ingrowth appeared non-progressive, with no involvement of the pupillary axis and no visual complaints, no active intervention was done. Nonetheless, treatment options available include mechanical scraping and Nd:YAG laser procedure.
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Affiliation(s)
- Sanjana Srivatsa
- Department of Cornea and Refractive Services, Dr.Agarwal's Eye Hospital, Bangalore, Karnataka, India
| | - Shana Sood
- Dr.Agarwal's Eye Hospital and Research Centre, Chennai, Tamil Nadu, India
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Ciocco L, Hassan S, Woreta F, Srikumaran D. Epithelial ingrowth through venting incision into laser-assisted in situ keratomileusis flap interface after descemet stripping automated endothelial keratoplasty. Am J Ophthalmol Case Rep 2019; 13:25-27. [PMID: 30519669 PMCID: PMC6260390 DOI: 10.1016/j.ajoc.2018.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/02/2018] [Accepted: 11/12/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To present a case of epithelial ingrowth into the laser-assisted in situ keratomileusis (LASIK) flap interface after a patient underwent descemet stripping automated endothelial keratoplasty (DSAEK) surgery with venting incisions. OBSERVATIONS We present a case of a 48-year-old man with previous history of LASIK that underwent DSAEK for pseudophakic bullous keratopathy after complicated cataract surgery requiring an intraocular lens (IOL) exchange. The patient developed epithelial ingrowth into the LASIK flap interface from one of the venting incisions. The epithelial ingrowth was observed as it was a small peripheral area that did not affect his visual acuity. CONCLUSIONS AND IMPORTANCE Epithelial ingrowth is a well-described complication following LASIK but has rarely been described to occur after endothelial keratoplasty (EK). Even rarer, are reports of epithelial ingrowth after EK cases that have been found to result from venting incisions. To the authors' knowledge, this is the first case of the ingrowth into a LASIK flap interface occurring after EK through a venting incision. Although it may be an uncommon occurrence in which a patient with a history of LASIK requires EK, surgeons should take extra precautions to avoid this complication.
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Affiliation(s)
- Lindsay Ciocco
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Shahzeb Hassan
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, 21287, USA
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Management of Complex Epithelial Ingrowth After Laser In Situ Keratomileusis Using Fibrin Tissue Glue. Eye Contact Lens 2018; 44 Suppl 2:S210-S214. [PMID: 29219897 DOI: 10.1097/icl.0000000000000447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of adjunctive fibrin tissue glue in the treatment of complex epithelial ingrowth after laser in situ keratomileusis (LASIK). METHODS A retrospective review was performed of 12 eyes in 12 patients treated for clinically significant epithelial ingrowth after LASIK with mechanical debridement of the ingrowth and placement of fibrin tissue glue. Primary outcome measurements including recurrence of ingrowth, visual acuity, and manifest refraction were evaluated at each postoperative examination. Changes in higher-order aberrometry were also evaluated. RESULTS After epithelial ingrowth removal with adjunctive fibrin tissue glue, 11 eyes (91.7%) had no recurrence of ingrowth at the final follow-up examination. Uncorrected distance visual acuity changed from 20/20 or better in 3 eyes (25%) and 20/40 or better in 6 eyes (50%) preoperatively to 20/20 or better in 5 eyes (41.7%) and 20/40 or better in 10 eyes (83.3%) postoperatively. Nine eyes (75%) gained one or more lines of best-corrected distance visual acuity (CDVA). No eyes lost any lines of CDVA. There was no significant change in mean spherical equivalent (P=0.22) or mean cylinder (P=0.26) before and after surgery. Higher-order aberrations also remained stable with no significant change in root-mean-square error, coma, trefoil, and spherical aberration. There were no complications associated with the treatment. CONCLUSIONS Adjunctive fibrin tissue glue seems to be a safe and effective treatment for epithelial ingrowth after LASIK. This therapy may be particularly useful in managing challenging cases of complex or recalcitrant ingrowth.
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Post-Laser In Situ Keratomileusis Epithelial Ingrowth: Treatment, Recurrence, and Long-Term Results. Cornea 2018; 37:1517-1521. [PMID: 30222719 DOI: 10.1097/ico.0000000000001760] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To study outcomes after surgical removal of epithelial ingrowth (EI) in post-laser in situ keratomileusis patients, specifically comparing visual results and recurrence rates between 2 different EI management techniques. METHODS In this retrospective chart review of 67 eyes of 54 patients who underwent surgical treatment for EI after laser in situ keratomileusis between July 1999 and July 2014 at the Bascom Palmer Eye Institute, Miami, FL, surgical techniques, recurrence rates, visual acuity (VA), and refractive error were assessed. RESULTS Of the 67 eyes, 56 eyes (83.6%) had flap lift + scraping alone, and 11 eyes (16.4%) had flap lift + scraping + suturing. After mean follow-up of 2.5 years, 11 of 56 eyes (19.6%) treated with flap lift + scraping alone had EI recurrence, whereas no eyes treated with flap lift + scraping + suturing had EI recurrence. VA results and refractive errors were better in eyes treated with lift + scraping alone compared with lift + scraping + suturing at 1 month. In the 67 eyes with 1-year follow-up, VA and refractive errors improved from preoperative values and were comparable between groups. CONCLUSIONS Scraping alone provides significantly better initial visual outcomes but higher EI recurrence rates compared with scrape-suturing. Long-term visual outcomes are comparable between 2 techniques.
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Friehmann A, Mimouni M, Nemet AY, Sela T, Munzer G, Kaiserman I. Risk Factors for Epithelial Ingrowth Following Microkeratome-Assisted LASIK. J Refract Surg 2018; 34:100-105. [PMID: 29425388 DOI: 10.3928/1081597x-20180105-01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the incidence and risk factors associated with epithelial ingrowth following uncomplicated microkeratome-assisted LASIK. METHODS All patients who underwent microkeratome-assisted LASIK between January 2006 and December 2014 in a single surgical center were reviewed. Epithelial ingrowth cases were identified and associated factors were assessed. RESULTS Overall, 149 (0.49%) of 30,574 cases developed epithelial ingrowth. The epithelial ingrowth group was older compared to controls (35.3 ± 12.3 vs 31.7 ± 10.3 years, P = .001) and had a higher percentage of moderate to high hyperopia (13.7% vs 5.3%, P < .001), early postoperative flap slippage requiring flap repositioning (9.4% versus 2.8%, P < .001), or flap lifting for enhancement (48.6% vs 4.3%, P < .001), were treated with a smaller optic zone (6 mm) (37.7% vs 15.2%, P < .001), with a Moria M2 microkeratome (Moria SA, Antony, France) (70.1% vs 55.5%, P = .02), by low volume surgeons (n < 1,000) (5.8% vs 1.3%, P < .001), in a lower operating room temperature (22.3 ± 1.8 vs 22.8 ± 1.6, P = .005), and with a greater maximum ablation depth (67.3 ± 29.7 vs 57.3 ± 30.3, P < .001). There was a high incidence of epithelial ingrowth in the enhancement group compared to primary LASIK (4.8% vs 0.2%, P < .001). The time between treatments (primary and enhanced LASIK) was significantly greater in the epithelial ingrowth group (mean: 1,110 ± 870 vs 626 ± 662 days, P < .001). There was a significant rise in epithelial ingrowth rates as time between primary and enhancement LASIK increased, peaking at 4 to 5 years (P < .001). In multivariate analysis, flap lifting for enhancement (odds ratio [OR] = 19.5, P < .001), 6-mm optic zone (OR = 2.2, P < .001), moderate to severe hyperopia (OR = 2.4, P = .005), greater ablation depth (OR = 1.005, P < .001), and low volume surgeon (OR = 3.9, P = .01) were associated with epithelial ingrowth (total R2 = 15.4). CONCLUSIONS The potential risk factors described above may forewarn surgeons as to which individuals merit closer observation for this complication. [J Refract Surg. 2018;34(2):100-105.].
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11
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Late-onset traumatic dislocation of laser in situ keratomileusis corneal flaps: a case series with many clinical lessons. Int Ophthalmol 2018; 39:1397-1403. [DOI: 10.1007/s10792-018-0946-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
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Mohammed OA, Mounir A, Hassan AA, Alsmman AH, Mostafa EM. Nd:YAG laser for epithelial ingrowth after laser in situ keratomileusis. Int Ophthalmol 2018; 39:1225-1230. [PMID: 29728896 DOI: 10.1007/s10792-018-0923-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for treatment of epithelial ingrowth after laser in situ keratomileusis (LASIK). PATIENTS AND METHODS Fifty-eight patients with epithelial ingrowth presented to Sohag refractive center, Sohag, Egypt, between January 2015 and March 2017. Only 41 patients (18 females and 23 males, mean age: 33.4 years) involving 41 eyes were indicated for treatment by Nd:YAG laser as the rest of the eyes were only under observation. Patients with epithelial ingrowth were recognized at a mean of 6 months after primary LASIK procedure (range: 2-16 months). Four eyes had undergone previous LASIK enhancements. Four eyes had the epithelial ingrowth removed by flap lift and scrapping. The mean intensity of the spots used was 0.8 mJ with variable number of shots depending on the size and density of the epithelial ingrowth area. Twenty-eight eyes showed complete regression after one session, while the rest necessitated 2-3 sessions for complete resolution. Mean follow-up period was 8 months (range 5-12 months). RESULTS Epithelial ingrowth was treated successfully in all 41 eyes. The uncorrected visual acuities were 20/20, and there was no evidence of recurrent epithelial ingrowth after 6 months with no complications reported. CONCLUSION YAG laser is a simple, effective outpatient procedure for the management of epithelial ingrowth after LASIK.
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Affiliation(s)
- Osama Ali Mohammed
- Ophthalmology Department, Faculty of Medicine, Sohag University, Nasr City, Sohag, 82524, Egypt
| | - Amr Mounir
- Ophthalmology Department, Faculty of Medicine, Sohag University, Nasr City, Sohag, 82524, Egypt
| | - Amin Aboali Hassan
- Ophthalmology Department, Faculty of Medicine, Sohag University, Nasr City, Sohag, 82524, Egypt
| | - Alahmady Hamad Alsmman
- Ophthalmology Department, Faculty of Medicine, Sohag University, Nasr City, Sohag, 82524, Egypt
| | - Engy Mohamed Mostafa
- Ophthalmology Department, Faculty of Medicine, Sohag University, Nasr City, Sohag, 82524, Egypt.
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Ting DSJ, Srinivasan S, Danjoux JP. Epithelial ingrowth following laser in situ keratomileusis (LASIK): prevalence, risk factors, management and visual outcomes. BMJ Open Ophthalmol 2018; 3:e000133. [PMID: 29657982 PMCID: PMC5895975 DOI: 10.1136/bmjophth-2017-000133] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/03/2018] [Accepted: 03/02/2018] [Indexed: 11/28/2022] Open
Abstract
The number of laser in situ keratomileusis (LASIK) procedures is continuing to rise. Since its first application for correcting simple refractive errors over 25 years ago, the role of LASIK has extended to treat other conditions, including postkeratoplasty astigmatism/ametropia, postcataract surgery refractive error and presbyopia, among others. The long-term effectiveness, predictability and safety have been well established by many large studies. However, due to the creation of a potential interface between the flap and the underlying stroma, interface complications such as infectious keratitis, diffuse lamellar keratitis and epithelial ingrowth may occur. Post-LASIK epithelial ingrowth (PLEI) is an uncommon complication that usually arises during the early postoperative period. The reported incidence of PLEI ranged from 0%–3.9% in primary treatment to 10%–20% in retreatment cases. It can cause a wide spectrum of clinical presentations, ranging from asymptomatic interface changes to severe visual impairment and flap melt requiring keratoplasty. PLEI can usually be treated with mechanical debridement of the affected interface; however, additional interventions, such as alcohol, mitomycin C, fibrin glue, ocular hydrogel sealant, neodymium:yttriumaluminum garnet laser and amniotic membrane graft, may be required for recurrent or refractory cases. The aims of this review are to determine the prevalence and risk factors of PLEI; to describe its pathogenesis and clinical features and to summarise the therapeutic armamentarium and the visual outcome of PLEI.
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Affiliation(s)
| | - Sathish Srinivasan
- Department of Ophthalmology, University Hospital Ayr, Ayr, UK.,Faculty of Medicine, University of Glasgow, Glasgow, UK
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Guhan S, Peng SL, Janbatian H, Saadeh S, Greenstein S, Al Bahrani F, Fadlallah A, Yeh TC, Melki SA. Surgical adhesives in ophthalmology: history and current trends. Br J Ophthalmol 2018; 102:1328-1335. [DOI: 10.1136/bjophthalmol-2017-311643] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/24/2018] [Accepted: 03/04/2018] [Indexed: 11/04/2022]
Abstract
Tissue adhesives are gaining popularity in ophthalmology, as they could potentially reduce the complications associated with current surgical methods. An ideal tissue adhesive should have superior tensile strength, be non-toxic and anti-inflammatory, improve efficiency and be cost-effective. Both synthetic and biological glues are available. The primary synthetic glues include cyanoacrylate and the recently introduced polyethylene glycol (PEG) derivatives, while most biological glues are composed of fibrin. Cyanoacrylate has a high tensile strength, but rapidly polymerises upon contact with any fluid and has been associated with histotoxicity. Fibrin induces less toxic and inflammatory reactions, and its polymerisation time can be controlled. Tensile strength studies have shown that fibrin is not as strong as cyanoacrylate. While more research is needed, PEG variants currently appear to have the most promise. These glues are non-toxic, strong and time-effective. Through MEDLINE and internet searches, this paper presents a systematic review of the current applications of surgical adhesives to corneal, glaucoma, retinal, cataract and strabismus surgeries. Our review suggests that surgical adhesives have promise to reduce problems in current ophthalmic surgical procedures.
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Refractive Errors & Refractive Surgery Preferred Practice Pattern®. Ophthalmology 2018; 125:P1-P104. [DOI: 10.1016/j.ophtha.2017.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
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Moshirfar M, Jehangir N, Fenzl CR, McCaughey M. LASIK Enhancement: Clinical and Surgical Management. J Refract Surg 2017; 33:116-127. [DOI: 10.3928/1081597x-20161202-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/26/2016] [Indexed: 11/20/2022]
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Kwon KY, Ji YW, Lee J, Kim EK. Inhibition of recurrence of epithelial ingrowth with an amniotic membrane pressure patch to a laser in situ keratomileusis flap with a central stellate laceration: a case report. BMC Ophthalmol 2016; 16:111. [PMID: 27430523 PMCID: PMC4950235 DOI: 10.1186/s12886-016-0291-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical lifting and scraping is a well-known treatment for epithelial ingrowth, but treatment for epithelial ingrowth on the centrally perforated laser in situ keratomileusis (LASIK) flap has not been well studied. CASE PRESENTATION We present a patient who had epithelial ingrowth to the backside of the flap through a central LASIK flap laceration with a stellate shape. The patient had undergone uncomplicated bilateral LASIK surgery 3 years before the trauma. Because the epithelial ingrowth was suspected during the first visit 2 weeks after trauma, and definite epithelial ingrowth was noted during the additional 2 week observation period, the ingrown epithelial tissue was removed mechanically with a number 15 blade after lifting of the flap 4 weeks after the trauma. An amniotic membrane overlay was applied over the cornea and was sutured tightly to the episclera to firmly press down the flap to the remaining posterior stroma, to prevent growth of the epithelium again to the backside of the flap. At the last follow-up visit, 5 months after surgery, the patient's visual acuity remained stabilized with no sign of recurrent epithelial ingrowth. CONCLUSION These results showed that an amniotic membrane patch can be a useful adjuvant in the treatment of epithelial ingrowth, even on the central stellate laceration of the LASIK flap over the visual axis.
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Affiliation(s)
- Kye Yoon Kwon
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro Seodaemun-gu, 120-752, Seoul, South Korea
| | - Yong Woo Ji
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro Seodaemun-gu, 120-752, Seoul, South Korea
| | - Jeihoon Lee
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro Seodaemun-gu, 120-752, Seoul, South Korea
| | - Eung Kweon Kim
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro Seodaemun-gu, 120-752, Seoul, South Korea. .,Corneal Dystrophy Research Institute, Severance Biomedical Science Institute, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea.
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Hardten DR, Fahmy MM, Vora GK, Berdahl JP, Kim T. Fibrin adhesive in conjunction with epithelial ingrowth removal after laser in situ keratomileusis: long-term results. J Cataract Refract Surg 2016; 41:1400-5. [PMID: 26287878 DOI: 10.1016/j.jcrs.2014.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/08/2014] [Accepted: 10/11/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the long-term results of fibrin adhesive use in the management of epithelial ingrowth after laser in situ keratomileusis (LASIK). SETTING Private practice, Minneapolis, Minnesota, and an academic medical center, Durham, North Carolina, USA. DESIGN Retrospective case series. METHODS Patients with a history of LASIK had epithelial ingrowth removal with mechanical debridement and fibrin glue application. Visual outcomes and the presence or absence of epithelial ingrowth were evaluated again after 3 months and at the last follow-up. The main outcome measures were recurrence of epithelial ingrowth and visual acuity. RESULTS Thirty-nine eyes of 38 patients were evaluated. After epithelial ingrowth removal and application of fibrin glue, 31 eyes (79.5%) had no recurrence of ingrowth at the final follow-up and 5 eyes (12.8%) had mild epithelial ingrowth not requiring removal. Three eyes (7.7%) had significant epithelial ingrowth at the 3-month follow-up that required subsequent removal and fibrin application. At the 3-month follow-up visit, 76.9% of eyes achieved 20/25 or better corrected distance visual acuity (CDVA) and 69.2% of eyes achieved 20/40 or better uncorrected distance visual acuity (UDVA). At the last follow-up visit (mean 26.6 ± 17.0 months [SD]), 84.6% of eyes had 20/25 or better CDVA and 74.4% of eyes had 20/40 or better UDVA. CONCLUSIONS Fibrin adhesive in conjunction with manual epithelial removal prevented a clinically significant recurrence of epithelial ingrowth in the majority of eyes. Larger randomized studies are needed to compare the success of this technique with that of others. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- David R Hardten
- From the Minnesota Eye Consultants (Hardten, Fahmy, Berdahl), Minneapolis, Minnesota, and Duke University Eye Center (Vora, Kim), Durham, North Carolina, USA
| | - Mona M Fahmy
- From the Minnesota Eye Consultants (Hardten, Fahmy, Berdahl), Minneapolis, Minnesota, and Duke University Eye Center (Vora, Kim), Durham, North Carolina, USA
| | - Gargi K Vora
- From the Minnesota Eye Consultants (Hardten, Fahmy, Berdahl), Minneapolis, Minnesota, and Duke University Eye Center (Vora, Kim), Durham, North Carolina, USA
| | - John P Berdahl
- From the Minnesota Eye Consultants (Hardten, Fahmy, Berdahl), Minneapolis, Minnesota, and Duke University Eye Center (Vora, Kim), Durham, North Carolina, USA
| | - Terry Kim
- From the Minnesota Eye Consultants (Hardten, Fahmy, Berdahl), Minneapolis, Minnesota, and Duke University Eye Center (Vora, Kim), Durham, North Carolina, USA.
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Santos AMD, Torricelli AAM, Marino GK, Garcia R, Netto MV, Bechara SJ, Wilson SE. Femtosecond Laser-Assisted LASIK Flap Complications. J Refract Surg 2016; 32:52-9. [DOI: 10.3928/1081597x-20151119-01] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/01/2015] [Indexed: 01/13/2023]
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Abstract
Femtosecond-assisted laser in-situ keratomileusis flaps have revolutionized refractive surgery since their introduction. Although these lasers are exceedingly safe, complications still do occur. This review focuses specifically on examining the literature and evidence for flap complications during femtosecond-assisted laser in-situ keratomileusis as well as their management.
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Affiliation(s)
- Deepika N Shah
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, Massachusetts , USA
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22
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Lapid-Gortzak R, Hughes JM, Nieuwendaal CP, Mourits MP, van der Meulen IJE. LASIK Flap Breakthrough in Nd:YAG Laser Treatment of Epithelial Ingrowth. J Refract Surg 2015; 31:342-5. [DOI: 10.3928/1081597x-20150424-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/19/2015] [Indexed: 11/20/2022]
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23
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Nugent RB, Lee GA. Ophthalmic use of blood-derived products. Surv Ophthalmol 2015; 60:406-34. [PMID: 26077627 DOI: 10.1016/j.survophthal.2015.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 12/23/2022]
Abstract
There is a wide spectrum of blood-derived products that have been used in many different medical and surgical specialties with success. Blood-derived products for clinical use can be extracted from autologous or allogeneic specimens of blood, but recombinant products are also commonly used. A number of blood derivatives have been used for a wide range of ocular conditions, from the ocular surface to the retina. With stringent preparation guidelines, the potential risk of transmission of blood-borne diseases is minimized. We review blood-derived products and how they are improving the management of ocular disease.
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Affiliation(s)
| | - Graham A Lee
- City Eye Centre, Brisbane, Queensland, Australia; Department of Ophthalmology, University of Queensland, Brisbane, Queensland, Australia.
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24
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Yesilirmak N, Diakonis VF, Battle JF, Yoo SH. Application of a Hydrogel Ocular Sealant to Avoid Recurrence of Epithelial Ingrowth After LASIK Enhancement. J Refract Surg 2015; 31:275-7. [DOI: 10.3928/1081597x-20150303-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/04/2015] [Indexed: 11/20/2022]
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25
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Chae JJ, McIntosh Ambrose W, Espinoza FA, Mulreany DG, Ng S, Takezawa T, Trexler MM, Schein OD, Chuck RS, Elisseeff JH. Regeneration of corneal epithelium utilizing a collagen vitrigel membrane in rabbit models for corneal stromal wound and limbal stem cell deficiency. Acta Ophthalmol 2015; 93:e57-66. [PMID: 25495158 DOI: 10.1111/aos.12503] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 06/15/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE This study was performed to evaluate the potential of a collagen-based membrane, collagen vitrigel (CV), for reconstructing corneal epithelium in the stromal wound and limbal stem cell deficiency (LSCD) models. METHODS Three groups of rabbits were used in the stromal wound model: CV affixed using fibrin glue (CV + FG group, n = 9), fibrin glue only (FG group, n = 3) and an untreated control group (n = 3). In the LSCD model, one group received CV containing human limbal epithelial cells (CV + hLEC group, n = 2) and the other was an untreated control (n = 1). Gross observation, including fluorescent staining, pathological examination, immunohistochemistry and electron microscopy, was used to evaluate the effect of CV on the corneal epithelium. RESULTS In the stromal wound model, fluorescent staining showed that epithelial reconstruction occurred as rapidly in the CV + FG group as it did in the control group. The pathological examination proved that the CV supported a healthy corneal epithelium in the CV + FG group, whereas FG led to hypertrophy and inappropriate differentiation of corneal epithelium in the FG group. In the LSCD model, the corneas in the CV + hLEC group showed sustained tissue transparency with good epithelialization, low inflammatory response and reduced neovascularization. However, the control cornea was translucent and showed high amounts of inflammation and neovascularization. CONCLUSION We have demonstrated that CV supports corneal epithelial differentiation and prevents epithelial hypertrophy, in addition to serving as a scaffold for hLEC transplantation, without complications.
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Affiliation(s)
- J. Jeremy Chae
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
| | - Winnette McIntosh Ambrose
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
| | - Freddy A. Espinoza
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
| | - Daniel G. Mulreany
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
| | - Shengyong Ng
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
| | - Toshiaki Takezawa
- Division of Animal Sciences; National Institute of Agrobiological Sciences; Tsukuba Japan
| | - Morgana M. Trexler
- Research and Exploratory Development Department; The Johns Hopkins University Applied Physics Laboratory; Laurel Maryland USA
| | - Oliver D. Schein
- Department of Ophthalmology; Johns Hopkins University; Baltimore Maryland USA
| | - Roy S. Chuck
- Department of Ophthalmology; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York USA
| | - Jennifer H. Elisseeff
- Translational Tissue Engineering Center; Wilmer Eye Institute and Department of Biomedical Engineering; Johns Hopkins University; Baltimore Maryland USA
- Department of Ophthalmology; Johns Hopkins University; Baltimore Maryland USA
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Leccisotti A. Femtosecond laser–assisted hyperopic laser in situ keratomileusis with tissue-saving ablation: Analysis of 800 eyes. J Cataract Refract Surg 2014; 40:1122-30. [DOI: 10.1016/j.jcrs.2013.11.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 10/29/2013] [Accepted: 11/04/2013] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE Epithelial ingrowth is a known complication after laser in situ keratomileusis (LASIK), with a high incidence after repeat surgery or trauma. The authors report the occurrence of epithelial ingrowth 23 months after primary LASIK and its subsequent spontaneous resolution over the following 6 months. METHODS A 35-year-old man underwent bilateral uneventful microkeratome-assisted LASIK in June 2008. The patient presented 23 months later after noticing a "white spot" in his left eye. Examination of the left eye showed an oval patch of epithelial growth in the superonasal quadrant. Uncorrected distance visual acuity (UDVA) was 1.0 OD and 0.6 OS. Topical fluorometholone 0.1% eye drops were prescribed four times a day. Over the next 2 weeks, the UDVA improved to 1.0 and the size of the interface opacities decreased slightly. However, no further change was observed with continuation of corticosteroid eye drops over the next 2 weeks. All treatment was stopped. Three months later, the epithelial ingrowth expanded toward the visual axis. An option of surgical intervention was refused by the patient. RESULTS Subsequent monthly follow-ups over another 3 months showed gradual decrease in the size of epithelial growth. Final slit-lamp examination showed complete clearance of the epithelial cells from the interface. The UDVA returned to 1.0 in the left eye. CONCLUSIONS Epithelial ingrowth can occur after a long interval after primary LASIK. In our case, the epithelial cells disappeared without any surgical intervention over a period of 6 months.
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Randleman JB, Shah RD. LASIK interface complications: etiology, management, and outcomes. J Refract Surg 2012; 28:575-86. [PMID: 22869235 DOI: 10.3928/1081597x-20120722-01] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 07/16/2012] [Indexed: 01/31/2023]
Abstract
PURPOSE To describe the etiology, diagnosis, clinical course, and management of LASIK interface complications. METHODS Literature review. RESULTS Primary interface complications include infectious keratitis, diffuse lamellar keratitis, central toxic keratopathy, pressure-induced stromal keratopathy (PISK), and epithelial ingrowth. Infectious keratitis is most commonly caused by Methicillin-resistant Staphylococcus aureus (early onset) or atypical Mycobacterium (late onset) postoperatively, and immediate treatment includes flap lift and irrigation, cultures, and initiation of broad-spectrum topical antibiotics, with possible flap amputation for recalcitrant cases. Diffuse lamellar keratitis is a white blood cell infiltrate that appears within the first 5 days postoperatively and is acutely responsive to aggressive topical and oral steroid use in the early stages, but may require flap lift and irrigation to prevent flap necrosis if inflammation worsens. In contrast, PISK is caused by acute steroid response and resolves only with cessation of steroid use and intraocular pressure lowering. Without appropriate therapy PISK can result in severe optic nerve damage. Central toxic keratopathy mimics stage 4 diffuse lamellar keratitis, but occurs early in the postoperative period and is noninflammatory. Observation is the only effective treatment, and flap lift is usually not warranted. Epithelial ingrowth is easily distinguishable from other interface complications and may be self-limited or require flap lift to treat irregular astigmatism and prevent flap melt. CONCLUSIONS Differentiating between interface entities is critical to rapid appropriate diagnosis, treatment, and ultimate visual outcome. Although initial presentations may overlap significantly, the conditions can be readily distinguished with close follow-up, and most complications can resolve without significant visual sequelae when treated appropriately.
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Affiliation(s)
- J Bradley Randleman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
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29
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Henry CR, Canto AP, Galor A, Vaddavalli PK, Culbertson WW, Yoo SH. Epithelial Ingrowth After LASIK: Clinical Characteristics, Risk Factors, and Visual Outcomes in Patients Requiring Flap Lift. J Refract Surg 2012; 28:488-92. [DOI: 10.3928/1081597x-20120604-01] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 05/22/2012] [Indexed: 11/20/2022]
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30
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Güell JL, Elies D, Gris O, Manero F, Morral M. Femtosecond laser-assisted enhancements after laser in situ keratomileusis. J Cataract Refract Surg 2012; 37:1928-31. [PMID: 22018361 DOI: 10.1016/j.jcrs.2011.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/22/2011] [Accepted: 06/27/2011] [Indexed: 11/17/2022]
Abstract
UNLABELLED We describe a technique of femtosecond laser-assisted enhancement after primary LASIK with a mechanical microkeratome-created flap. The vertical side-cut incision by the femtosecond laser creates a wound configuration that decreases mechanical trauma to the epithelium and prevents epithelial cell migration. These factors may decrease the risk for post-LASIK enhancement epithelial ingrowth. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
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Affiliation(s)
- Jose L Güell
- Cornea and Refractive Surgery Unit, Instituto Microcirugia Ocular, the Universitat Autonoma de Barcelona, Barcelona, Spain.
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Abstract
BACKGROUND The purpose was to report a case of a novel approach for the removal of central interface epithelial ingrowth caused by a perforating corneal injury 6 years after laser-assisted in situ keratomileusis (LASIK). METHODS Access to a large central area of epithelial ingrowth under a LASIK flap was achieved through the wound tract from a perforating corneal injury. Suturing of the central LASIK flap in a similar manner commonly carried out peripherally was then performed to prevent recurrent epithelial ingrowth. RESULTS The offending epithelial ingrowth was removed with no recurrence over a 1-year follow-up. CONCLUSIONS This is, to our knowledge, the first reported case of central epithelial ingrowth removal from a LASIK interface by a perforating injury wound tract.
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32
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Bibliography. Refractive surgery. Current world literature. Curr Opin Ophthalmol 2011; 22:304-5. [PMID: 21654397 DOI: 10.1097/icu.0b013e3283486839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Handzel DM, Stanzel BV, Briesen S. [Complication cascade after hyperopic LASIK]. Ophthalmologe 2011; 108:665-8. [PMID: 21484301 DOI: 10.1007/s00347-011-2347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This report concerns the case of a 28-year-old female patient who was treated with topical steroids for 2 years following complicated hyperopic LASIK surgery with a re-treatment including a re-lift of the flap. A steroid-induced rise in the intraocular pressure (IOP) was subsequently observed on the treated eye, together with a glaucomatous subtotal destruction of the optic nerve, resulting in a residual vision of 1/15. An erroneously low IOP measurement, which was probably the reason for the delay in detecting steroid-induced glaucoma, has been reported in several cases concerning LASIK patients. The reason for the unusually severe course in the case in question can only be presumed, namely a possible accumulation of fluid at the interface or altered biomechanics following hyperopic LASIK surgery. The need for a thorough postoperative examination following refractive surgery must be emphasized. This case shows a cascade of complications following hyperopic LASIK surgery resulting in the functional blindness of one eye.
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Affiliation(s)
- D M Handzel
- Augenklinik Dardenne, Friedrich-Ebert-Str. 23-25, 53177, Bonn, Deutschland.
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Shin HY, Cho KJ, Kim MS. Combined Mitomycin-C Assisted Photorefractive Keratectomy in the Treatment of Epithelial Ingrowth after LASIK. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.8.984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hye Young Shin
- Department of Ophthalmology and Visual Science, The Catholic University College of Medicine, Seoul, Korea
| | - Kyong Jin Cho
- Department of Ophthalmology and Visual Science, The Catholic University College of Medicine, Seoul, Korea
| | - Man Soo Kim
- Department of Ophthalmology and Visual Science, The Catholic University College of Medicine, Seoul, Korea
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