Epithelial ingrowth after laser in situ keratomileusis: clinical features and possible mechanisms
Section snippets
Design
This study was an interventional case series of patients with epthelial ingrowth occurring after LASIK.
Patients
Four thousand eight hundred sixty-seven eyes of 2,502 patients (1,452 male and 1,050 female; average age 34.5 ± 9.0 [SEM] years), who underwent myopic LASIK from May 1998 to March 2001 at Minamiaoyama Eye Clinic, were included in this study. The mean attempted correction was −6.08 ± 2.58 diopters. Sixty-four eyes (1.3%) of 54 patients (33 male and 21 female, average age 38.6 ± 9.0 [SEM] years) developed epithelial ingrowth. The slit-lamp examination findings, type of microkeratome used, and
Microkeratomes and flap thickness
Epithelial ingrowth was diagnosed in 30 eyes (0.94%) of the LSK-One group (3,187 eyes) and 34 eyes (2.0%) in the MK-2000 group (1,680 eyes). The frequency of epithelial ingrowth in the MK-2000 group was significantly higher than that in the LSK-One group (P = .001). When the incidence of epithelial ingrowth was compared among different types of heads, it was found that heads with lower estimated thicknesses were more likely to develop epithelial ingrowth (Table 1).
The corneal flap was
Discussion
The incidence of epithelial ingrowth after LASIK in the present study was 1.31%. Epithelial ingrowth was diagnosed within 1 month in 79% of eyes. These results are consistent with previous reports.2, 3, 4, 5, 6 Epithelial ingrowth mainly developed near the corneal flap margin, most often at the temporal edge.
Many findings were observed before the epithelial ingrowth. A loose epithelial layer or epithelial defect was detected significantly more often in cases with epithelial ingrowth than in
Acknowledgements
The authors thank Mrs. Chikako Sakai, Minamiaoyama Eye Clinic, for her help with statistical data analysis, and Yoshihisa Oguchi, MD, Department of Ophthalmology, Keio University School of Medicine, for supervising the electron microscopic observation.
References (10)
- et al.
Epithelial ingrowth after laser in situ keratomileusis
Am J Ophthalmol
(2000) - et al.
Laser in situ keratomileusisliterature review of a developing technique
J Cataract Refract Surg
(1998) - et al.
Dry eye following laser in situ keratomileusis
Am J Ophthalmol
(2001) - et al.
Sloughing of corneal epithelium and wound healing complications associated with laser in situ keratomileusis in patients with epithelial basement membrane dystrophy
Am J Ophthalmol
(2000) - et al.
The corneal wound healing responsecytokine-mediated interaction of the epithelium, stroma, and inflammatory cells
Prog Retin Eye Res
(2001)
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Corneal foreign body post laser in-situ keratomileusis: Diagnosis, management, outcome and review of literature
2024, American Journal of Ophthalmology Case ReportsDisruption of ingrown epithelium via Nd:YAG laser or DIEYAG. A retrospective case series of Post-LASIK patients
2021, American Journal of Ophthalmology Case ReportsCitation Excerpt :There have been two proposed hypotheses for the mechanism of epithelial ingrowth. One theory is that implantation of epithelial cells under the flap occurs during the surgery; the other theory is that there is a postoperative invasion of surface epithelial cells under the edge of the corneal flap.9–11 Deposited epithelial cells appear to have limited ability to proliferate due to poor nutrient supply, supporting the postoperative migration theory.10
Usefulness of bandage contact lenses in the immediate postoperative period after uneventful myopic LASIK
2018, Contact Lens and Anterior EyeCitation Excerpt :There is a lack of research and the benefits are unclear as the flap replacement after the stromal ablation is recognized as a natural bandage. While some studies conclude that BCL are useful to reduce discomfort in the management of recurrent epithelial loosening following LASIK [9], in cases of excessive hydration of the flap and to prevent epithelial ingrowth [10], other studies point out that there is not benefit on this practice that potentially may lead to corneal edema or infection [11,12]. Some of these studies have chosen Likert-type [13] or normalized scales (as the Cornea and Contact Lens Research Unit Grading Scale) in order to evaluate corneal integrity [14]; both provide subjective results as are conditioned by the examiner criteria and thus, the accuracy may be compromised.
Comparison of 5468 retreatments after laser in situ keratomileusis by lifting the flap or performing photorefractive keratectomy on the flap
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2017, Journal of Cataract and Refractive SurgeryCitation Excerpt :Temporary interrupted sutures were used in the chronic cases that did not respond to repeated relifting and irrigation. Of interest is the small rate of under-flap epithelial ingrowth requiring removal (1.0%), less than reported in flap relift excimer enhancements for microkeratome-assisted LASIK.27–29 This is likely because care was taken not to introduce epithelium with the relift technique and because the intervention was performed early, before flap edge scarring began.
Management of recurrent epithelial ingrowth following laser in situ keratomileusis with mechanical debridement, alcohol, mitomycin-C, and fibrin glue
2017, Journal of Cataract and Refractive Surgery