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Management of Epithelial Ingrowth After Laser In Situ Keratomileusis on a Tertiary Care Cornea Service

Rapuano, Christopher J MD

doi: 10.1097/ICO.0b013e3181b7f3c5
Clinical Science

Purpose: To review the management of epithelial ingrowth after laser in situ keratomileusis (LASIK) on the Wills Eye Institute Cornea Service from 1996 through 2007.

Methods: Data of all patients referred to the Wills Eye Cornea Service after having undergone LASIK were reviewed. Charts of all patients with the diagnosis of epithelial ingrowth were analyzed. Data included patient demographics, previous ocular history, visual acuity, size and location of the ingrowth, and management. Additional data on eyes that underwent removal of the ingrowth at Wills were obtained.

Results: Three hundred five patients (153 female and 152 male, mean age: 44.7 years) were referred for eye problems after LASIK during the study period. Epithelial ingrowth was confirmed in 46 patients (15%) (19 female and 27 male, mean age: 47.4 years) involving 55 eyes (27 right and 28 left). Patients with epithelial ingrowth were seen at a mean of 26 months after LASIK (range: 0.5-108 months). Twenty-four eyes had undergone previous enhancements, 2 twice. Fourteen eyes had undergone previous removal of epithelial ingrowth, 8 more than once (range: 2-8). In 35 eyes, simple observation was recommended. In 7 eyes, epithelial removal was recommended to the referring physician. Thirteen eyes underwent flap lift and epithelial removal at Wills Eye; 9 included flap suturing. One eye required repeat treatment with flap suturing and fibrin glue, after which no recurrence was found. In the other 12 eyes, there was no recurrence in 9, small recurrences in 2, and a large recurrence in 1 eye (mean follow-up: 16 months).

Conclusions: Epithelial ingrowth after LASIK is not rare in our referral practice. Mild ingrowth can be observed, whereas significant ingrowth can respond well to removal with a low chance of significant recurrence.

From the Cornea Service, Wills Eye Institute, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.

Received for publication January 3, 2009; revision received June 20, 2009; accepted July 8, 2009.

Presented as poster at the American Ophthalmological Society meeting May 16-18, 2008, Colorado Springs, CO.

Dr. C. J. Rapuano had no financial or proprietary interest in any material or method mentioned in this article.

Reprints: Dr. Christopher J. Rapuano, MD, Cornea Service, Wills Eye Institute, 840 Walnut St, Suite 920, Philadelphia, PA 19107 (e-mail:

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