Original articleTreatment of Laser In Situ Keratomileusis Interface Epithelial Ingrowth with Neodymium:Yytrium–Aluminum–Garnet Laser
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
References (22)
- et al.
Epithelial ingrowth alter laser in situ keratomileusis
Am J Ophthalmol
(2000) - et al.
Epithelial ingrowth: causes, prevention, and treatment in 5 cases
J Cataract Refract Surg
(2001) - et al.
Flap suturing with proparacaine for recurrent epithelial ingrowth following laser in situ keratomileusis surgery
J Cataract Refract Surg
(2005) - et al.
Amniotic membrane as a biologic pressure patch for treating epithelial ingrowth under laser in situ keratomileusis flap
J Cataract Refract Surg
(2006) - et al.
Retreatment after laser in situ keratomileusis
Ophthalmology
(1999) - et al.
Epithelial defect, diffuse lamellar keratitis, and epithelial ingrowth following post-LASIK epithelial toxicity
J Cataract Refract Surg
(2002) - et al.
Comparison of the effects of LASIK retreatment techniques on epithelial ingrowth rates
Ophthalmology
(2007) - et al.
Nd:YAG laser corneal disruption as adjuvant treatment for infectious crystalline keratopathy
Am J Ophthalmol
(2000) Epithelial ingrowth after LASIK personal experience
Klin Oczna
(2003)- et al.
Incidence and prevention of epithelial growth within the interface after laser in situ keratomileusis
Cornea
(2000)
Risk factors in interface epithelialization alter laser in situ keratomileusis
J Refract Surg
Cited by (50)
Disruption 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 are a number of techniques currently utilized for the management of epithelial ingrowth. We and others have had documented success in disruption of ingrown epithelium via Nd:YAG laser which we refer to as, and for which we propose the acronym, DIEYAG.1–3 The most common complication of LASIK is undercorrection, which may be managed by lifting the flap and performing additional laser ablation.4
Laser flap enhancement 5 to 9 years and 10 or more years after laser in situ keratomileusis: Safety and efficacy
2019, Journal of Cataract and Refractive SurgeryCitation Excerpt :Grade 1 epithelial ingrowth developed in 31.43% of eye but did not require additional treatment and did not affect visual outcomes. Grade 2 epithelial ingrowth developed in 7.14% of eyes and was managed with Nd:YAG laser treatment.10 In no eye did grade 2 ingrowth require surgical intervention or adversely affect visual outcomes.
Epithelial ingrowth through venting incision into laser-assisted in situ keratomileusis flap interface after descemet stripping automated endothelial keratoplasty
2019, American Journal of Ophthalmology Case ReportsCitation Excerpt :5-Fluorouracil has been reported as a successful treatment in a few cases post keratoplasty.15,16 YAG laser has also been reported as a potential treatment of epithelial ingrowth post LASIK, but involves the risk of flap breakthrough with additional ingrowth.17,18 Repeat EK or PKP may be necessary in severe cases such as those resulting in graft failure.
March consultation #7
2018, Journal of Cataract and Refractive SurgeryComparison of 5468 retreatments after laser in situ keratomileusis by lifting the flap or performing photorefractive keratectomy on the flap
2018, Archivos de la Sociedad Espanola de OftalmologiaManagement 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
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.