Treatment of Epithelial Ingrowth After Laser In Situ KeratomileusisWith Mechanical Debridement and Flap Suturing

Rojas, Maria C.; Lumba, Joanna D.; Manche, Edward E.

doi:10.1001/archopht.122.7.997

Cited by 41 publications

(28 citation statements)

References 18 publications

(35 reference statements)

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“…Flap suturing is a suggested method to create a tight junction between the stromal bed and the flap and prevent the recurrence of ingrowth. 4 In the case described, however, the paracentral location of the flap precluded the placement of sutures, as it was thought that the induced astigmatism and potential scarring would be severe.…”

Section: Discussionmentioning

confidence: 91%

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Fibrin glue for prevention of recurrent epithelial ingrowth under a LASIK flap with a central buttonhole defect

Manche

2012

Journal of Cataract and Refractive Surgery

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A 61-year-old woman presented with a paracentral buttonhole flap defect associated with a linear tear, extensive epithelial ingrowth, and macrostriae in the right eye. A laser in situ keratomileusis enhancement had been performed 3 weeks earlier. The epithelial ingrowth was removed after careful lifting of the flap, and tissue adhesive was used postoperatively as a barrier to further ingrowth. Six months postoperatively, the patient's corrected distance visual acuity had improved to 20/20 and the slitlamp examination showed no evidence of recurrent epithelial ingrowth. This case presents a novel approach to the management of a buttonhole defect.

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Section: Discussionmentioning

confidence: 91%

“…[3][4][5] This condition occurs up to several-fold times more often after retreatment than after primary LASIK flap creation. 5,6 The recurrence rate after ingrowth removal has been as high as 44%.…”

Section: Discussionmentioning

confidence: 99%

Fibrin glue for prevention of recurrent epithelial ingrowth under a LASIK flap with a central buttonhole defect

Manche

2012

Journal of Cataract and Refractive Surgery

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“…A more improved version of this treatment is to lift the flap, remove the ingrowth mechanically, and then suture the flap (Rojas MC et al, 2004). Suturing would ensure that the fistula closes properly, preventing further progression of ingrowth cells into the flap interface to allow complete healing.…”

Section: Epithelial Ingrowthmentioning

confidence: 99%

“…One study showed that no regrowth occurred after scraping of ingrowth under the flap with sutures (Rojas MC et al, 2004). One problem with this technique is the induction of astigmatism (Narvaez et al, 2006).…”

Section: Epithelial Ingrowthmentioning

confidence: 99%

Corneal Densitometry as a Tool to Measure Epithelial Ingrowth After Laser In Situ Keratomileusis

Adran

Vaillancourt

Harissi‐Dagher

et al. 2017

Cornea

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were obtained for each patient pre-operatively and post-operatively after ingrowth was discovered. Densitometry was recorded at the central nest of opacity and at the leading edges of the ingrowth. For all patients, the most severe stages of epithelial ingrowth observed on slit lamp photographs correlated to the highest densitometry readings, with peak densitometry ranging from 73.3 -95.1. These values were much higher than pre-operative densitometry readings, which ranged from 21.8 -27.2. In two cases, the Pentacam densitometry map revealed progression of ingrowth towards the visual axis that was only faintly detectable or not detectable at all on corresponding slit lamp photographs.Corneal densitometry can be used as an objective measure of the severity and progression of epithelial ingrowth.vi

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“…When necessary, the initial surgical treatment of epithelial growth is accomplished with the elevation of the flap, removal of epithelial cells from the posterior surface of the flap and the stromal bed with a knife or similar instrument, and replacement of the flap without sutures or adhesive tissues (29) . In case of recurrent episodes of epithelial growth, additional measurements are typically made, including suturing the flap (35) (Figure 3), fibrin glue (36) or yag laser treatment (37) .…”

Section: Epithelial Growthmentioning

confidence: 99%

LASIK interface primary complications

Moraes¹,

Ghanem²,

Ghanem³

et al. 2016

Revista Brasileira De Oftalmologia

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Laser in situ Keratomileusis (LASIK) RESUMOLaser in situ Keratomileusis (LASIK) é uma das técnicas mais aceitas na cirurgia refrativa atualmente. Sua previsibilidade, reprodutibilidade, segurança e baixos índices de efeitos colaterais justificam a ampla difusão dessa técnica. Trata-se de um procedimento cirúrgico a laser cujo objetivo consiste na modificação da estrutura corneana, permitindo uma mudança do ponto focal do olho. Dessa forma, é possível corrigir ametropias tais como a miopia, astigmatismo e pequenos graus de hipermetropia. A técnica do LASIK consiste na criação de um flap corneano por meio da utilização de um microcerátomo ou do laser de femtossegundo. Em seguida, é realizada a aplicação do excimer laser sobre o leito estromal com posterior reposicionamento do flap, criando-se uma interface entre as lamelas anterior e posterior da córnea. Apesar das inúmeras vantagens, existem patologias que resultam de complicações primárias da interface do flap, que podem causar confusão no momento do diagnóstico, por possuírem semelhanças quanto à sua apresentação clínica. O objetivo desse trabalho é definir, caracterizar e comparar tais entidades com intuito de facilitar o diagnóstico diferencial dessas patologias evitando a adoção de um tratamento equivocado. Como resultado do estudo, são apresentadas recomendações quanto à conduta nos casos de cada patologia de interface, com investigação por meio da anamnese e exame clínico, a fim de permitir diagnóstico diferencial entre as principais entidades primárias da interface do procedimento LASIK. Descritores: Ceratomileuse assistida por excime laser in situ/efeitos adversos; Procedimentos cirúrgicos oftalmológicos/efeitos adversos Rev Bras Oftalmol. 2016; 75 (1): 70-5

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Treatment of Epithelial Ingrowth After Laser In Situ KeratomileusisWith Mechanical Debridement and Flap Suturing

Abstract: To evaluate the efficacy and safety of mechanical debridement and suturing of the laser in situ keratomileusis (LASIK) flap in the treatment of clinically significant epithelial ingrowth after LASIK.

Cited by 41 publications

References 18 publications

Fibrin glue for prevention of recurrent epithelial ingrowth under a LASIK flap with a central buttonhole defect

Fibrin glue for prevention of recurrent epithelial ingrowth under a LASIK flap with a central buttonhole defect

Corneal Densitometry as a Tool to Measure Epithelial Ingrowth After Laser In Situ Keratomileusis

LASIK interface primary complications

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