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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...

Incidence of epithelial ingrowth in primary and retreatment laser in situ keratomileusis.

Related Articles

Incidence of epithelial ingrowth in primary and retreatment laser in situ keratomileusis.

J Cataract Refract Surg. 2010 Jan;36(1):97-101

Authors: Caster AI, Friess DW, Schwendeman FJ

PURPOSE: To analyze the risk for clinically significant epithelial ingrowth after primary laser in situ keratomileusis (LASIK) and flap-lift retreatment LASIK. SETTING: Private practice, Beverly Hills, California, USA. METHODS: All cases of primary and flap-lift retreatment LASIK performed by the same surgeon in a single surgical center between January 2004 and June 2007 were retrospectively reviewed. Cases that subsequently developed clinically significant epithelial ingrowth, defined as epithelial ingrowth impeding on the visual axis and negatively affecting uncorrected or corrected distance visual acuity, were identified and analyzed. RESULTS: Clinically significant epithelial ingrowth occurred in none of the 3866 primary LASIK cases and in 15 (2.3%) of the 646 flap-lift retreatment cases (P<.0001). Clinically significant ingrowth was more frequent when flap-lift retreatment was performed 3 or more years after primary LASIK (7.7% versus 1.0%) (P = .0001). Patient age and sex did not have a statistically significant effect on the epithelial ingrowth rate. There was a nonsignificant trend toward increased epithelial ingrowth after flap-lift retreatment of Automated Corneal Shaper (ACS) microkeratome flaps. CONCLUSION: Flap-lift retreatment performed 3 or more years after primary LASIK led to a higher risk of clinically significant epithelial ingrowth than primary LASIK or earlier flap-lift retreatment. FINANCIAL DISCLOSURE: The author has no financial or proprietary interest in any material or method mentioned.

PMID: 20117711 [PubMed - in process]

 

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Last updated Friday, January 01, 2010

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