Epithelial ingrowth after LASIK treatment with scraping and phototherapeutic keratectomy

Disruption of ingrown epithelium via Nd:YAG laser or DIEYAG. A retrospective case series of Post-LASIK patients

Purpose

To describe in detail the technique used and results of disruption of ingrown epithelium via Nd:YAG laser (DIEYAG) after LASIK treatment and enhancement.

Observations

Epithelial ingrowth following laser in situ keratomileusis (LASIK) enhancement has the potential to cause significant refractive error and discomfort when allowed to progress. This retrospective case series following seven eyes after LASIK enhancement and one eye with flap trauma, assessed the effectiveness and safety of the disruption of ingrown epithelium via Nd:YAG laser. In all cases, we found that the progression of ingrown epithelium was eliminated. Using best spectacle corrected visual acuity and topography as our main outcome measures, we found that refractive error and visual disturbance caused by ingrowth stabilized or improved, with no subsequent complications identified.

Conclusion and Importance

The disruption of ingrown epithelium via Nd:YAG laser offers a safe and effective alternative to other treatments for epithelial ingrowth after LASIK treatment and enhancement.

Epithelial implantation treatment after small-incision lenticule extraction

Two cases of epithelial implantation after small-incision lenticule extraction (SMILE) treated by Nd:YAG laser and interface sweeping are described. A 40-year-old woman and 33-year-old man underwent SMILE and subsequently were noted to have epithelial cells implanted into the surgical interface. One case was treated using Nd:YAG laser. The laser was focused to the level of the interface with an energy level of 0.3 mJ. The treatment covered the entire area of epithelial implantation. The second case was treated by opening the original SMILE incision and sweeping the residual epithelial cells from the interface followed by a washout. Both the Nd:YAG laser and interface sweeping proved to be effective in reducing or eliminating the epithelial cells from the SMILE interface. Further studies are needed to report on overall safety and efficacy of these 2 techniques.

Nd:YAG laser for epithelial ingrowth after laser in situ keratomileusis

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.

Epithelial ingrowth following laser in situ keratomileusis (LASIK): prevalence, risk factors, management and visual outcomes

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.

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

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.

Nd:YAG laser treatment for epithelial ingrowth after laser refractive surgery

Epithelial ingrowth under refractive surgery flaps occurs in primary treatment and in further flap lift. Nd:YAG treatment was first described in 2008. In the only series published to date, 100% of patients treated had topographic and symptomatic improvement. The authors pictorially illustrate two cases of epithelial ingrowth following laser in situ keratomileusis achieving complete symptomatic relief and marked microscopic improvement following Nd:YAG laser treatment.

Treatment of laser in situ keratomileusis interface epithelial ingrowth with neodymium:yytrium-aluminum-garnet laser

PURPOSE

To evaluate the results obtained with the treatment for interface epithelial ingrowth after laser in situ keratomileusis (LASIK) with neodymium:yytrium-aluminum-garnet (Nd:YAG) laser.

DESIGN

Retrospective, interventional, noncomparative, consecutive case series.

METHODS

Thirty eyes were treated with Nd:YAG laser for clinically significant epithelial ingrowth developed after LASIK. Each impact produced an explosion with evaporation of epithelial cells giving rise to bubbles. The mean intensity of the spots was 0.6 mJ, and they were variable in quantity depending on the size of the epithelial ingrowth area. The patients were followed up for two years.

RESULTS

The opacities caused by the epithelial ingrowth disappeared in 80% of the cases with the Nd:YAG laser treatment. In 40% of the cases, two or more sessions of Nd:YAG laser treatment were necessary to eliminate the epithelial ingrowth areas entirely. In 60% of the cases, visual acuity improved by one or more lines of vision and the corneal topography was more regular. After the treatment, symptoms like glare and halos improved in all cases. The intensity of the laser was adjusted in each case and was focused perfectly on the epithelial ingrowth areas. There were no complications.

CONCLUSIONS

Nd:YAG laser, in our experience, is an easy and effective technique for the treatment of epithelial ingrowth after LASIK.

Nordic research in ophthalmology

Nordic ophthalmologists and vision scientists are active in many fields of eye research. This is most evident at the biannual Nordic Congress of Ophthalmology, most recently held in Malmö in June 2004. The authors here review some of the research in vision and ophthalmology presented at this meeting or published recently by Nordic scientists. This paper does not represent a comprehensive review of all Nordic research in the field, but attempts to give an overview of some of the activities underway in eye research in this part of the world.