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Consultation section: Refractive

March consultation #3

Güell, José L. MD

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Journal of Cataract & Refractive Surgery: March 2018 - Volume 44 - Issue 3 - p 411
doi: 10.1016/j.jcrs.2018.03.011
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Epithelial ingrowth after lamellar corneal surgery, especially LASIK, is a relatively uncommon but typical complication that used to be handled in a too simple way (most often, an incomplete cyst extraction with topical anesthesia under the laser surgical microscope). This is the reason multiple reoperations are usually performed, and it seems that happened in this case.

Focusing on this case, it looks as though some important information is missing: Identical UDVA and CDVA in both eyes of 20/25, considering a topographic astigmatism of nearly 5.0 D, do not clearly fit. I will assume that CDVA in the left eye is 20/25 but the UDVA is significantly lower and is therefore, together with the irritative symptoms, the main reasons this patient is seeking surgery.

In general, the main reasons to consider surgery in a case with a secondary epithelial cyst at the post-LASIK interface are as follows: ocular surface symptoms usually associated with the edge of a fistula and/or secondary astigmatism and/or hyperopia. It appears that this patient has both secondary symptoms and ametropia (astigmatism and hyperopia). The recommended surgical approach would preferably be to, under a sub-Tenon or peribulbar block, reopen the interface and clean all the extension from the cyst (this typically goes farther than the whitish area). Then, suture the flap with interrupted 10–0 nylon sutures. The flap edge area of the ingrowth should be left without epithelium in an area of about 1.0 mm. A bandage contact lens is usually left in place for 1 week and then, the sutures can be extracted at the 3- to 4-week follow-up. Using this approach, the reoperation rate is usually extremely low.1

REFERENCE

1.Güell JL, Verdaguer P, Mateu-Figueras G, Elies D, Gris O, Manero F, Morral M. Epithelial ingrowth after LASIK: visual and refractive results after cleaning the interface and suturing the lenticule. Cornea. 2014;33:1046-1050.
© 2018 by Lippincott Williams & Wilkins, Inc.