Abstract
Purpose:
The objective of this study is to assess the rate of epithelial ingrowth after flap-lift LASIK retreatment and secondarily to evaluate risk factors for ingrowth such as time from primary LASIK, pre-primary and pre-retreatment refractive error, and method of original flap creation. This is the largest study to date to examine this, and includes over 750 eyes. Previous studies report ingrowth with varying frequency, but more often if retreatment was done over 3 years after primary LASIK, in hyperopic eyes, and with flap creation by microkeratome as compared to femtosecond laser. Reported rates of post-retreatment ingrowth in much smaller studies have been as high as 41%, and up to 6% for ingrowth requiring surgical removal.
Methods:
An IRB approved retrospective chart review was performed of all cases of flap-lift LASIK retreatment done by a single surgeon (MR) at Northwestern Memorial Faculty Foundation from July 1999 to May 2013. Eyes without recorded post-procedure follow up by 1 month were excluded from the study. Time from primary treatment, method of flap creation, best uncorrected and pre-retreatment refractive error, patient age at time of procedure, and incidence of clinically significant ingrowth were recorded. Ingrowth was classified as either requiring observation or surgical management. Eyes that were retreated multiple times were included but analyzed in a separate category.
Results:
The average patient age at time of procedure was 38 years. The average spherical equivalent prior to primary LASIK was -5.03, and prior to retreat was -0.71. The rate of epithelial ingrowth after retreatment was as low as 1%. Of note, this rate did not differ significantly from rate of ingrowth after primary LASIK in eyes requiring retreatment (2%). Time to retreatment, age at time of procedure, pre-primary and pre-retreatment refractive error, and method of original flap creation did not significantly impact risk of ingrowth.
Conclusions:
In this large retrospective study of over 750 eyes which underwent LASIK retreatment, the rate of epithelial ingrowth after flap-lifting procedure was low for all patients regardless of timing and method of original LASIK. When considering methods for LASIK retreatment, flap lifting may offer a preferable option compared to PRK in terms of patient comfort and recovery time. Physicians should not be deterred from flap lifting as an alternative to PRK out of concern for development of ingrowth.
Keywords: 683 refractive surgery: LASIK •
482 cornea: epithelium •
578 laser