Original article
Treatment of Laser In Situ Keratomileusis Interface Epithelial Ingrowth with Neodymium:Yytrium–Aluminum–Garnet Laser

https://doi.org/10.1016/j.ajo.2007.11.022Get rights and content

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.

Section snippets

Methods

Thirty eyes of 25 patients with epithelial ingrowth after LASIK surgery were treated with Nd:YAG laser. All the LASIK procedures were performed by the same surgeon (J.L.A.) using the same technique. During LASIK surgery, the flaps were created using various microkeratomes: Hansatome (Bausch & Lomb, Rochester, New York, USA), Carriazo Pendular (Schwind Eye-Tech-Solutions, Kleinostheim, Germany), Moria M2 (Moria, Antony, France), and BD microkeratome (BD, Franklin Lakes, New Jersey, USA). The

Results

A total of 30 eyes from 20 patients were included in this study: 16 eyes underwent myopic LASIK and 14 eyes underwent LASIK for hyperopia. Eleven patients were female and nine were male. The mean age was 35 years (range, 22 to 45 years).

In three eyes (10%), epithelial ingrowth appeared after the first LASIK surgery, and in the other 27 eyes (90%), it appeared after LASIK retreatment. The location of the epithelial ingrowth was central in 10 eyes, affecting in part the visual axis. In 20 eyes,

Case Report

A 29-year-old man had a refractive defect of −3.5 − 0.5 × 170 degrees in his left eye. His BCVA was 1.00 (20/20 Snellen equivalent). Three months after LASIK surgery, his UCVA was 1.00 (20/20 Snellen equivalent). One year later, his UCVA was 0.8 (20/25 Snellen equivalent), with −1 diopter (D) of spherical defect, and his BCVA was 1.00 (20/20 Snellen equivalent).

He was retreated by lifting the flap, after which his UCVA was 0.6 (20/32 Snellen equivalent). His UCVA decreased after five months to

Discussion

Several risk factors have been reported that may lead to the development of epithelial ingrowth. These include: epithelial basement membrane dystrophy, previous ingrowth in the other eye, hyperopic LASIK correction, flap instability, intraoperative epithelial defects, history of recurrent corneal erosions, diabetes mellitus with epithelial keratopathy, decentered flaps, trauma, the surgeon’s learning curve in both LASIK and flap lift enhancement techniques.1, 4, 16, 17 The incidence of ingrowth

Dr Maria José Ayala, Graduated in Medicine and Surgery from the Alicante University, Spain, in 1983 and completed her PhD in 1991. She received an PhD Special Award in 1992 from Alicante University. Dr Ayala is a Ophthalmologist specialized in Cornea and Refractive Surgery in the Instituto Oftalmologico of Alicante, now in Vissum Corporation Alicante, since 1987. She is an Honorific collaborator in the Pathology and Surgery Department of Alicante University, since 1989. Dr Ayala received the

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    Dr Maria José Ayala, Graduated in Medicine and Surgery from the Alicante University, Spain, in 1983 and completed her PhD in 1991. She received an PhD Special Award in 1992 from Alicante University. Dr Ayala is a Ophthalmologist specialized in Cornea and Refractive Surgery in the Instituto Oftalmologico of Alicante, now in Vissum Corporation Alicante, since 1987. She is an Honorific collaborator in the Pathology and Surgery Department of Alicante University, since 1989. Dr Ayala received the 2001 TROUTMAN Award, presented in the ISRS meeting in New Orleans, Louisiana. Dr Ayala is on the European Board of Ophthalmology and is an author of 60 peer-review articles.

    Dr Jorge L. Alió, is a Professor and Chairman of Ophthalmology of Alicante University and Miguel Hernandez University, Elche, Spain, since 1986. He is a Founder and Medical Director of Vissum Corporation-Instituto Oftalmologico de Alicante. Dr Alió is an author of over 52 books, 157 chapters, 289 articles in peer-review journals, and 36 patents. He has received 31 National and International Clinical and Research Awards. Dr Alió is a member of 26 scientific societies, current President of the ISRS/AAO, and is on the Editorial Board of numerous peer-review journals.

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