Removal Of Epithelial Ingrowth Research Articles

Clinical outcomes of epithelial ingrowth following laser in situ keratomileusis with mechanical debridement and compressed heating air flow: a case series.

To describe the clinical outcomes of manual scraping of epithelial ingrowth followed by compressed heating air flow after laser in situ keratomileusis (LASIK). We underwent a retrospective, noncomparative, and interventional case series. Twenty eyes of 17 patients were included in this study. Each patient with a history of LASIK underwent epithelial removal with mechanical debridement followed by compressed heating air flow. Our primary outcome was the recurrence of epithelial ingrowth after 3 months of follow-up, while our secondary outcomes were uncorrected distance visual acuity, corrected distance visual acuity, and complications after surgery. Ten patients (58.8%) were male, and eight eyes of seven (41.2%) patients underwent primary LASIK surgery, while12 eyes of 10 patients had flap-lift retreatment LASIK; sixteen eyes (80.0%) underwent mechanical microkeratome LASIK and four (20.0%) underwent femtosecond laser-assisted LASIK. Mean age at surgical removal of epithelial ingrowth was 37.0 years ± 9.3 years (range 24 to 55 years). There was recurrence of ingrowth in two eyes (10%) after 3 months of follow-up. The mean corrected distance visual acuity of patients before surgery was 0.07 ± 0.09 logMAR, and after the last follow-up was 0.02 ± 0.04 logMAR (p=0.06). The odds ratio of presenting with epithelial ingrowth after LASIK enhancement compared to primary LASIK was 29.41. Manual scraping followed by compressed heating air flow is a safe and effective treatment of clinically significant epithelial ingrowth after LASIK. At the last follow-up, no eye lost any line in corrected distance visual acuity.

Management of Complex Epithelial Ingrowth After Laser In Situ Keratomileusis Using Fibrin Tissue Glue.

To evaluate the efficacy and safety of adjunctive fibrin tissue glue in the treatment of complex epithelial ingrowth after laser in situ keratomileusis (LASIK). A retrospective review was performed of 12 eyes in 12 patients treated for clinically significant epithelial ingrowth after LASIK with mechanical debridement of the ingrowth and placement of fibrin tissue glue. Primary outcome measurements including recurrence of ingrowth, visual acuity, and manifest refraction were evaluated at each postoperative examination. Changes in higher-order aberrometry were also evaluated. After epithelial ingrowth removal with adjunctive fibrin tissue glue, 11 eyes (91.7%) had no recurrence of ingrowth at the final follow-up examination. Uncorrected distance visual acuity changed from 20/20 or better in 3 eyes (25%) and 20/40 or better in 6 eyes (50%) preoperatively to 20/20 or better in 5 eyes (41.7%) and 20/40 or better in 10 eyes (83.3%) postoperatively. Nine eyes (75%) gained one or more lines of best-corrected distance visual acuity (CDVA). No eyes lost any lines of CDVA. There was no significant change in mean spherical equivalent (P=0.22) or mean cylinder (P=0.26) before and after surgery. Higher-order aberrations also remained stable with no significant change in root-mean-square error, coma, trefoil, and spherical aberration. There were no complications associated with the treatment. Adjunctive fibrin tissue glue seems to be a safe and effective treatment for epithelial ingrowth after LASIK. This therapy may be particularly useful in managing challenging cases of complex or recalcitrant ingrowth.

Post-Laser In Situ Keratomileusis Epithelial Ingrowth: Treatment, Recurrence, and Long-Term Results.

To study outcomes after surgical removal of epithelial ingrowth (EI) in post-laser in situ keratomileusis patients, specifically comparing visual results and recurrence rates between 2 different EI management techniques. In this retrospective chart review of 67 eyes of 54 patients who underwent surgical treatment for EI after laser in situ keratomileusis between July 1999 and July 2014 at the Bascom Palmer Eye Institute, Miami, FL, surgical techniques, recurrence rates, visual acuity (VA), and refractive error were assessed. Of the 67 eyes, 56 eyes (83.6%) had flap lift + scraping alone, and 11 eyes (16.4%) had flap lift + scraping + suturing. After mean follow-up of 2.5 years, 11 of 56 eyes (19.6%) treated with flap lift + scraping alone had EI recurrence, whereas no eyes treated with flap lift + scraping + suturing had EI recurrence. VA results and refractive errors were better in eyes treated with lift + scraping alone compared with lift + scraping + suturing at 1 month. In the 67 eyes with 1-year follow-up, VA and refractive errors improved from preoperative values and were comparable between groups. Scraping alone provides significantly better initial visual outcomes but higher EI recurrence rates compared with scrape-suturing. Long-term visual outcomes are comparable between 2 techniques.

Fibrin adhesive in conjunction with epithelial ingrowth removal after laser in situ keratomileusis: Long-term results

To describe the long-term results of fibrin adhesive use in the management of epithelial ingrowth after laser in situ keratomileusis (LASIK). Private practice, Minneapolis, Minnesota, and an academic medical center, Durham, North Carolina, USA. Retrospective case series. Patients with a history of LASIK had epithelial ingrowth removal with mechanical debridement and fibrin glue application. Visual outcomes and the presence or absence of epithelial ingrowth were evaluated again after 3 months and at the last follow-up. The main outcome measures were recurrence of epithelial ingrowth and visual acuity. Thirty-nine eyes of 38 patients were evaluated. After epithelial ingrowth removal and application of fibrin glue, 31 eyes (79.5%) had no recurrence of ingrowth at the final follow-up and 5 eyes (12.8%) had mild epithelial ingrowth not requiring removal. Three eyes (7.7%) had significant epithelial ingrowth at the 3-month follow-up that required subsequent removal and fibrin application. At the 3-month follow-up visit, 76.9% of eyes achieved 20/25 or better corrected distance visual acuity (CDVA) and 69.2% of eyes achieved 20/40 or better uncorrected distance visual acuity (UDVA). At the last follow-up visit (mean 26.6 ± 17.0 months [SD]), 84.6% of eyes had 20/25 or better CDVA and 74.4% of eyes had 20/40 or better UDVA. Fibrin adhesive in conjunction with manual epithelial removal prevented a clinically significant recurrence of epithelial ingrowth in the majority of eyes. Larger randomized studies are needed to compare the success of this technique with that of others. No author has a financial or proprietary interest in any material or method mentioned.

Removal of Epithelial Ingrowth via Central Perforating Wound Tract 6 Years Post LASIK

The purpose was to report a case of a novel approach for the removal of central interface epithelial ingrowth caused by a perforating corneal injury 6 years after laser-assisted in situ keratomileusis (LASIK). Access to a large central area of epithelial ingrowth under a LASIK flap was achieved through the wound tract from a perforating corneal injury. Suturing of the central LASIK flap in a similar manner commonly carried out peripherally was then performed to prevent recurrent epithelial ingrowth. The offending epithelial ingrowth was removed with no recurrence over a 1-year follow-up. This is, to our knowledge, the first reported case of central epithelial ingrowth removal from a LASIK interface by a perforating injury wound tract.

Straylight measurements before and after removal of epithelial ingrowth

Straylight measurements before and after removal of epithelial ingrowth

Management of Epithelial Ingrowth After Laser In Situ Keratomileusis on a Tertiary Care Cornea Service

To review the management of epithelial ingrowth after laser in situ keratomileusis (LASIK) on the Wills Eye Institute Cornea Service from 1996 through 2007. Data of all patients referred to the Wills Eye Cornea Service after having undergone LASIK were reviewed. Charts of all patients with the diagnosis of epithelial ingrowth were analyzed. Data included patient demographics, previous ocular history, visual acuity, size and location of the ingrowth, and management. Additional data on eyes that underwent removal of the ingrowth at Wills were obtained. Three hundred five patients (153 female and 152 male, mean age: 44.7 years) were referred for eye problems after LASIK during the study period. Epithelial ingrowth was confirmed in 46 patients (15%) (19 female and 27 male, mean age: 47.4 years) involving 55 eyes (27 right and 28 left). Patients with epithelial ingrowth were seen at a mean of 26 months after LASIK (range: 0.5-108 months). Twenty-four eyes had undergone previous enhancements, 2 twice. Fourteen eyes had undergone previous removal of epithelial ingrowth, 8 more than once (range: 2-8). In 35 eyes, simple observation was recommended. In 7 eyes, epithelial removal was recommended to the referring physician. Thirteen eyes underwent flap lift and epithelial removal at Wills Eye; 9 included flap suturing. One eye required repeat treatment with flap suturing and fibrin glue, after which no recurrence was found. In the other 12 eyes, there was no recurrence in 9, small recurrences in 2, and a large recurrence in 1 eye (mean follow-up: 16 months). Epithelial ingrowth after LASIK is not rare in our referral practice. Mild ingrowth can be observed, whereas significant ingrowth can respond well to removal with a low chance of significant recurrence.

Straylight measurements before and after removal of epithelial ingrowth

Straylight measurements before and after removal of epithelial ingrowth

Straylight measurements before and after removal of epithelial ingrowth

In 3 eyes with epithelial ingrowth after laser in situ keratomileusis, straylight was measured before and after the ingrowth was removed. In 2 eyes of 1 patient, epithelial ingrowth reached the pupillary axis. Straylight decreased (improved) significantly after ingrowth removal: a 3.6-fold decrease in the right eye and a 10-fold decrease in the left eye. The uncorrected distance visual acuity (UDVA) improved from 0.25 (20/80) in both eyes to 1.0 (20/20) and 0.8 (20/25), respectively. In 1 eye of another patient, from which epithelial ingrowth was removed to prevent flap melting and distortion, the pupillary opening was not obscured and no significant change in straylight was found. The UDVA improved from 0.32 (20/60) to 1.0 (20/20) after the ingrowth was removed. An increase in straylight can be a significant complication of epithelial ingrowth. After the interlamellar space is cleared, the improvement in straylight is several factors larger than the gain in UDVA.

Epithelial Ingrowth After Femtosecond Laser-Assisted In Situ Keratomileusis

To describe the incidence and clinical features of epithelial ingrowth after femtosecond laser-assisted in situ keratomileusis (LASIK). All eyes with clinically significant epithelial ingrowth were identified from patients who underwent primary femtosecond laser-assisted LASIK and their subset of patients who underwent enhancement procedures from January 2005 to March 2007 at Kudret Eye Hospital. Clinical course in terms of severity, type of epithelial ingrowth, time of appearance, effect on visual acuity, and treatment was described for each patient. Two eyes of 6415 eyes after primary procedure and 2 eyes of 108 eyes after enhancement procedure developed clinically significant epithelial ingrowth. All eyes were treated with surgical removal of epithelial ingrowth. The epithelial ingrowths in all the patients were seen as solitary islands of cells, with a size ranging between 1 and 3 mm, beneath the flap with no connection with the surface epithelium. There was recurrence of ingrowth in 1 eye. Visually significant epithelial ingrowth after femtosecond laser-assisted LASIK is an infrequent complication. The lower incidence of epithelial ingrowth after femtosecond LASIK surgery compared with mechanical microkeratome-assisted LASIK may be attributed to the anatomy of the femtosecond laser-created side cut in contrast to that created with a mechanical microkeratome and the creation of less peripheral trauma at the time of flap creation.

Alcohol and Mechanical Scraping for Epithelial Ingrowth Following Laser in situ Keratomileusis

To determine whether the use of 70% isopropyl alcohol is useful as an adjunct to simple mechanical removal of epithelial ingrowth following laser in situ keratomileusis (LASIK). A retrospective comparison of two techniques of epithelial ingrowth removal following LASIK was performed. A total of 38 procedures on 31 patients were included. In one group, the epithelium was removed using a simple mechanical scraping technique and in the other, a similar technique combined with the application of 70% isopropyl alcohol was used. The rates of recurrence in the two groups were compared using a chi-square analysis. The total incidence of epithelial ingrowth recurrence in both groups was 57.9% (22/38). The incidence of clinically significant ingrowth recurrence in both groups was 34.2% (13/38). In the scrape group, the recurrence of any ingrowth was 43.8% (7/16) and the recurrence of clinically significant ingrowth was 31.3% (5/16). In the alcohol group, these rates were 68.2% (15/22) and 36.4% (8/22), respectively. The difference between the two groups did not show statistical significance in either comparison (P=.14 and P=.75, respectively). The use of 70% isopropyl alcohol showed no additional benefit over simple mechanical scraping in the removal and prevention of epithelial ingrowth recurrence following LASIK.

Fibrin glue for the prevention of epithelial ingrowth after laser in situ keratomileusis

We present 3 cases of recurrent epithelial ingrowth following laser in situ keratomileusis. All patients consented to flap lifting, epithelial ingrowth removal, and placement of fibrin glue (Tisseel® VH, Baxter) at the flap edges. Two of 3 eyes had no evidence of recurrent epithelial ingrowth within a relatively short follow-up. One eye that also had had radial keratotomy had a small nest of stable epithelial cells that had not progressed. Fibrin glue may be a useful adjunct to prevent recurrent epithelial ingrowth. There were no complications associated with its use.

Block excision with tectonic corneoscleroplasty for cystic and/or diffuse epithelial invasion of the anterior eye segment. Report of 51 consecutive patients (1980-1996)

Many surgical and nonsurgical techniques for the treatment of cystic and/or diffuse sheet-like epithelial ingrowth of the anterior chamber led to recurrences or even enucleation of the eye. There were 32 (62.7%) men and 19 (37.3%) women ranging in age from 1 month to 80 years (median, 55.5 years). Cystic epithelial ingrowth occurred in 45 patients, and diffuse sheet-like epithelial downgrowth in 6 patients. Block excision consisted of simultaneous en bloc removal of epithelial ingrowth together with adjacent iris, pars plicata of the ciliary body, and cornea and sclera in full-thickness. The resulting defect was covered with a tectonic corneoscleral graft. The median follow-up was 7.9 years. The main causes for epithelial ingrowth were trauma (41.2%) and complicated cataract extractions (27.5%). Eleven patients had undergone surgery of epithelial ingrowth before block excision, elsewhere. Epithelial ingrowth involved up to 5 clock hours of the circumference of the chamber angle (median, 3 clock hours). The median preoperative visual acuity was 0.3 (range, hand motions -1.0). The median diameter of the block excision was 8.0 mm (range, 5.5-12.0 mm). The main postoperative complications were vitreous hemorrhage (27.5%) and corneal endothelial decompensation (21.6%). The median postoperative visual acuity was 0.2. Visual acuity was > or = 0.3 in 43.1% of patients and < 0.1 in 35.3% of patients. Visual results were significantly better after simultaneous cataract extraction with intraocular lens implantation (n = 5). Histopathologically, the invading epithelium mainly consisted of nonkeratinizing squamous epithelium with goblet cells (64.7%). There was a secondary proliferation of corneal endothelium on the cyst's surface in 82.4% of patients. There was no clinical evidence of recurrence of epithelial ingrowth, and no enucleation had to be performed during follow-up. Block excision with tectonic corneoscleral grafting is the treatment of choice for cystic and/or diffuse sheet-like epithelial ingrowth of the anterior chamber or anterior uvea, retrospectively.