Flap amputation with phototherapeutic keratectomy (PTK) and adjuvant mitomycin C for severe post-LASIK epithelial ingrowth

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami University, Miami, FL 33136, USA.
European journal of ophthalmology (Impact Factor: 1.07). 01/2009; 19(2):301-3.
Source: PubMed


To report a patient with severe post-laser in situ keratomileusis (LASIK) epithelial ingrowth and keratolysis treated with flap amputation and phototherapeutic keratectomy (PTK) with adjuvant intraoperative mitomycin C (MMC).
Case report.
A 55-year-old woman was referred to our department due to severe post-LASIK epithelial ingrowth with corneal melting 2 years after primary LASIK. The patient had had two previous attempts for epithelial ingrowth treatment (flap lift and epithelial ingrowth manual removal) that were unsuccessful. Slit lamp biomicroscopy and anterior segment optical coherence tomography showed extensive epithelial ingrowth and keratolysis (thinning of the LASIK flap) while the patient had photophobia and could not tolerate contact lenses. Flap amputation with subsequent PTK (in order to smooth out the corneal irregularities caused by the keratolysis and/or variations in flap thickness) and adjuvant intraoperative MMC application for 2 minutes was performed. There were no intra- or postoperative adverse events seen during the follow-up period. Six months after the procedure, uncorrected visual acuity improved to 20/40 compared with 20/50 preoperatively, while best spectacle-corrected visual acuity improved from 20/40 to 20/32. The topographic astigmatism was decreased from 3.24 diopters (D) to 1.00 D.
Flap amputation with PTK and adjuvant intraoperative MMC is an option for the management of severe post-LASIK epithelial ingrowth with keratolysis.

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    • "According to Machat´s classification, grade I epithelial ingrowth (thin, transparent line, 1-2 cells, well limited, within 2mm of flap border, and non-progressive) requires observation and treatment for grades II (thicker nest, within 2 mm of flap border, no demarcation line and transparent cells without ocular surface pathology) and III (confluent greyish-white opacities well beyond 2 mm of the flap border, geographic areas made of up white necrotic cells, flap borderHistopathology has reported that early epithelial ingrowth resembles normal corneal epithelium, multilayered squamous epithelium, while late ingrowth are made up of clumps of amorphous material with scarce cells[10]. Classical treatment consists in flap relifting and surface debridement with or without sutures, phototherapeutic keratectomy, alcohol or mitomycin use, amniotic membrane, or even flap amputation1234567. YAG laser has been recently reported as a successful treatment for epithelial ingrowth, with important visual and topography profile improvement89. "

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