Prevention of epithelial Prevention of epithelial ingrowth recurrence .ingrowth recurrence .
Faik Orucov MD, Frederik Raiskup MD, Faik Orucov MD, Frederik Raiskup MD, Abraham Solomon MD, David Landau MD, Abraham Solomon MD, David Landau MD,
Joseph Frucht-Pery MD.Joseph Frucht-Pery MD.
Cornea and Refractive Surgery Service Cornea and Refractive Surgery Service Hadassah University Hospital Hadassah University Hospital
JerusalemJerusalemIsraelIsrael
Surgical Epithelial ingrowth <1% of Surgical Epithelial ingrowth <1% of
casescases Recurrence rate Recurrence rate 44%44%RefRef:: Wang MY, AJO 2000Wang MY, AJO 2000
PurposePurposeTo describe the outcomeTo describe the outcome
of a new surgicalof a new surgical
approach for treatmentapproach for treatment
of epithelial ingrowthof epithelial ingrowth..
STUDY GROUPSTUDY GROUP
9 patients – 5 females/4 males [19-56 yo] 9 patients – 5 females/4 males [19-56 yo] significant epithelial ingrowth > 2.5mmsignificant epithelial ingrowth > 2.5mm SymptomsSymptoms
Blurred vision, Decreased night vision, Discomfort – dryness, Blurred vision, Decreased night vision, Discomfort – dryness, FBFB
UCVA 20/20 – 20/50UCVA 20/20 – 20/50
REASONS FOR EPITHELIAL INGROWTHREASONS FOR EPITHELIAL INGROWTH 4 patients - post primary LASIK 4 patients - post primary LASIK 4 patients - post enhancement 4 patients - post enhancement 1 patient – post traumatic dehiscence1 patient – post traumatic dehiscence
Follow-up: 9 mo. to 5 yearsFollow-up: 9 mo. to 5 years
Surgical TechniqueSurgical Technique The flap was divided by a 10-0 stitch into The flap was divided by a 10-0 stitch into
two segments, that allows to lift one two segments, that allows to lift one segment of the flap at a time segment of the flap at a time
Breaking the marginal flap-epithelium over the Breaking the marginal flap-epithelium over the epithelial ingrowthepithelial ingrowth
Lifting one segment of the flapLifting one segment of the flap
Removal of the epithelial ingrowthRemoval of the epithelial ingrowth
Segment washout with BSSSegment washout with BSS
Replacement and suturing with 10-0 nylon Replacement and suturing with 10-0 nylon suturessutures
Lifting the second segment of the flap Lifting the second segment of the flap and doing the same procedure if neededand doing the same procedure if needed
ResultsResultsSURG. PROCEDURESURG. PROCEDURE 1 segment lifted - 6 1 segment lifted - 6
eyes eyes 2 segments lifted - 3 2 segments lifted - 3
eyeseyes
Focused removal of Focused removal of epithelial ingrowth [only 1 epithelial ingrowth [only 1 min.]min.]
Stromal bed exposure: Stromal bed exposure: only 2-4 minutes.only 2-4 minutes.
POSTOP. OUTCOMEPOSTOP. OUTCOME 24-48 hours : 24-48 hours :
--minimal minimal hyperemia hyperemia
-m-mild flap edema ild flap edema No DLK No DLK Stitches removed: 7-Stitches removed: 7-
14d14d No recurrence of No recurrence of
epithelial ingrowthepithelial ingrowth UCVA: 20/20 – 20/30UCVA: 20/20 – 20/30 No loss of BCVANo loss of BCVA
ConclusionsConclusions
Reducing the surgical exposure time Reducing the surgical exposure time and the area of the stromal bed with and the area of the stromal bed with appropriate suturing of the flap, may appropriate suturing of the flap, may reduce the postoperative reduce the postoperative inflammatory process and prevent inflammatory process and prevent the recurrence of epithelial ingrowth. the recurrence of epithelial ingrowth.
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