1
|
Uday S, Modak D, Sanjay S. Corneal epithelial and fibrovascular downgrowth postcataract surgery with intrastromal bleed: a rare case study with multimodal imaging. BMJ Case Rep 2024; 17:e253299. [PMID: 38479826 PMCID: PMC10941121 DOI: 10.1136/bcr-2022-253299] [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: 03/18/2024] Open
Abstract
A woman in her 60s presented with diminution of vision and redness in her right eye (OD) 1.5 months duration, 10 months post cataract surgery. The best-corrected visual acuity (BCVA) on the OD was fingers counting at 0.5 m. The anterior section of the OD demonstrated superior pre-Descemet's intrastromal bleeding, superior dense fibrovascular growth in the corneal mid-stroma and superior fibrovascular downgrowth measuring 5×5 mm in the anterior chamber. Along with topical prednisolone acetate (1%) suspension 4 times per day on a tapering dose, antivascular endothelial growth factor therapy was administered intrastromally and subconjunctivally in the superior bulbar conjunctiva near limbus (0.05 mL of 2.5 mg/0.1 mL at each site). Over the course of a week, the intrastromal bleed had completely stopped. Three months later, at the final follow-up, the BCVA had marginally improved to fingers counting 2 m, with a lingering 4×4 mm nebulomacular scar.
Collapse
Affiliation(s)
- Shylaja Uday
- Cornea, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Durgalaxmi Modak
- Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Srinivasan Sanjay
- Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
| |
Collapse
|
2
|
Moshirfar M, Zhang S, Pandya S, Murri M, Hura A, Zhu D, Mehta JS, Liu YC, Ganesh S, Kim G. Central corneal distortion after small-incision lenticule extraction. J Cataract Refract Surg 2023; 49:1183-1186. [PMID: 37867287 DOI: 10.1097/j.jcrs.0000000000001311] [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: 10/24/2023]
Abstract
A 33-year-old woman with a prior history of small-incision lenticule extraction (SMILE) presented with gradual deterioration of vision in her right eye since the surgery. She had undergone bilateral SMILE for myopic correction (-7.00 diopters [D] in the right eye and -6.00 D in the left eye) 3 weeks prior. SMILE was performed with a Zeiss VisuMax femtosecond laser system, with a cap thickness of 120 µm, a cap diameter of 7.50 mm, and a lenticule diameter of 6.50 mm. At the completion of the surgery, loose epithelium was noted at the SMILE incision bilaterally, and bandage contact lenses were placed in both eyes. On the first postoperative day, the patient's uncorrected distance visual acuity (UDVA) was 20/40 in both eyes. The bandage lenses were removed from both eyes, with the epithelium intact. At the first-week postoperative visit, her visual acuity was recorded as 20/30 in the right eye and 20/20 in the left eye. She noticed her vision in the right eye was not as sharp as that in her left eye. She denied experiencing any pain, redness, or ocular surface irritations. She was advised to return to the clinic for a 1-month postoperative visit and continue with aggressive lubrication in both eyes. However, a week later, the patient returned for an emergency visit, citing significant central visual distortion in the right eye and difficulty working on the computer. At this visit, her UDVA and corrected distance visual acuity (CDVA) was 20/50 in the right eye and 20/15 in the left eye at both near and far distances. A slitlamp examination revealed mild central changes in the right eye. She once again denied any pain, redness, or irritation. She was advised to continue with artificial tears and return to the office in 1 week for further observation of the central distortion in her right eye. Upon returning to the clinic at the third postoperative week, the patient still complained of central visual changes in the right eye, with a visual acuity of 20/70. Further slitlamp examination revealed a nonspecific central haze in the same eye, but there was no corneal staining or signs of epithelial defects. Anterior segment ocular coherence tomography (AS-OCT) and NIDEK topography were performed, showing the same central distortion in the right eye (Figures 1 and 2JOURNAL/jcrs/04.03/02158034-202311000-00016/figure1/v/2023-10-18T004638Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202311000-00016/figure2/v/2023-10-18T004638Z/r/image-tiff). Based on the examination and images provided, what is your working medical diagnosis? What other medical conditions are in your differential diagnosis? What medical and/or surgical interventions would you recommend, if any?
Collapse
|
3
|
Moshirfar M, Zhang S, Pandya S, Stoakes IM, Hoopes PC. Incidence and Management of Epithelial-Related Complications After SMILE. Clin Ophthalmol 2023; 17:2777-2789. [PMID: 37750098 PMCID: PMC10518173 DOI: 10.2147/opth.s426547] [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] [Received: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
Purpose To investigate the incidence and management of only epithelial-related complications following small incision lenticule extraction (SMILE). Patients and Methods A retrospective, single-site study analyzed patients who underwent SMILE at Hoopes Vision Clinic in Draper, Utah, from June 2017 to February 2023. Demographic data and preoperative parameters were reviewed. Postoperatively, patients were assessed for visual acuity and complications at different time points. Statistical analyses were conducted between the control and complication groups. Results Four hundred and thirty-two eyes of 220 patients received SMILE. Postoperative epithelial-related complications were indicated in 68 (15.7%) eyes, including anterior basement membrane (ABM) changes (five [1.2%]) eyes), epithelial ingrowth (nine [2.1%] eyes), erosion (two [0.5%] eyes), rough epithelium (18 [4.2%] eyes), epithelial defect (12 [2.8%] eyes), diffuse lamellar keratitis (DLK) secondary to epitheliopathy (two [0.5%] eyes), microstriae secondary to epitheliopathy (four [0.9%] eyes), interface debris (21 [4.9%] eyes), and incisional fibrosis (one [0.2%] eye). There was a statistically significant difference in age, with older patients more likely to develop epitheliopathy postoperatively (P = 0.001). Additionally, patients with epithelial-related complications were more likely to receive photorefractive keratectomy (PRK) enhancement after SMILE than the control (P = 0.001). However, there was no statistical difference in uncorrected distance visual acuity (UDVA) better than 20/20 and corrected distance visual acuity (CDVA) between the complications group and the control at the last postoperative visit (P = 0.974 and 0.310, respectively). There was no statistically significant difference in the safety and efficacy indices between the complications and control group (P = 0.281 and 0.617, respectively). Conclusion In our study, epithelial-related complications were more prevalent in older patients and predisposed patients to require PRK enhancements after recovery from SMILE. Despite the incidence of epithelial-related complications, visual prognoses were favorable and achieved through various management strategies.
Collapse
Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
| | - Stephanie Zhang
- University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA
| | - Shreya Pandya
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Isabella M Stoakes
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | | |
Collapse
|
4
|
Lázaro-Rodríguez V, Sauvageot P, Álvarez de Toledo J. Treatment of epithelial ingrowth after LASIK with partial flap lifting, mechanical debridement and sectorial flap suturing. J Fr Ophtalmol 2021; 45:e129-e131. [PMID: 34961648 DOI: 10.1016/j.jfo.2021.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- V Lázaro-Rodríguez
- Centro de Oftalmología Barraquer, Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Muntaner 314, 08021 Barcelona, Spain.
| | - P Sauvageot
- Centro de Oftalmología Barraquer, Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Muntaner 314, 08021 Barcelona, Spain
| | - J Álvarez de Toledo
- Centro de Oftalmología Barraquer, Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Muntaner 314, 08021 Barcelona, Spain
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Abstract
A 27-year-old female patient came for a routine postoperative check-up, with a history of bilateral ReLEx small incision lenticule extraction (SMILE) surgery done 1.5 years back. On examination, epithelial ingrowth was noticed in the left eye at 8-9'o'clock position. Topography showed excess flattening in the area of ingrowth. Anterior Segment OCT showed hyper-reflectivity and was measured to be at a depth of 120 microns from the corneal surface. As the ingrowth appeared non-progressive, with no involvement of the pupillary axis and no visual complaints, no active intervention was done. Nonetheless, treatment options available include mechanical scraping and Nd:YAG laser procedure.
Collapse
Affiliation(s)
- Sanjana Srivatsa
- Department of Cornea and Refractive Services, Dr.Agarwal's Eye Hospital, Bangalore, Karnataka, India
| | - Shana Sood
- Dr.Agarwal's Eye Hospital and Research Centre, Chennai, Tamil Nadu, India
| |
Collapse
|
7
|
Nanavaty MA. Epithelial ingrowth following LASIK managed with Nd:YAG laser. Indian J Ophthalmol 2019; 67:1474. [PMID: 31436200 PMCID: PMC6727717 DOI: 10.4103/ijo.ijo_1825_18] [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: 12/05/2022] Open
|
8
|
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.
Collapse
|
9
|
Mohammed OA, Mounir A, Hassan AA, Alsmman AH, Mostafa EM. Nd:YAG laser for epithelial ingrowth after laser in situ keratomileusis. Int Ophthalmol 2018; 39:1225-1230. [PMID: 29728896 DOI: 10.1007/s10792-018-0923-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for treatment of epithelial ingrowth after laser in situ keratomileusis (LASIK). PATIENTS AND METHODS Fifty-eight patients with epithelial ingrowth presented to Sohag refractive center, Sohag, Egypt, between January 2015 and March 2017. Only 41 patients (18 females and 23 males, mean age: 33.4 years) involving 41 eyes were indicated for treatment by Nd:YAG laser as the rest of the eyes were only under observation. Patients with epithelial ingrowth were recognized at a mean of 6 months after primary LASIK procedure (range: 2-16 months). Four eyes had undergone previous LASIK enhancements. Four eyes had the epithelial ingrowth removed by flap lift and scrapping. The mean intensity of the spots used was 0.8 mJ with variable number of shots depending on the size and density of the epithelial ingrowth area. Twenty-eight eyes showed complete regression after one session, while the rest necessitated 2-3 sessions for complete resolution. Mean follow-up period was 8 months (range 5-12 months). RESULTS Epithelial ingrowth was treated successfully in all 41 eyes. The uncorrected visual acuities were 20/20, and there was no evidence of recurrent epithelial ingrowth after 6 months with no complications reported. CONCLUSION YAG laser is a simple, effective outpatient procedure for the management of epithelial ingrowth after LASIK.
Collapse
Affiliation(s)
- Osama Ali Mohammed
- Ophthalmology Department, Faculty of Medicine, Sohag University, Nasr City, Sohag, 82524, Egypt
| | - Amr Mounir
- Ophthalmology Department, Faculty of Medicine, Sohag University, Nasr City, Sohag, 82524, Egypt
| | - Amin Aboali Hassan
- Ophthalmology Department, Faculty of Medicine, Sohag University, Nasr City, Sohag, 82524, Egypt
| | - Alahmady Hamad Alsmman
- Ophthalmology Department, Faculty of Medicine, Sohag University, Nasr City, Sohag, 82524, Egypt
| | - Engy Mohamed Mostafa
- Ophthalmology Department, Faculty of Medicine, Sohag University, Nasr City, Sohag, 82524, Egypt.
| |
Collapse
|
10
|
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.
Collapse
Affiliation(s)
| | - Sathish Srinivasan
- Department of Ophthalmology, University Hospital Ayr, Ayr, UK.,Faculty of Medicine, University of Glasgow, Glasgow, UK
| | | |
Collapse
|
11
|
Lapid-Gortzak R, Hughes JM, Nieuwendaal CP, Mourits MP, van der Meulen IJE. LASIK Flap Breakthrough in Nd:YAG Laser Treatment of Epithelial Ingrowth. J Refract Surg 2015; 31:342-5. [DOI: 10.3928/1081597x-20150424-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/19/2015] [Indexed: 11/20/2022]
|
12
|
Güell JL, Verdaguer P, Mateu-Figueras G, Elies D, Gris O, Manero F, Morral M. Epithelial Ingrowth After LASIK. Cornea 2014; 33:1046-50. [DOI: 10.1097/ico.0000000000000214] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Leccisotti A. Femtosecond laser–assisted hyperopic laser in situ keratomileusis with tissue-saving ablation: Analysis of 800 eyes. J Cataract Refract Surg 2014; 40:1122-30. [DOI: 10.1016/j.jcrs.2013.11.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 10/29/2013] [Accepted: 11/04/2013] [Indexed: 10/25/2022]
|
14
|
Kim JM, Goel M, Pathak A. Epithelial ingrowth - Nd:YAG laser approach. Clin Exp Ophthalmol 2013; 42:389-90. [DOI: 10.1111/ceo.12240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jenna May Kim
- Ophthalmology and Visual Sciences; Washington University; St. Louis Missouri USA
| | - Manik Goel
- Ophthalmology and Visual Sciences; Washington University; St. Louis Missouri USA
| | - Anjali Pathak
- Ophthalmology and Visual Sciences; Washington University; St. Louis Missouri USA
| |
Collapse
|
15
|
Lindfield D. September Consultation #6. J Cataract Refract Surg 2012. [DOI: 10.1016/j.jcrs.2012.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Vaddavalli PK. September Consultation #9. J Cataract Refract Surg 2012. [DOI: 10.1016/j.jcrs.2012.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|