Reactive Epithelium Syndrome (RES): Diagnosis, Management and Results of 22 Eyes Following Lasik

Abstract

Abstract: : Purpose: To define a new clinical syndrome and highlight its' significance to refractive outcome and stability following Lasik. Methods: A retrospective review of Lasik patients between August of 2001 and August of 2002 was conducted. Out of 1750 eyes, 22 eyes (1.25%) were determined to have intraoperative epithelial sloughing and postoperative "Reactive Epithelium Syndrome" as defined by "dot" and "map" epithelial findings by slit lamp exam in the identical area of the slough. No evidence of anterior basement degeneration was evident by slit lamp exam preoperatively. Results: All 22 eyes lost >2 lines of best corrected vision on postoperative day one. Over a three week period, the surface regularity index improved by topography for all eyes. All eyes revealed undercorrection at 3 months. Two eyes with no evidence of "dot" epithelial changes at 3 months revealed recurrence in the identical region of primary sloughing and undercorrection following a lift retreatment. All 22 eyes underwent superficial keratectomy and showed no "reactive" changes following lift retreatment. Conclusions: Reactive Epithelium Syndrome (RES) is a distinct finding that significantly impacts the refractive outcome following Lasik. More research to determine preoperative tests to prevent this complication is needed. Prompt diagnosis and management is critical for stable refractive outcomes. A thorough clinical history including "Reactive Epithelium Syndrome" in the differential diagnosis of irregular astigmatism is paramount. Superficial Keratectomy may be the primary treatment of choice prior to "smoothing" with a wavefront or topographic guided ablation.

Keywords: cornea: epithelium • cornea: clinical science • anterior segment