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 Post subject: Epithelial ingrowth
PostPosted: Sat Jul 29, 2006 1:15 pm 
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Recurrent Epithelial Ingrowth and Regression

By Tal Raviv, MD, FACS; Elizabeth A. Davis, MD, FACS; and Yunhee Lee, MD, MPH

CASE PRESENTATION
A 37-year-old female presented for an evaluation. She had undergone bilateral LASIK 33 months earlier. Although she saw well initially with both eyes, she has undergone flap lifting and/or enhancement surgery in her left eye 12 times during the subsequent 29 months for recurrent epithelial ingrowth and/or regression (no records are available). The last lifting of the flap occurred 5 months ago, and the patient again complains of poor vision in her left eye. She has tried rigid gas permeable contact lenses but has been unsuccessful due to a poor fit and discomfort.

The current ocular examination reveals a UCVA of 20/25 OD and count fingers at 4 feet in her left eye. Her near UCVA measures J1 OD and J14 OS. The keratometry readings are 40.6/43.3@94 OD and 35.4/41.2@124 OS. Figure 1 shows the view from the slit lamp. Her right eye is dominant. Pachymetry measures 468?m OD and 426?m OS (Figures 2 and 3). Her manifest refractions are +0.25 +0.50 X 135 = 20/20 OD and +2.00 +5.25 X 145 = 20/25-2 OS. She has an IOP of 15mmHg OD and 13mmHG OS.

The patient is interested in pursuing a permanent solution. How would you proceed with the visual rehabilitation of her left eye?

Read the entire article at: http://www.crstoday.com/PDF%20Articles/ ... 06_06.html

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"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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PostPosted: Fri Aug 04, 2006 1:50 pm 
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OCULAR SURGERY NEWS U.S. EDITION August 1, 2006

Man reports experiencing blurry vision for 2 months after LASIK

The patient also had a foreign body sensation in his left eye since the procedure.

By Stefanie Schuman, MD; Helen K. Wu, MD

Excerpts:


After LASIK, epithelial ingrowth has been reported to occur in 1% to 20% of cases, with a cumulative mean of 4.3% in a review of LASIK publications. Most cases are self-limited, occurring at the edge of the flap and extending inward less than 0.5 mm, and cause no adverse effect on the results of surgery.

However, when epithelial ingrowth becomes clinically significant, surgical removal is required. Epithelial ingrowth can extend into the pupil and cause decreased vision or induce nighttime glare as it approaches the edge of the pupil. It can also induce astigmatism by raising an area of the flap. Epithelial ingrowth can cause epithelial irregularity with fluorescein staining at the edge of the flap creating a foreign body sensation. If progressive, epithelial ingrowth can lead to keratolysis or induce melting of the overlying flap.

The clinical signs of epithelial ingrowth include epithelial pearls in the flap interface, which can sometimes appear as a sheet of confluent opacity. Fluorescein pooling at the edge of the flap, a white fibrotic demarcation line, and keratolysis or melting of the edge of the flap can also be seen.

Risk factors of epithelial ingrowth include trauma, LASIK enhancements, lacerated flaps, buttonholed flaps, thin or irregular flaps, and free flaps. Two hypotheses exist on the pathogenesis of epithelial ingrowth after LASIK. One states that epithelial cells are implanted in the lamellar interface by the microkeratome blade or during irrigation of the stromal bed. The second hypothesis postulates that epithelial cells grow under the edge of the flap and progress into the interface.

The continuity of the epithelial ingrowth with the surface epithelium makes the second hypothesis more likely. It has therefore been suggested that epithelial ingrowth consists of an epithelial fistula underneath the flap with a tract extending to the edge of the flap. A fistula may form owing to poor flap adhesion, which allows for surface epithelial cells to enter into the lamellar interface. Epithelial defects, basement membrane dystrophy or excessive hydration of the flap intraoperatively may cause poor flap adhesion and predispose to fistula formation.


Read the entire article at:
http://www.osnsupersite.com/view.asp?rID=17873

_________________
Broken Eyes

"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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PostPosted: Sat Mar 17, 2007 9:10 pm 
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http://www.crstoday.com/PDF%20Articles/ ... 307_01.php

"Of the 1% to 15% of post-LASIK patients affected with epithelial ingrowth, approximately 10% require surgical treatment. Visually significant epithelial ingrowth recurs in 40% to 50% treated with scraping alone. Various alternative methods such as the use of fibrin glue, amniotic membrane as a pressure patch, flap sutures, and topical proparacaine may decrease the recurrence of epithelial ingrowth. Sutures, however, may increase the incidence of striae and the degree of astigmatism. PTK may also be an effective treatment for epithelial ingrowth, but it can cause a change in refraction and irregular astigmatism."


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 Post subject:
PostPosted: Sun Sep 09, 2007 4:39 pm 
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http://www.ophthalmologytimes.com/ophth ... ail/454608


Quote:
Epithelial ingrowth, a common complication after LASIK enhancement procedures, may be more frequent with increasing patient age and as hyperopic ablations are more common in older patients. This may explain previous findings that epithelial ingrowth occurs more often in hyperopic ablations.


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