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Ana Paula Canto, Christopher R. Henry, Anat Galor, Sonia H. Yoo; Epithelial Ingrowth Under LASIK Flap: Characteristics, Associated Factors And Visual Outcomes In Patients Requiring Flap Lift. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1489.
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To describe the associated factors and visual outcomes in patients requiring flap lift for treatment of epithelial ingrowth (EI) following laser assisted stromal in-situ keratomileusis (LASIK) surgery.
Consecutive, non-comparative, retrospective case series. Eyes that required flap lift for treatment of epithelial ingrowth following LASIK surgery in an academic center during the period of June 2004 through June 2011 were studied. Exclusion criteria included age<18 years and follow up <3 months. Demographic details, details of the primary LASIK, characteristics of the epithelial ingrowth, and best-corrected visual acuity (BCVA) before and after epithelial ingrowth scrapping (EIS) were analyzed.
39 eyes of 36 patients were included in the current study. The average age was 49.95 ± 11.03 years (range 20-74) and 18 were patients were female (50%). For the initial LASIK surgery, a microkeratome was used in 26 eyes (67%) and femtosecond laser was used in 13 eyes (33%). Primary LASIK was performed for myopia in 26 patients (67%) and for hyperopia in 13 patients (33%). Causative etiology for epithelial ingrowth included primary LASIK treatment (10/39 [26%]), LASIK enhancement (23/39 [59%]), infection (4/39 [10%]) and flap dislocation (2/39 [5%]). Average time from causative etiology to clinical diagnosis of EI was 8.3±28.4 months. Average time from causative etiology to EIS was 9.9±28.9 months. EI was located centrally in 8 eyes (21%) and peripherally in 31 eyes (79%). Density of EI was punctate in 8 eyes (21%), moderate in 21 eyes (54%) and confluent in 10 eyes (26%). Additional flap lifting was required in 7/39 patients (18%) due to recurrence. Flap melting occurred in 2 patients, and no patients required flap amputation. Average BCVA before EIS was 0.17±0 (logMAR) and at last follow up visit was 0.03 ± 0.11 (logMAR). All patients had ≥ 20/50 BCVA at last follow up visit. Average follow-up was 25±21.0 months.
Epithelial ingrowth scraping was performed most commonly in middle aged patients, with a history of myopia, and with microkeratome flap creation for primary LASIK. Despite the occurrence of EI, patients had excellent visual outcomes following EIS.
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