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Epithelial Ingrowth

Complication after Lasik and Bladeless 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 Bladeless Lasik that can resolve on its own or may require the Lasik flap to be lifted and the cells removed.

Errant Cells

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 Bladeless 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, and P-IOL 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.

Treatment Options

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.

Looking For Best Lasik Surgeon?

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Doctor.

Personalized Answers

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

Recent Epithelial Ingrowth Medical Journal Articles...

Related Articles

Salzmann nodular degeneration associated with epithelial ingrowth after LASIK treated with superficial keratectomy.

BMJ Case Rep. 2015;2015

Authors: Stem MS, Hood CT

A 41-year-old woman who underwent uncomplicated LASIK and two subsequent flap lifts for epithelial ingrowth of the right eye became progressively symptomatic with blurred vision, photophobia and foreign body sensation over the ensuing 5 years. Clinical examination of the right eye demonstrated extensive epithelial ingrowth around the flap periphery with overlying Salzmann nodules in the same distribution. Similar findings were not present in the left eye. Anterior segment optical coherence tomography demonstrated subclinical flap elevation in the areas of epithelial ingrowth, which may have predisposed to nodule development due to a dellen effect. The patient underwent superficial keratectomy with significant improvement of her symptoms.

PMID: 25564642 [PubMed - indexed for MEDLINE]


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