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andrew rollin davis, Mario Joseph Rojas, Peyton Neatrour; Hydrogel Sealant in Prevention of Epithelial Ingrowth. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5282.
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© ARVO (1962-2015); The Authors (2016-present)
Epithelial ingrowth has been reported in up to 32% of post-LASIK enhancement cases, and clinically significant epithelial ingrowth has been reported in 1.7% of post-LASIK enhancement cases. Poor flap adhesion is thought to allow for epithelial invasion. We hypothesize that use of a hydrogel sealant (ReSure) will help promote flap adhesion and prevent clinically significant epithelial ingrowth in post-LASIK enhancement cases.
In this prospective study, a single surgeon performed LASIK enhancement on 26 eyes over the course of 2016. The surgeon lifted the existing flap and treated the residual refractive error with an excimer laser before sealing the flap with hydrogel (Group A).In addition, a retrospective review of 104 eyes that underwent LASIK enhancements from 2013–2014, with the same surgeon and the same technique, but that did not receive hydrogel, were reviewed (Group B).All enhancements were done using the EyeQ or Visx Star S4 lasers, and patients were examined for epithelial ingrowth at subsequent visits. The risk factors for epithelial ingrowth were identified and compared between groups.
In Group A, 85% of patients were 20/20–25 at one month. There was a 12% incidence of epithelial ingrowth and a 0% incidence of clinically significant epithelial ingrowth at a follow-up interval of up to 10 months post enhancement. In Group B, there was a 24% incidence of epithelial ingrowth and a 6.7% incidence of clinically significant epithelial ingrowth without using hydrogel at a follow-up interval of up to two years post enhancement. There were no vision-threatening complications in the hydrogel group. The risk factors for epithelial ingrowth after LASIK enhancement include microkeratome flap creation, LASIK enhancement more than 10 years after initial LASIK, Anterior Basement Membrane Dystrophy, initial LASIK for myopia, enhancement for myopia, age greater than 40, and superior hinge location.
Hydrogel sealant effectively reduced clinically significant epithelial ingrowth to 0% post-LASIK enhancement at up to 10 months post-op. In addition, hydrogel reduced mild epithelial ingrowth from 25% to 12 %. Therefore, the use of a hydrogel sealant is a safe and effective option to prevent epithelial ingrowth.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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