Epithelial Ingrowth

Epithelial ingrowth is a relatively benign complication of conventional or custom wavefront Lasik and All-Laser Lasik that can resolve on its own or may require the Lasik flap to be lifted and the cells removed.

The epithelium is the outermost layer of cells of the cornea, just under the tear film. If you stick your finger on your eye, you are touching your epithelium. These cells are the most rapidly reproducing cells in the human body.

The process of conventional or custom wavefront Lasik and All-Laser Lasik includes the creation of a flap of corneal stroma tissue, folding the flap back, applying laser energy to the exposed cornea, and replacing the flap. It is possible that epithelial cells may get under the flap.

PRK, LASEK, Epi-Lasik, RLE, P-IOL, and NearVision CK do not have this Lasik stromal flap and are not subject to epithelial ingrowth.

Cells do what cells do: divide and multiply. If the epithelial cells start growing under the Lasik flap, they can cause bumps in the flap. This is called epithelial ingrowth and may provide vision that is out of focus.

In some cases, the epithelial cells will not continue to grow, will die, and will be absorbed by the cornea. In this case, no additional action is required by the doctor other than to monitor the condition.

If the cells do grow and if allowed to remain, the epithelial cells can starve the cornea from nutrients causing disintegration of the flap (flap melt).

The most common resolution for epithelial ingrowth is for the doctor to lift the flap, wash out the area, and reposition the flap. In some cases, the doctor will apply a small amount of excimer energy or a diluted alcohol solution to destroy any remaining cells. It is uncommon, but if necessary multiple flap lifts can be performed to resolve stubborn epithelial cell ingrowth.

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, NearVision CK, RLE, or any refractive surgery procedure, we highly recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Laser Eye Surgery Doctor.

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.

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Current Epithelial Ingrowth Medical Journal News...

Complications of Descemet's Stripping with Automated Endothelial Keratoplasty Survey of 118 Eyes at One Institute.

Related Articles

Complications of Descemet's Stripping with Automated Endothelial Keratoplasty Survey of 118 Eyes at One Institute.

Ophthalmology. 2008 Mar 29;

Authors: Suh LH, Yoo SH, Deobhakta A, Donaldson KE, Alfonso EC, Culbertson WW, O'Brien TP

PURPOSE: To compile a survey of complications during and after Descemet's stripping with automated endothelial keratoplasty (DSAEK) in 118 eyes conducted by cornea subspecialists at a single academic center. DESIGN: Retrospective case series. PARTICIPANTS: One hundred eighteen eyes undergoing DSAEK in 99 patients. METHODS: Outcomes of DSAEK performed in 118 eyes by 10 surgeons were reviewed retrospectively. Sixty-four eyes had pseudophakic bullous keratopathy. Forty-one had Fuchs' endothelial dystrophy and cataract. Three had aphakic bullous keratopathy. In 10 eyes, previous DSAEK performed at the same institution failed. Complications of DSAEK were noted from the intraoperative and postoperative periods. Detached DSAEK grafts were repositioned, rebubbled, or both immediately after diagnosis of this complication. MAIN OUTCOME MEASURES: Intraoperative and postoperative complications of DSAEK. RESULTS: Graft detachment was the most common type of complication encountered. In 27 (23%) of 118 eyes, graft detachments were observed. Twenty-five eyes with detached grafts successfully were repositioned or rebubbled after surgery, or both. In 1 eye, a previously detached graft reattached spontaneously. In 1 aphakic eye, the graft detached into the vitreous cavity. In 17 eyes, successful reattachment of the cornea occurred (68%). Twenty-one of the 118 eyes were considered to have failed DSAEK, meaning that persistent edema was present after DSAEK. Seven (6%) demonstrated graft rejection. In 5 eyes (4%), retinal detachment (RD) developed. In 6 (5%), cystoid macular edema developed. In 1 aphakic patient, an air bubble could not be maintained during surgery, and sulfur hexafluoride was injected into the anterior chamber. In 1 eye (1%), epithelial ingrowth developed. One eye (1%) demonstrated blood in the graft interface. In 1 eye (1%), a limited intraoperative suprachoroidal hemorrhage occurred. Two eyes (2%) had pupillary block after surgery that resolved with removal of the air bubble. CONCLUSIONS: Descemet's stripping with automated endothelial keratoplasty has become a popular and effective treatment for corneal endothelial dysfunction, but complications resulting from DSAEK do occur. Graft detachment is the most common complication, but postoperative repositioning or rebubbling, or both, allow for graft reattachment in most cases. Other complications found in this series were graft failure, graft rejection, cystoid macular edema, RD, suprachoroidal hemorrhage, and pupillary block. Retained Descemet's membrane and epithelial ingrowth, are potential causes of dislocation.

PMID: 18378315 [PubMed - as supplied by publisher]