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Epithelial Ingrowth

Complication after Lasik and All-Laser Lasik.


Lasik Epithelial Ingrowth
Epithelial Ingrowth after Lasik appears as whitish islands in the cornea when illuminated.

 

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.


Current Epithelial Ingrowth Medical Journal News...

Traumatic dislocation of LASIK flaps 4 and 9 years after surgery.

Traumatic dislocation of LASIK flaps 4 and 9 years after surgery.

J Refract Surg. 2010 Jun;26(6):447-52

Authors: Kim HJ, Silverman CM

PURPOSE: To report two patients who developed a corneal flap dehiscence 4 years and 9 years after LASIK, respectively, following trauma during routine domestic activities. METHODS: Retrospective chart review of two patients. Clinical presentation, mechanism of injury, treatment, complications, and outcome were studied. A review of published cases in the English literature on late onset flap dislocation was performed. RESULTS: Case 1 involved a 30-year-old man who presented 4 years after LASIK, after his eye was struck with a piece of wood from a window trim. Examination showed uncorrected visual acuity (UCVA) of 20/25 and flap displacement, creating a fold at the superior edge. Because the injury involved the periphery of the flap, the patient was treated medically only. Final UCVA was 20/20(-1) with a persistent fold. Case 2 involved a 29-year-old man who dislocated his flap after being hit with a dog's paw 9 years after LASIK. Uncorrected visual acuity was count fingers, and a complete flap dislocation that was folded at the hinge with 30% epithelial ingrowth was noted. Immediate surgical removal of the epithelium from the stromal bed was completed and a bandage contact lens was used along with topical medication. Final UCVA was 20/25, with no complications. CONCLUSIONS: Flap dehiscence is a rare, late complication of LASIK. Case 1 is the second report of flap dislocation treated medically only and case 2 is the latest report. Tangential force applied to the flap during routine activities of life can result in flap displacement for up to 9 years after LASIK.

PMID: 20677731 [PubMed - in process]

 

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Last updated Monday, April 12, 2010

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