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

Abstract

BackgroundSurgical 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 presentationWe 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.ConclusionThese 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.

Self-Retained, Sutureless Amniotic Membrane Transplantation for the Management of Ocular Surface Diseases

“…The literature revealed the effect of an AM pressure patch inhibited epithelial ingrowth in cases of LASIK flap trauma. Kwon et al applied the AM over the cornea and sutured tightly to the episclera, and no recurrent epithelial ingrowth occurred after a 5-month follow-up [13,14]. Meskin et al [15] sutured the central LASIK flap in cases of epithelial ingrowth following perforated cornea injury.…”

Management of recalcitrant epithelial ingrowth after laser in situ keratomileusis

“…Unfortunately, epithelial ingrowth can recur after intervention. Therefore, mitomycin C, fibrin glue, [ 2 ] Nd:YAG laser, [ 3 ] hydrogel ocular sealant, [ 4 ] amniotic membrane patch, [ 5 ] and corneal collagen crosslinking [ 6 ] have all been used to eliminate corneal epithelial cells that have grown between the corneal flap and stromal bed. This case report presents a rare case of epithelial ingrowth that was diagnosed with slit-lamp microscopy and Pentacam imaging.…”