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.