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Morgado CR, Santhiago MR, Steigleman WA, Hofmeister EM, Henriquez MA, Zarei-Ghanavati S, Yoo SH, Jacob S, Schallhorn J. Late approach for LASIK flap striae. J Cataract Refract Surg 2023; 49:1285-1289. [PMID: 37982777 DOI: 10.1097/j.jcrs.0000000000001342] [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: 11/21/2023]
Abstract
A 24-year-old man was referred for postrefractive surgery evaluation. The patient had a history of uneventful laser in situ keratomileusis (LASIK) in both eyes 3 months previously. According to the surgeon who originally performed the surgery, on slitlamp examination, only microstriae in the left eye was detected on postoperative day 1 and a more conservative follow-up approach was adopted without further immediate intervention. The patient returned only 3 months after surgery, complaining of low vision in the left eye that, according to the patient, had been present since postoperative week 2. The patient was then referred for examination and surgical procedure with a diagnosis of significant postoperative striae. The slitlamp examination revealed a LASIK flap with striae, epithelial filling, and a wrinkled appearance (Figure 1JOURNAL/jcrs/04.03/02158034-202312000-00017/figure1/v/2023-11-20T151558Z/r/image-tiff). There were no signs of infection or inflammation. Originally, the LASIK flap was programmed to be 110 μm. Preoperative manifest refraction in the right eye was -5.25 (20/20) and in the left eye was -5.25 (20/20). Assuming it is a case of late-approach LASIK flap striae, how would you proceed? Would you try to hydrate and lift the flap and just reposition it? Would you avoid lifting and associate phototherapeutic keratectomy (PTK) with excimer laser on top of the flap? Would you consider topo-guided surgery with regularization of the visual axis or even amputation of the flap?
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2
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Kheir WJ, Khalil AA, Ibrahim P, Rashid E, El Moussawi Z, El Hadi D, Kahale F, Awwad S, Bou Ghannam A, Alameddine RM. Ophthalmic injuries from the beirut blast: Managing long-term consequences. Exp Eye Res 2023:109546. [PMID: 37394086 DOI: 10.1016/j.exer.2023.109546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
The 2020 Beirut Port explosion was one of the largest non-nuclear urban explosions in history, and resulted in a plethora of oculofacial injuries. In this retrospective study, we present the two year follow up ophthalmic outcomes of the survivors of the blast. Only 16 out of 39 patients continued follow up at our center, with 13 having delayed complications and 7 requiring further surgery. The most common delayed complications related to the eyelid, lacrimal system, and orbit. Treatment of disfiguring facial and peri-ocular scarring with laser-assisted drug delivery of topical 5-fluorouracil showed great promise and significantly improved patients' functional and well as cosmetic outcomes.
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Affiliation(s)
- Wajiha J Kheir
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Ali A Khalil
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Perla Ibrahim
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Elza Rashid
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Zeinab El Moussawi
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Dalia El Hadi
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Francesca Kahale
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Shady Awwad
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Alaa Bou Ghannam
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Ramzi M Alameddine
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon.
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3
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Krakhmaleva DA, Malozhen SA. [Epithelial ingrowth after anterior lamellar keratoplasty (clinical observation)]. Vestn Oftalmol 2023; 139:87-92. [PMID: 36924519 DOI: 10.17116/oftalma202313901187] [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] [Indexed: 03/17/2023]
Abstract
Epithelial ingrowth (EI) is a rarely occurring complication of surgeries on the anterior eye segment characterized by migration and proliferation of epithelial cells along the wound tract or into the anterior chamber. Several decades ago, EI often led to severe complications, including enucleation. Modern treatment methods allow not only removing the pathological focus of EI, but also minimizing the risk of its reoccurrence. This article presents a clinical case of EI after anterior lamellar keratoplasty involving formation of implant bed under the pathological focus without cutting open the interface zone. The technique helps minimize dissemination of epithelial cells in the area of the lesion. To prevent growth reoccurrence, the method was supplemented with application of a cytostatic agent. The treatment resulted in stable remission throughout the follow-up period (26 months).
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Affiliation(s)
| | - S A Malozhen
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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4
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Hebri HV, Nayak R, Rao R. Commentary: Intraoperative optical coherence tomography-guided management of post-laser-assisted in situ keratomileusis epithelial ingrowth. Indian J Ophthalmol 2021; 70:291-292. [PMID: 34937258 PMCID: PMC8917565 DOI: 10.4103/ijo.ijo_2336_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hariprasad V Hebri
- Department of Cornea and Anterior Segment, ShreeHari Netralaya, Shivamogga, Karnataka, India
| | - Ramya Nayak
- Department of Cornea and Anterior Segment, PRAYAG, Shivamogga, Karnataka, India
| | - Roopashree Rao
- Department of Cornea and Anterior Segment, ShreeHari Netralaya, Shivamogga, Karnataka, India
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5
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Kaur M, Nair S, Mazumdar SA, Titiyal JS. Intraoperative optical coherence tomography-guided management of post-laser-assisted in situ keratomileusis epithelial ingrowth. Indian J Ophthalmol 2021; 70:288-291. [PMID: 34937257 PMCID: PMC8917524 DOI: 10.4103/ijo.ijo_1173_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We describe a modified technique of intraoperative optical coherence tomography (iOCT)-guided removal of post-laser-assisted in situ keratomileusis (LASIK) epithelial ingrowth with interface ethyl alcohol and mitomycin C application to prevent a recurrence. Epithelial ingrowth was visualized as hyperreflective deposits in the interface on iOCT, and the location and extent were noted at the beginning of the procedure. A simple dimple-down maneuver was performed to help identify the circumference of the LASIK flap. iOCT helped to delineate the flap edge and ensure dissection in the correct plane with complete removal of epithelial cell nests. Real-time visualization of the interface helped in on-table decision making regarding the extent of lifting the flap to encompass the entire region of hyperreflective epithelial ingrowth, as well as the need for additional interventions to ensure complete flap apposition at the end of surgery. All patients gained an uncorrected visual acuity of 20/20–20/25 with no recurrence.
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Affiliation(s)
- Manpreet Kaur
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sridevi Nair
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Saima A Mazumdar
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jeewan S Titiyal
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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6
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Lucena MA, Alves EDM, Krause HB, Alves MMDM, Aquino PLDR. Tratamento de crescimento epitelial persistente pós-Lasik com debridamento mecânico, uso de álcool a 20% e cola de fibrina. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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7
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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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8
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Topical use of alcohol in ophthalmology - Diagnostic and therapeutic indications. Ocul Surf 2021; 21:1-15. [PMID: 33895368 DOI: 10.1016/j.jtos.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 01/02/2023]
Abstract
Alcohol (ethanol) has been used in medicine since time immemorial. In ophthalmic practice, besides as an antiseptic, it was given as retrobulbar injections to relieve severe ocular pain. Alcohol can be applied topically to the surface of neoplastic or suspicious lesions to kill cells that might desquamate and seed during surgical excision, to treat epithelial ingrowth that can occur following corneal surgeries, particularly laser in situ keratomileusis (LASIK), and to treat superficial infectious keratitis. In view of its ability to achieve a smooth cleavage plane between the epithelium and the Bowman's layer, alcohol-assisted delamination (ALD) of the corneal epithelium has been used widely and effectively for a variety of diagnostic and therapeutic indications, at times delivering both outcomes. Diagnostically, ALD yields an intact epithelial sheet which can be fixed flat to provide excellent orientation for histopathological evaluation. Therapeutically, it is most commonly used to treat recurrent corneal erosion syndrome, where its efficacy is comparable to that of phototherapeutic keratectomy but with several advantages. It has also been used to treat various forms of epithelial/anterior stromal dystrophies, which can obviate or delay the need for corneal transplantation for several years. In addition, ALD is performed in corneal collagen cross-linking and corneal refractive surgery for relatively atraumatic removal of the epithelium. In this review, we aimed to provide a comprehensive overview of the diagnostic and therapeutic use of topical alcohol in ophthalmology, to describe the surgical and fixation techniques of ALD, and to highlight our experience in ALD over the past decade.
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9
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[A 27-year-old man with "corneal opacity" after being injured by a branch]. Ophthalmologe 2021; 118:186-189. [PMID: 32494913 PMCID: PMC7862528 DOI: 10.1007/s00347-020-01130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Cosgrove RJ, Borr MJ, Keil ML. Disruption of ingrown epithelium via Nd:YAG laser or DIEYAG. A retrospective case series of Post-LASIK patients. Am J Ophthalmol Case Rep 2021; 22:101071. [PMID: 33869890 PMCID: PMC8044645 DOI: 10.1016/j.ajoc.2021.101071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/14/2020] [Accepted: 03/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe in detail the technique used and results of disruption of ingrown epithelium via Nd:YAG laser (DIEYAG) after LASIK treatment and enhancement. Observations Epithelial ingrowth following laser in situ keratomileusis (LASIK) enhancement has the potential to cause significant refractive error and discomfort when allowed to progress. This retrospective case series following seven eyes after LASIK enhancement and one eye with flap trauma, assessed the effectiveness and safety of the disruption of ingrown epithelium via Nd:YAG laser. In all cases, we found that the progression of ingrown epithelium was eliminated. Using best spectacle corrected visual acuity and topography as our main outcome measures, we found that refractive error and visual disturbance caused by ingrowth stabilized or improved, with no subsequent complications identified. Conclusion and Importance The disruption of ingrown epithelium via Nd:YAG laser offers a safe and effective alternative to other treatments for epithelial ingrowth after LASIK treatment and enhancement.
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Affiliation(s)
- Ryan J Cosgrove
- Michigan State University, Department of Neurology and Ophthalmology, 804 Service Rd, East Lansing, 48824, MI, USA.,Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd., Madison Heights, 48071, MI, USA
| | - Matthew J Borr
- Michigan State University, Department of Neurology and Ophthalmology, 804 Service Rd, East Lansing, 48824, MI, USA.,University of Michigan Metro Health Hospital, Department of Surgery, 5900 Byron Center Ave SW, Wyoming, 49519, MI, USA
| | - Michael L Keil
- Michigan State University, Department of Neurology and Ophthalmology, 804 Service Rd, East Lansing, 48824, MI, USA.,University of Michigan Metro Health Hospital, Department of Surgery, 5900 Byron Center Ave SW, Wyoming, 49519, MI, USA.,Keil LASIK Vision Center, 2500 E Beltline Ave SE Ste C., Grand Rapids, 49546, MI, USA
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11
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Tian M. Management of recalcitrant epithelial ingrowth after laser in situ keratomileusis: A case report. Medicine (Baltimore) 2018; 97:e13024. [PMID: 30412143 PMCID: PMC6221683 DOI: 10.1097/md.0000000000013024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 Surgically lifting and scraping, mitomycin C, fibrin glue, Nd:YAG laser, hydrogel ocular sealant, and amniotic membrane patch are the reported methods for treating epithelial ingrowth after laser in situ keratomileusis (LASIK). Here we report the management of a rare case of recalcitrant epithelial ingrowth using a combined scraping/laser ablation that occurred after LASIK. PATIENT CONCERNS A female patient underwent uncomplicated bilateral LASIK 10 years before incurring trauma to the right eye. Approximately 2.5 years later, she presented with a complaint of blurred vision and a foreign body sensation. DIAGNOSES The patient was diagnosed with epithelial ingrowth because of the presence of corneal melting, wrinkling, and scarring. Approximately 6 months after injury, the patient underwent corneal scraping to remove the epithelial ingrowth. Even after 2 more scraping procedures, the epithelial ingrowth recurred. Corneal densitometry was performed (Oculus Pentacam), which revealed a maximum corneal densitometry value of 87.4 gray scale units (GSUs) in the inferonasal quadrant. This reading highly elevated compared to readings from normal cornea (approximately 20 GSU). INTERVENTIONS We used a combination scraping/laser ablation procedure to correct astigmatism and eliminate any undetected residual corneal epithelial cells. OUTCOMES Two days following the procedure, the patient developed a mild corneal opacity in the area where the epithelial ingrowth had been located. At this time, visual acuity was 20/40, refractive error (manifest refraction) was -0.50 Diopter (D) sph, and the maximum corneal densitometry value was 79.2 GSU. After 2 months, the central cornea remained slightly blurred, but visual acuity was 20/25. No signs of recurrent epithelial ingrowth were present and the maximum corneal densitometry reading had decreased to 55.4 GSU. LESSONS This case demonstrates that epithelial ingrowth should be treated as soon as possible after trauma and that thorough scraping combined with laser ablation is effective for treating recalcitrant epithelial ingrowth. Additionally, corneal densitometry can be used to assess epithelial ingrowth severity and treatment efficacy.
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12
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Song YW, He R, Ma JX, Koch DD, Wang L. Long-term safety of laser in situ keratomileusis in eyes with thin corneas: 5-year follow-up. Int J Ophthalmol 2018; 11:1227-1233. [PMID: 30046544 DOI: 10.18240/ijo.2018.07.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/05/2018] [Indexed: 01/01/2023] Open
Abstract
AIM To investigate the long term (≥5y) efficacy, predictability, and safety of laser in situ keratomileusis (LASIK) in eyes with thin corneas [central corneal thickness (CCT) <500 µm]. METHODS A total of 339 patients met the criteria of this study. Finally, 175 eyes of 89 patients who had thin corneas and underwent LASIK≥5y ago returned to our clinic and included in this study. Preoperative parameters recorded included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), manifest refraction, CCT and corneal topography. At returning visits, in addition to visual acuity and manifest refraction, ultrasound CCT and corneal topography were performed. Optical coherence tomography was used to measure the CCT, LASIK flap thickness, and residual stromal bed thickness (RSBT). Safety index, efficacy index, percentage of eyes within ±0.5 D and ±1.0 D of refraction, percent tissue altered (PTA), and percentage stromal bed thickness (PSBT) were calculated. RESULTS The safety index was 1.09 and efficacy index was 0.99. The percentages of eyes within ±0.5 D and ±1.0 D were 71.2% and 87.7%, respectively. The mean PTA was 40%±6% (range 20% to 55%); 76 eyes (43.4%) had PTA <40% and 99 eyes (56.6%) had PTA≥40%. The mean RSBT was 303±27 µm (range 240 to 390 µm), and 2 eyes had RSBT<250 µm. The mean PSBT was 61%±9% (range 51% to 85%). No eyes developed ectasia. CONCLUSION In this cohort with the PSBT of 50% or more, LASIK is safe with follow-up for at least 5y.
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Affiliation(s)
- Yao-Wen Song
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
| | - Rui He
- Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China
| | - Jack X Ma
- McGovern Medical School, University of Texas Health Science Center at Houston, TX 75835, USA
| | - Douglas D Koch
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 75844, USA
| | - Li Wang
- Shanxi Eye Hospital, Taiyuan 030002, Shanxi Province, China.,Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 75844, USA
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13
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March consultation #9. J Cataract Refract Surg 2018; 44:413-414. [PMID: 29703303 DOI: 10.1016/j.jcrs.2018.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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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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