Treatment of Epithelial Ingrowth After LASIK Enhancement With a Combined Technique of Mechanical Debridement, Flap Suturing, and Fibrin Glue Application

Narváez, Julio; Chakrabarty, Arun; Chang, Kenneth

doi:10.1097/01.ico.0000240086.56522.69

Cited by 45 publications

(19 citation statements)

References 14 publications

(16 reference statements)

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“…Treatment includes mechanical debridement and flap reattachment. Successful cases of flap attachment has been reported with no recurrence of epithelial ingrowth or fluid accumulation in the interface [107][108][109][110]. Azar et al treated recurrent epithelial ingrowth after LASIK by attaching an annular AM graft with fibrin glue [111].…”

Section: Epithelial Ingrowth and Other Laser-assisted In Situ Keratomilmentioning

confidence: 99%

Tissue adhesives in ocular surgery

Park

Champakalakshmi

Panengad

et al. 2011

Expert Review of Ophthalmology

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Section: Epithelial Ingrowth and Other Laser-assisted In Situ Keratomilmentioning

confidence: 99%

Tissue adhesives in ocular surgery

Park

Champakalakshmi

Panengad

et al. 2011

Expert Review of Ophthalmology

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“…[18][19][20] Fibrin glue has also been successfully used to secure AM in cases with corneal ulcers or perforations, 21,22 scleral melt, 23 conjunctivochalasis, 24,25 and pterygium. 26 It has been shown that in contrast to suturing, epithelial growth takes place only over AM when fibrin glue is used for central epithelial defects in rabbit corneas.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Sutureless Amniotic Membrane Transplantation for Partial Limbal Stem Cell Deficiency

Kheirkhah

Casas

Raju

et al. 2008

American Journal of Ophthalmology

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PURPOSE-To evaluate the results of sutureless amniotic membrane (AM) transplantation using fibrin glue for reconstructing corneal surfaces with partial limbal stem cell deficiency (LSCD). DESIGN-Retrospective noncomparative interventional case series.METHODS-Eleven eyes of nine patients that had LSCD with 120 degrees to almost 360 degrees of limbal involvement underwent superficial keratectomy to remove the conjunctivalized pannus followed by AM transplantation using fibrin glue. Additional sutureless AM patch (ProKera; BioTissue, Inc, Miami, Florida, USA) was used in seven patients, and mitomycin C was applied on the cornea in four eyes and during fornix reconstruction in seven eyes. The surgery was repeated in three eyes for residual pannus.RESULTS-During a mean follow-up of 14.2 ± 7.7 months (range, six to 26 months), all eyes maintained a smooth and stable corneal epithelial surface without recurrent erosion or persistent epithelial defect, and showed less stromal cloudiness and vascularization. Best-corrected visual acuity improved in nine eyes (81.8%). Corneal epithelialization proceeded by epithelial growth over AM (n = 4), accompanied by dissolution of AM (n = 4) or a combination of both (n = 3). No complication was noted regarding initial or repeated uses of fibrin glue.CONCLUSION-AM transplantation using fibrin glue appears to be a safe and effective method of restoring a stable corneal epithelium for cases with partial LSCD. This approach avoids the need of transplanting limbal epithelial stem cells. THE MAINTENANCE OF A HEALTHY CORNEAL EPITHElium under both normal and traumatic conditions is provided by a unique subpopulation of stem cells located at the limbus. 1,2 When limbal epithelial stem cells are destroyed and/or their supporting stromal environment becomes dysfunctional, a pathological state known as limbal stem cell deficiency (LSCD) develops (for review; see Reference 3 ). LSCD carries the cytologic evidence of conjunctivalization of the corneal surface by a goblet cell-containing conjunctival epithelium. 4 Pathologically, limbal-deficient corneas exhibit destruction of the basement membrane, superficial neovascularization, chronic inflammation, scarring, and poor epithelial integrity (for reviews; see References 3 and 5 ). Clinically, LSCD is a major cause of corneal blindness unable to be corrected by traditional corneal transplantation alone.For eyes inflicted with partial LSCD, where a part of the limbus is damaged, the corneal surface can be reconstructed by debridement of conjunctivalized epithelium with 6-8 or without 9 transplantation of amniotic membrane (AM). Several studies have shown that in eyes with partial LSCD, AM promotes expansion of remaining limbal epithelial stem cells. [6][7][8]10 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript these studies, sutures were used to secure AM to the cornea following the removal of conjunctivalized pannus from the corneal surface. Recent findings suggest that epithelialization may occur both over and unde...

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Section: Epithelial Ingrowthmentioning

confidence: 99%

“…One problem with this technique is the induction of astigmatism (Narvaez et al, 2006). An alternative method of scraping and suturing with the application of fibrin glue has been found to reduce the induction of astigmatism (Narvaez et al, 2006). Ethanol and mitomycin treatments have also been proposed as methods to destroy epithelial ingrowth but are not as reliable due to their toxic effects (Wang and Maloney, 2000).…”

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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Treatment of Epithelial Ingrowth After LASIK Enhancement With a Combined Technique of Mechanical Debridement, Flap Suturing, and Fibrin Glue Application

Abstract: Severe progressive epithelial ingrowth may be treated successfully with a combination of mechanical debridement, flap suturing, and fibrin glue application.

Cited by 45 publications

References 14 publications

Tissue adhesives in ocular surgery

Tissue adhesives in ocular surgery

Sutureless Amniotic Membrane Transplantation for Partial Limbal Stem Cell Deficiency

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

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