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Fernández-Barrientos Y, Ortega-Usobiaga J, Beltran-Sanz J, Druchkiv V, Ramos-Navarro JL, González-de-Gor-Crooke JL. Efficacy and Safety of Surgically Managed Late Traumatic LASIK Flap Displacements in a Study of 66 Cases. J Refract Surg 2022; 38:270-276. [PMID: 35412921 DOI: 10.3928/1081597x-20220128-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate safety and efficacy in the management of flap displacement after laser in situ keratomileusis (LASIK) and subsequent complications. METHODS This was a retrospective study performed using data recorded at the center's database from October 2002 to August 2021. Efficacy and safety were both converted to binary outcomes (loss of one or more lines and no change or gain in lines of visual acuity). The effects of time from surgery to complication and from complication to repair were assessed and the odds ratios and probabilities were calculated. The same procedure was applied to investigate the effect of these temporal variables on complications. RESULTS A total of 66 eyes with late traumatic LASIK flap displacements were studied. Efficacy remained unchanged in 48 patients (64 eyes, 75%), and safety remained unchanged in 53 patients (59 eyes, 90%). Sixty-six patients (64 eyes, 100%) achieved visual acuity values of 20/40 and 45 patients (64 eyes, 70.3%) achieved values of 20/20. The flap displacement was resolved in the first 24 hours (SD ± 0.1 days). Surgery was performed in 58 patients (65 eyes, 90%). Epithelial ingrowth was the most frequent complication. Patients who underwent surgery tended not to lose lines (P = .05). The risk of developing epithelial ingrowth increases with time after LASIK surgery until traumatic flap displacement (odds ratio: 1.001; P < .001). The prevalence of dislocation during the study period was 0.012%. CONCLUSIONS Visual safety values were favorable after resolution of the flap complication. Immediate surgical management leads to better visual efficacy, and the time between LASIK and trauma increases the risk of epithelial ingrowth after flap displacement. [J Refract Surg. 2022;38(4):270-276.].
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Nair S, Kaur M, Bari A, Titiyal JS. Flap amputation for long-standing post-LASIK flap dislocation with epithelial ingrowth. BMJ Case Rep 2022; 15:e247068. [PMID: 35135801 PMCID: PMC8830197 DOI: 10.1136/bcr-2021-247068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/04/2022] Open
Abstract
A man aged 26 years presented with complaints of diminution of vision in his right eye for 1 year following a fist injury. He had a history of laser-assisted in situ keratomileusis in both eyes 5 years earlier. On examination, his uncorrected distance visual acuity (UDVA) in the right eye was 1.0 logMAR. Slit-lamp examination of the right eye revealed a superotemporal dislocation of the flap with coexisting epithelial ingrowth encroaching the pupillary area. Due to the presence of long-standing fixed flap folds, a flap amputation was performed along with removal of the epithelial ingrowth using 0.02% mitomycin C as adjunct. Postoperatively, the UDVA was 0.3 logMAR on day 1, which improved to 0.2 logMAR at 1 week. At 1 year, the UDVA was 0.2 logMAR improving to 0.1 logMAR with refraction, with minimal paracentral corneal haze and no signs of corneal ectasia.
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Affiliation(s)
- Sridevi Nair
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Aafreen Bari
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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3
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Lee PH, Huang YH. Application of two-part glue technique in epithelial ingrowth after laser in situ keratomileusis flap dislocation. Indian J Ophthalmol 2021; 69:1614-1617. [PMID: 34011754 PMCID: PMC8302305 DOI: 10.4103/ijo.ijo_3263_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old woman who underwent uneventful laser in situ keratomileusis surgery 16 years ago presented with traumatic flap dislocation complicated by an epithelial ingrowth in the right eye. The epithelial ingrowth was managed with re-lifting the flap, mechanical debridement, soaking with 70.0% alcohol, and irrigation. The flap was repositioned and secured with a two-part glue technique. Serial anterior segment-optical coherence tomography demonstrated a well-attached flap with no gap or haze in the flap-stromal interface. Three weeks postoperatively, the patient returned to emmetropia and the uncorrected distance visual acuity improved to 20/20. Twelve months postoperatively, the patient's visual acuity remained 20/20, and there was no evidence of recurrent epithelial ingrowth.
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Affiliation(s)
- Peng-Hsuan Lee
- Department of Ophthalmology, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hsun Huang
- Department of Ophthalmology, National Cheng Kung University Hospital; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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4
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Chang YC, Lee YC. Traumatic laser in situ keratomileusis flap dislocation with epithelial ingrowth, Propionibacterium acnes infection, and diffuse lamellar keratitis: A case report. Medicine (Baltimore) 2020; 99:e19257. [PMID: 32150061 PMCID: PMC7478497 DOI: 10.1097/md.0000000000019257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Traumatic flap dislocation might occur anytime after laser in situ keratomileusis (LASIK), but it is rarely concomitantly complicated with epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis altogether. Here we report a case of traumatic LASIK flap inversion with epithelial ingrowth, Propionibacterium acnes infection, and diffuse lamellar keratitis. PATIENT CONCERNS A 42-year-old man receiving bilateral LASIK surgery 10 years ago complained of right eye pain for 6 days after twig injury. Temporal flap inversion with epithelial ingrowth and dense infiltration at the interface were noted. DIAGNOSES Traumatic LASIK flap inversion with epithelial ingrowth, Propionibacterium acnes infection and diffuse lamellar keratitis. INTERVENTIONS Removal of corneal epithelium around the flap inversion site, flap lifting, scraping of epithelial ingrowth, removal of the dense infiltrate, alcohol soaking, interface irrigation with antibiotics, and flap reposition were performed. Diffuse lamellar keratitis was noted postoperatively. Culture of the infiltrate revealed P acnes. The infiltrate subsided and the cornea cleared up under topical antibiotics and steroid. OUTCOMES The visual acuity returned to 20/20. No recurrent epithelial ingrowth or infiltrate was noted during the follow-up. LESSONS This is the first report of Propionibacterium acnes keratitis after traumatic flap inversion. Although epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis all developed after the flap inversion, early recognition and proper intervention lead to a good result without sequels.
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Affiliation(s)
| | - Yuan-Chieh Lee
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital
- Department of Ophthalmology and Visual Science
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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5
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Fischinger I, Wendelstein J, Bolz M, Tetz M. Calzone-Like Traumatic Flap Dislocation Four Years after Laser in situ Keratomileusis. Case Rep Ophthalmol 2019; 10:281-286. [PMID: 31692604 PMCID: PMC6760352 DOI: 10.1159/000502283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/21/2019] [Indexed: 12/03/2022] Open
Abstract
A 46-year-old patient presented with a flip-folded partially dislocated flap after trauma caused by a sheet of paper, four years after a reportedly uneventful laser in situ keratomileusis procedure using microkeratome. Flap re-lift, mechanical debridement, and flap stretching were performed in a first interventional approach. Due to epithelial ingrowth two month after the first intervention, a flap re-lift and mechanical removal of epithelial cells from the stroma bed and flap were performed. In addition, triamcinolone was applied subconjunctivally. Thereafter, best corrected visual acuity of 20/20 was regained and no more epithelial ingrowth was observed. Only few cases of flap dislocation with epithelial ingrowth have been described in the literature following trauma, though none of a permanently inward folded flap. The use of subconjunctival triamcinolone is a new approach to prevent recurrent epithelial ingrowth.
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Affiliation(s)
- Isaak Fischinger
- Department of Ophthalmology, Augentagesklinik Spreebogen, Berlin, Germany.,Department of Ophthalmology, Johannes Kepler Universität, Kepler Universitätsklinikum, Linz, Austria
| | - Jascha Wendelstein
- Department of Ophthalmology, Johannes Kepler Universität, Kepler Universitätsklinikum, Linz, Austria
| | - Matthias Bolz
- Department of Ophthalmology, Johannes Kepler Universität, Kepler Universitätsklinikum, Linz, Austria
| | - Manfred Tetz
- Department of Ophthalmology, Augentagesklinik Spreebogen, Berlin, Germany
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6
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Alvarez MT, Montesel A, Bataille L. Late traumatic flap dislocation seven years after femtosecond laser-assisted in situ keratomileusis. Int J Ophthalmol 2019; 12:862-865. [PMID: 31131251 DOI: 10.18240/ijo.2019.05.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/13/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- María T Alvarez
- Cataract and Refractive Surgery Department, VISSUM, Madrid 28035, Spain.,Research and Development Department, VISSUM, Alicante 03016, Spain
| | - Andrea Montesel
- Research and Development Department, VISSUM, Alicante 03016, Spain
| | - Laurent Bataille
- Research and Development Department, VISSUM, Alicante 03016, Spain
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7
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Galvis V, Tello A, Ortiz AI, Quintero MP, Parra MM, Blanco NA. Traumatic corneal flap avulsion and loss 13 years after LASIK. Saudi J Ophthalmol 2018; 33:172-176. [PMID: 31384163 PMCID: PMC6664271 DOI: 10.1016/j.sjopt.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/12/2018] [Accepted: 08/06/2018] [Indexed: 11/30/2022] Open
Abstract
Postoperative flap displacements after Laser In Situ Keratomileusis (LASIK) are uncommon complications, and flap losses are even less frequent, occurring most commonly within 24 hours after the procedure. Although cases of late subluxation have been reported up to 14 years after the surgery, the longest reported time after surgery for late flap loss is four years after LASIK. We report a case of a 54-year-old man that presented a traumatic total flap avulsion and loss 13 years after LASIK. According to our knowledge, this is the longest time reported in such a case in the literature. Medical treatment yielded an acceptable visual result. This case reinforces the concept that there could be a lifelong potential risk of traumatic corneal flap loss after LASIK.
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Affiliation(s)
- Virgilio Galvis
- Fundación Oftalmológica de Santander FOSCAL, Ophthalmology Department, Floridablanca, Colombia.,Universidad Autonoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Colombia.,Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
| | - Alejandro Tello
- Fundación Oftalmológica de Santander FOSCAL, Ophthalmology Department, Floridablanca, Colombia.,Universidad Autonoma de Bucaramanga, Faculty of Health Sciences, Bucaramanga, Colombia.,Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
| | - Alvaro I Ortiz
- Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia
| | - María P Quintero
- Fundación Oftalmológica de Santander FOSCAL, Ophthalmology Department, Floridablanca, Colombia.,Universidad Industrial de Santander, Faculty of Health, Bucaramanga, Colombia
| | - M Margarita Parra
- Fundación Oftalmológica de Santander FOSCAL, Ophthalmology Department, Floridablanca, Colombia.,Universidad Industrial de Santander, Faculty of Health, Bucaramanga, Colombia
| | - Nicolás A Blanco
- Fundación Oftalmológica de Santander FOSCAL, Ophthalmology Department, Floridablanca, Colombia.,Universidad Industrial de Santander, Faculty of Health, Bucaramanga, Colombia
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8
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Late-onset traumatic dislocation of laser in situ keratomileusis corneal flaps: a case series with many clinical lessons. Int Ophthalmol 2018; 39:1397-1403. [DOI: 10.1007/s10792-018-0946-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
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9
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Ting DSJ, Srinivasan S, Danjoux JP. Epithelial ingrowth following laser in situ keratomileusis (LASIK): prevalence, risk factors, management and visual outcomes. BMJ Open Ophthalmol 2018; 3:e000133. [PMID: 29657982 PMCID: PMC5895975 DOI: 10.1136/bmjophth-2017-000133] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/03/2018] [Accepted: 03/02/2018] [Indexed: 11/28/2022] Open
Abstract
The number of laser in situ keratomileusis (LASIK) procedures is continuing to rise. Since its first application for correcting simple refractive errors over 25 years ago, the role of LASIK has extended to treat other conditions, including postkeratoplasty astigmatism/ametropia, postcataract surgery refractive error and presbyopia, among others. The long-term effectiveness, predictability and safety have been well established by many large studies. However, due to the creation of a potential interface between the flap and the underlying stroma, interface complications such as infectious keratitis, diffuse lamellar keratitis and epithelial ingrowth may occur. Post-LASIK epithelial ingrowth (PLEI) is an uncommon complication that usually arises during the early postoperative period. The reported incidence of PLEI ranged from 0%–3.9% in primary treatment to 10%–20% in retreatment cases. It can cause a wide spectrum of clinical presentations, ranging from asymptomatic interface changes to severe visual impairment and flap melt requiring keratoplasty. PLEI can usually be treated with mechanical debridement of the affected interface; however, additional interventions, such as alcohol, mitomycin C, fibrin glue, ocular hydrogel sealant, neodymium:yttriumaluminum garnet laser and amniotic membrane graft, may be required for recurrent or refractory cases. The aims of this review are to determine the prevalence and risk factors of PLEI; to describe its pathogenesis and clinical features and to summarise the therapeutic armamentarium and the visual outcome of PLEI.
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Affiliation(s)
| | - Sathish Srinivasan
- Department of Ophthalmology, University Hospital Ayr, Ayr, UK.,Faculty of Medicine, University of Glasgow, Glasgow, UK
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10
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Xu YS, Xie WJ, Yao YF. Satisfactory clinical outcome following delayed repositioning of a traumatic post-LASIK flap with dislocation and shrinkage managed by irrigation, stretching, and debridement. J Zhejiang Univ Sci B 2017; 18:539-543. [PMID: 28585430 DOI: 10.1631/jzus.b1600363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To report surgical management and favorable outcome in a case with delayed repair of traumatic laser in situ keratomileusis (LASIK) flap dislocation with shrinkage and folds. METHODS A 30-year-old man with a five-year history of bilateral LASIK experienced blunt trauma to his right eye followed by decreased vision for 5 weeks. The surgical management included initially softening the flap by irrigation with balanced salt solution (BSS). The shrinkage folds were carefully and gently stretched by scraping with a 26-gauge cannula accompanied by BSS irrigation. All of the epithelial ingrowth on the flap inner surface and on the bed was thoroughly debrided by scraping and irrigation. After the flap was repositioned to match its original margin, a soft bandage contact lens was placed. RESULTS At his initial visit, slit-lamp microscopy and optical coherence tomography (OCT) showed shrinkage of the LASIK flap with an elevated margin approximately 3 mm above the original position. The flap covered half of the pupil and had multiple horizontal folds. Two months after surgery, the flap remained well positioned with only faint streaks in the anterior stroma. The uncorrected visual acuity of the right eye was 20/20 with a manifest refraction of Plano. CONCLUSIONS For delayed repair of traumatically dislocated LASIK flaps, sufficient softening by BSS, stretching the shrinkage folds, and thorough debridement of ingrowth epithelium enable resetting the flap and provide satisfactory results.
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Affiliation(s)
- Ye-Sheng Xu
- Department of Ophthalmology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Wen-Jia Xie
- Department of Ophthalmology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Yu-Feng Yao
- Department of Ophthalmology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
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11
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Tsai TH, Peng KL, Lin CJ. Traumatic corneal flap displacement after laser in situ keratomileusis (LASIK). Int Med Case Rep J 2017; 10:143-148. [PMID: 28458585 PMCID: PMC5403011 DOI: 10.2147/imcrj.s128637] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Laser in situ keratomileusis (LASIK) is the most common and popular procedure performed for the correction of refractive errors in the last two decades. We report a case of traumatic flap displacement with flap folding which occurred 3 years after LASIK was performed. Previous literature suggests that vision prognosis would be closely related to proper and prompt management of traumatic flap displacement with flap folding 3 years after LASIK. Case presentation A 23-year-old female presented to our hospital who had undergone uneventful LASIK in both eyes 3 years prior. Unfortunately, she had suffered a blunt trauma in her right eye in a car accident. A late onset of corneal flap displacement was found with upper and lower portion of the flap being folded inside the corneal bed. Surgical intervention for debridement with subsequent reposition of corneal flap was performed as soon as possible in the operating room. A bandage contact lens was placed, and topical antibiotic and corticosteroids were given postoperatively. Two days after the operation, the displaced corneal flap was found to be well attached smoothly on the corneal bed without folds. The best-corrected visual acuity was 6/6 with refraction of −0.75 D to 1.0 D ×175° in her right eye 1 month later. Literature review We reviewed a total of 19 published cases of late-onset traumatic flap dislocations or displacements after LASIK with complete data from 2000 to 2014. Conclusion Traumatic displacement of corneal flaps after LASIK may occur after blunt injury with specific direction of force to the flap margin, especially tangential one. According to the previous literature, late-onset traumatic flap displacement may happen at any time after LASIK and be caused by various types of injuries. Fortunately, good visual function could mostly be restored with immediate and proper management.
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Affiliation(s)
| | | | - Chien-Jen Lin
- Department of Radiology, Chi Mei Medical Center, Tainan, Taiwan
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12
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Hammer CM, Petsch C, Klenke J, Skerl K, Paulsen F, Kruse FE, Seiler T, Menzel-Severing J. Corneal tissue interactions of a new 345 nm ultraviolet femtosecond laser. J Cataract Refract Surg 2016; 41:1279-88. [PMID: 26189383 DOI: 10.1016/j.jcrs.2014.11.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/20/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the suitability of a new 345 nm ultraviolet (UV) femtosecond laser for refractive surgery. SETTING Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany. DESIGN Experimental study. METHODS Twenty-five porcine corneas were used for stromal flap or lamellar bed creation (stromal depth, 150 μm) and 15 rabbit corneas for lamellar bed creation near the endothelium. Ultraviolet femtosecond laser cutting-line morphology, gas formation, and keratocyte death rate were evaluated using light and electron microscopy and compared with a standard infrared (IR) femtosecond laser. Endothelial cell survival was examined after application of a laser cut near the endothelium. RESULTS Flaps created by the UV laser were lifted easily. Gas formation was reduced 4.2-fold compared with the IR laser (P = .001). The keratocyte death rate near the interface was almost doubled; however, the death zone was confined to a region within 38 μm ± 10 (SD) along the cutting line. Histologically and ultrastructurally, a distinct and continuous cutting line was not found after UV femtosecond laser application if flap lifting was omitted and standard energy parameters were used. Instead, a regular pattern of vertical striations, presumably representing self-focusing induced regions of optical tissue breakdown, were identified. Lamellar bed creation with standard energy parameters 50 μm from the endothelium rendered the endothelial cells intact and viable. CONCLUSION The new 345 nm femtosecond laser is a candidate for pending in vivo trials and future high-precision flap creation, intrastromal lenticule extraction, and ultrathin Descemet-stripping endothelial keratoplasty. FINANCIAL DISCLOSURES Mr. Klenke and Ms. Skerl were paid employees of Wavelight GmbH when the study was performed. Dr. Seiler is a scientific consultant to Wavelight GmbH. No other author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Christian M Hammer
- From the Department of Ophthalmology (Hammer, Petsch, Kruse, Menzel-Severing) and the Department of Anatomy II (Hammer, Paulsen), Friedrich-Alexander-University of Erlangen-Nürnberg, Wavelight GmbH (Klenke, Skerl), Erlangen, Germany; the Medical Research Institute (Skerl), University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom; the Institut für Refraktive und Ophthalmo-Chirurgie (Seiler), Zürich, Switzerland.
| | - Corinna Petsch
- From the Department of Ophthalmology (Hammer, Petsch, Kruse, Menzel-Severing) and the Department of Anatomy II (Hammer, Paulsen), Friedrich-Alexander-University of Erlangen-Nürnberg, Wavelight GmbH (Klenke, Skerl), Erlangen, Germany; the Medical Research Institute (Skerl), University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom; the Institut für Refraktive und Ophthalmo-Chirurgie (Seiler), Zürich, Switzerland
| | - Jörg Klenke
- From the Department of Ophthalmology (Hammer, Petsch, Kruse, Menzel-Severing) and the Department of Anatomy II (Hammer, Paulsen), Friedrich-Alexander-University of Erlangen-Nürnberg, Wavelight GmbH (Klenke, Skerl), Erlangen, Germany; the Medical Research Institute (Skerl), University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom; the Institut für Refraktive und Ophthalmo-Chirurgie (Seiler), Zürich, Switzerland
| | - Katrin Skerl
- From the Department of Ophthalmology (Hammer, Petsch, Kruse, Menzel-Severing) and the Department of Anatomy II (Hammer, Paulsen), Friedrich-Alexander-University of Erlangen-Nürnberg, Wavelight GmbH (Klenke, Skerl), Erlangen, Germany; the Medical Research Institute (Skerl), University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom; the Institut für Refraktive und Ophthalmo-Chirurgie (Seiler), Zürich, Switzerland
| | - Friedrich Paulsen
- From the Department of Ophthalmology (Hammer, Petsch, Kruse, Menzel-Severing) and the Department of Anatomy II (Hammer, Paulsen), Friedrich-Alexander-University of Erlangen-Nürnberg, Wavelight GmbH (Klenke, Skerl), Erlangen, Germany; the Medical Research Institute (Skerl), University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom; the Institut für Refraktive und Ophthalmo-Chirurgie (Seiler), Zürich, Switzerland
| | - Friedrich E Kruse
- From the Department of Ophthalmology (Hammer, Petsch, Kruse, Menzel-Severing) and the Department of Anatomy II (Hammer, Paulsen), Friedrich-Alexander-University of Erlangen-Nürnberg, Wavelight GmbH (Klenke, Skerl), Erlangen, Germany; the Medical Research Institute (Skerl), University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom; the Institut für Refraktive und Ophthalmo-Chirurgie (Seiler), Zürich, Switzerland
| | - Theo Seiler
- From the Department of Ophthalmology (Hammer, Petsch, Kruse, Menzel-Severing) and the Department of Anatomy II (Hammer, Paulsen), Friedrich-Alexander-University of Erlangen-Nürnberg, Wavelight GmbH (Klenke, Skerl), Erlangen, Germany; the Medical Research Institute (Skerl), University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom; the Institut für Refraktive und Ophthalmo-Chirurgie (Seiler), Zürich, Switzerland
| | - Johannes Menzel-Severing
- From the Department of Ophthalmology (Hammer, Petsch, Kruse, Menzel-Severing) and the Department of Anatomy II (Hammer, Paulsen), Friedrich-Alexander-University of Erlangen-Nürnberg, Wavelight GmbH (Klenke, Skerl), Erlangen, Germany; the Medical Research Institute (Skerl), University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom; the Institut für Refraktive und Ophthalmo-Chirurgie (Seiler), Zürich, Switzerland
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Abstract
Although photorefractive keratectomy often results in better corneal stability and fewer corneal flap complications than LASIK, pain remains a major drawback of the procedure. The authors compared the safety and efficacy of a postoperative cold patch versus intraoperative application of a chilled balanced salt solution on transepithelial photorefractive keratectomy-related postoperative pain. BACKGROUND: A return toward toward photorefractive keratectomy has occurred due to better corneal stability and fewer corneal flap complications; however, pain remains a major drawback of the procedure. Currently, clinical pain control measures focus on the administration of pain medications, which may delay corneal epithelial healing and has, occasionally, led to serious corneal toxicity. OBJECTIVES: To investigate the safety and efficacy of a cold patch on postoperative pain and other relevant consequences of transepithelial photorefractive keratectomy. METHODS: A prospective, randomized controlled study was conducted. Forty patients (80 eyes) scheduled to undergo transepithelial photorefractive keratectomy for myopia or myopic astigmatism were randomly and equally assigned to be treated with ice-cold balanced salt solution during surgery (wash group) or to wear a postoperative cold patch on the eye for 24 h. The main outcomes were pain score on a visual analogue scale, postoperative eyelid edema, conjunctival hyperemia, epithelial healing time, haze and postoperative best-corrected visual acuity. RESULTS: All patients completed the final tests. Demographic characteristics and pain scores during surgery were similar between the two groups. The mean postoperative pain scores of patients in the cold patch group at 8 h, 16 h and 24 h were significantly lower than those of patients in the wash group. Scores for postoperative eyelid edema and conjunctival hyperemia in the cold patch group were also lower than in the wash group. Patients in the cold patch group used fewer painkillers. Epithelial healing time, haze and early recovery of visual acuity were similar between the two groups. No eyelid frostbite was observed. CONCLUSION: Wearing a cold patch on the eye after transepithelial photorefractive keratectomy effectively relieved pain and inflammation, and reduced the use of painkillers without any side effects.
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14
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Kim JS, Chung B, Lee T, Kim WC, Kim TI, Kim EK. Management of long-standing partially torn and flipped laser in situ keratomileusis flaps. J Cataract Refract Surg 2014; 41:464-7. [PMID: 25537686 DOI: 10.1016/j.jcrs.2014.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 11/19/2022]
Abstract
UNLABELLED We describe 2 cases of traumatized and torn laser in situ keratomileusis (LASIK) flaps, partially flipped anteriorly or posteriorly, fixed for 8 months or 4 months, and accompanied by epithelial ingrowth. The 2 patients had had uneventful bilateral LASIK 6 years and 1 year before the trauma. In Case 1, the anteriorly flipped flap was removed with transepithelial phototherapeutic keratectomy. Next, mitomycin-C 0.04% was applied for 30 seconds. In Case 2, the portion of the flap that was flipped posteriorly and buried under the remaining intact LASIK flap was restored to its original normal position and epithelial ingrowth was removed mechanically with a microcurette. Irrigation with 20% ethanol was performed to inhibit the recurrence of interfacial epithelial ingrowth. The stretched amniotic membrane overlay over the cornea and sclera was sutured tightly to the episclera as the biologic pressure patch for the inhibition of epithelial re-ingrowth. Good visual acuity was restored in both cases. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Jin Sun Kim
- From the Department of Ophthalmology (J.S. Kim, Chung, Lee, T-i Kim, E.K. Kim), Corneal Dystrophy Research Institute and the Institute of Vision Research (Chung, Lee, T-i. Kim, E.K. Kim), Severance Biomedical Science Institute, Brain Korea 21 Plus Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea; the Department of Surgery (W.C. Kim), Virginia Commonwealth University, Richmond, Virginia, USA
| | - Byunghoon Chung
- From the Department of Ophthalmology (J.S. Kim, Chung, Lee, T-i Kim, E.K. Kim), Corneal Dystrophy Research Institute and the Institute of Vision Research (Chung, Lee, T-i. Kim, E.K. Kim), Severance Biomedical Science Institute, Brain Korea 21 Plus Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea; the Department of Surgery (W.C. Kim), Virginia Commonwealth University, Richmond, Virginia, USA
| | - Taekjune Lee
- From the Department of Ophthalmology (J.S. Kim, Chung, Lee, T-i Kim, E.K. Kim), Corneal Dystrophy Research Institute and the Institute of Vision Research (Chung, Lee, T-i. Kim, E.K. Kim), Severance Biomedical Science Institute, Brain Korea 21 Plus Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea; the Department of Surgery (W.C. Kim), Virginia Commonwealth University, Richmond, Virginia, USA
| | - Woon Cho Kim
- From the Department of Ophthalmology (J.S. Kim, Chung, Lee, T-i Kim, E.K. Kim), Corneal Dystrophy Research Institute and the Institute of Vision Research (Chung, Lee, T-i. Kim, E.K. Kim), Severance Biomedical Science Institute, Brain Korea 21 Plus Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea; the Department of Surgery (W.C. Kim), Virginia Commonwealth University, Richmond, Virginia, USA
| | - Tae-im Kim
- From the Department of Ophthalmology (J.S. Kim, Chung, Lee, T-i Kim, E.K. Kim), Corneal Dystrophy Research Institute and the Institute of Vision Research (Chung, Lee, T-i. Kim, E.K. Kim), Severance Biomedical Science Institute, Brain Korea 21 Plus Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea; the Department of Surgery (W.C. Kim), Virginia Commonwealth University, Richmond, Virginia, USA
| | - Eung Kweon Kim
- From the Department of Ophthalmology (J.S. Kim, Chung, Lee, T-i Kim, E.K. Kim), Corneal Dystrophy Research Institute and the Institute of Vision Research (Chung, Lee, T-i. Kim, E.K. Kim), Severance Biomedical Science Institute, Brain Korea 21 Plus Project for Medical Science (E.K. Kim), Yonsei University College of Medicine, Seoul, South Korea; the Department of Surgery (W.C. Kim), Virginia Commonwealth University, Richmond, Virginia, USA.
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Xiao J, Jiang C, Zhang M, Jiang H, Li S, Zhang Y. When case report became case series: 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis and review of Chinese literature. Br J Ophthalmol 2014; 98:1282-6. [PMID: 24735774 DOI: 10.1136/bjophthalmol-2013-304422] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To report 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis (LASIK) and discuss the continually increasing number of cases in China. METHODS A multicentre retrospective survey of eye injuries was carried in 31 military hospitals from January 2006 to December 2011. Detailed information from the medical records of all 92 cases with a history of prior LASIK treatment were collected and summarised, with respect to visual acuity (VA), flap condition, treatment and final outcome. All Chinese publications relevant to late traumatic flap complications in Chinese patients were retrieved and summarised. RESULTS 92 inpatients (92 eyes) underwent LASIK surgery; 45 of these had traumatic LASIK flap complications. Flap dislocation was the commonest and most needed surgical repair. VA after treatment was good and no statistically significant difference was observed when compared with the 47 cases without flap complications. 109 articles related to late traumatic flap complications after LASIK were retrieved from four Chinese document databases. There were 550 cases of late traumatic flap complications. From 2004, case reports became more common; 10 or more cases were reported in some case series. VA of most cases was good and there was no remarkable vision loss after treatment. CONCLUSIONS Late traumatic flap complications after LASIK have become more frequent in China, although the prognosis of most cases is good.
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Affiliation(s)
- Jianhe Xiao
- Department of Ophthalmology, PLA 150th Hospital, Luoyang, Henan, China Department of Ophthalmology, Jinan Military General Hospital, Jinan, Shandong, China
| | - Caihui Jiang
- Department of Ophthalmology, PLA General Hospital, Beijing, China
| | - Maonian Zhang
- Department of Ophthalmology, PLA General Hospital, Beijing, China
| | - Hua Jiang
- Department of Ophthalmology, Jinan Military General Hospital, Jinan, Shandong, China
| | - Shiyang Li
- Department of Ophthalmology, PLA 150th Hospital, Luoyang, Henan, China
| | - Ying Zhang
- Department of Ophthalmology, PLA General Hospital, Beijing, China
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A microscopy study of the structural features of post-LASIK human corneas. PLoS One 2013; 8:e63268. [PMID: 23650559 PMCID: PMC3641130 DOI: 10.1371/journal.pone.0063268] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 03/30/2013] [Indexed: 11/28/2022] Open
Abstract
Purpose To study the structural features of human post-LASIK corneas. Methods A pair of post-mortem donor corneas, from a 55-year old patient who underwent uncomplicated LASIK surgery five years previously, were bisected and fixed in 4% paraformaldehyde. The right cornea and one half of the left cornea were processed for light microscopy and scanning electron microscopy. One half of the right cornea was also examined by transmission electron microscopy. Results The flap-bed interface could be easily detected several years after LASIK and, although the flap appeared to be in close association with the stromal bed, there was a noticeable absence of reconnection between adjacent severed lamellae. Tissue gaps were evident at the flap margin, which once free of cellular components revealed the presence of a few bridging fibres. Conclusion Examination of corneas five years after LASIK revealed evidence of primitive reparative scar development at the wound interface, but no reconnection of severed collagen lamellae. Such findings may explain the occurrence of flap dislocation following trauma in some patients months or years after surgery.
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Iovieno A, Sharma DP, Wilkins MR. OCT visualization of corneal structural changes in traumatic dislocation of LASIK flap. Int Ophthalmol 2012; 32:459-60. [PMID: 22733251 DOI: 10.1007/s10792-012-9596-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 05/24/2012] [Indexed: 11/24/2022]
Abstract
A 45-year-old woman presented with a traumatic laser-assisted in situ keratomileusis (LASIK) flap dislocation in the right eye. Anterior segment optical coherence tomography (OCT) showed the presence of macrostriae, flap stromal edema, epithelial hyperplasia between the striae and epithelial ingrowth. The flap was surgically repositioned with optimal visual recovery. Anterior segment OCT can efficiently visualize corneal structural changes associated with LASIK flap dislocation.
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Management of a traumatic flap dislocation seven years after LASIK. Case Rep Ophthalmol Med 2011; 2011:514780. [PMID: 22606465 PMCID: PMC3350257 DOI: 10.1155/2011/514780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 12/10/2011] [Indexed: 11/18/2022] Open
Abstract
Seven years after uneventful laser in situ keratomileusis (LASIK), a 48-year-old woman presented one week after being hit with an iron cord with blurry vision, pain, and irritation. The injury resulted in traumatic flap dislocation, epithelial ingrowth, and macrostriae. Following epithelial removal, the flap was refloated and repositioned. Nine interrupted sutures were used to secure the flap. Three-weeks after surgery with no sutures remaining, the epithelial ingrowth and macrostriae had resolved with a visual acuity of 20/20.
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