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LASIK interface.... keep an eye

Poster Details

First Author: U.Gadgil INDIA

Co Author(s):                  

Abstract Details



Purpose:

potential space between anterior & posterior corneal lamella,after creation of lasik flap allows a variety of potential complications,which can arise from different etiologies & often have confusing presentationsalthough rare one has to keep an eye for these complications & their sequelae primarily interface complications include interface debries,infectious keratitis,diffuse lamellar keratitis(DLK),pressure induced stromal keratitis(PISK),CENTRAL TOXIC KERATOPATHY(CTK),& epithelial ingrowth differentiating between interface entities rapidly is critical to appropriate diagnosis,treatment & ultimate visual outcome careful history of symptoms,timing of onset clinical examination ensures accurate diagnosis & treatment,some of these entities originate specifically in the interface others may originate elsewhere & coalase ultimately in this potential space although initial similarities exist among different entities on presentation, we have to come to a accurate diagnosis with our history taking & examination,when overlap exists in symptoms we have to examine patient more frequently in early postoperative period,this will allow for accurate diagnosis & potential modification in treatment ,we retrospectively reviewed the incidence & treatments protocols observed in our setting in last 3 years we evaluated 1800 eyes undegoing flap lasik at our centre & this study pertains to various interface disorders encountered ,the way we managed these cases & ultimate visual outcomes

Setting:

retrospective analysis of 1800 eyes of 952 patients was done, all eyes were operated by single surgeon, wavelight allegratto 400 hz eye -q blueline machine was used,two types of mechanical microkeratomes were used RONDO from wavelight &MORIA OUP,(one use plus) was used in all cases patients operated between may 2010 & december 2012 were included all patients were examined on first, fifth ,15"th day,&1 & 3"rd month as a protocol & those who required more frequent followup were examined according to symptoms & signs that patients presented with & necessitated frequent visits, all cases were operated at ULTRALASE LASIK LASER CENTRE THANE INDIA,at every visit vision,refraction ,slitlamp exam,iop measurement on day 5,topography on every visit ,was done patients complaining of blurred vision,abnormal pain, redness,were called for more frequent followups,

Methods:

we diagnosed lasik interface disorders according to symptoms,time of onset,initial effect on visual acuity ,location of lesion,corneal haze pattern,conjunctival erythema,IOP reading,presence of interface fluid,response to topical steroids,need &effect of flap lift, differetiating dlk & infection was very important, time of onset for dlk is 1to 5 days & for infection it is from 4"th day onwards effect on visual acuity was minimal in dlk ,variable in infection & more pronounced in ctk & pisk. location wise dlk presents as diffuse,granular sheet of wbc"s , in infection ,corneal haze was more near clumped infiltrates dlk showed shifting sands of sahara pattern ,in ctk in 1 case showed dense focal corneal haze & clear surrounding ,pisk showed diffuse haze & corneal edema pattern, ,pain was very minimal apart from foreign body sensation in dlk & more severe in infection response to topical steroids was excllent in dlk, no response in ctk,worsening in pisk, flap lift was done in infection cases to irrigate flap interface epithelial ingrowth was not encroaching in any cases centrally hence only observed

Results:

1800 eyes of 952 patients were evaluated male/female=380/572age ranged from 18 to 55 yearsfollowup period ranged from 1 month to 6 month we tabulated interface disorders according to type,number of eyes, time of onset, management,& final visual acuity interface debris-65 eyes immediate postoperatively,resorted to observation as none of the debris was affecting vision DLK -most common 35 eyes(1.8%)-except for 3 cases onset was from 2;nd to 4"th day postoperatively-delayed DLK WAS SEEN IN 3 CASES MANIFESTING ON 10"TH-12"th DAY we raised frequency of steroid drops to hourly instillations,that gave excellent response,final visual acuity ranged from 6/9to 6/6 in all cases including delayed dlk cases & no patient lost ucva ,CTK was seen in 2 eyes manifesting on day 7 seen as dense corneal haze focally observation resorted to PISK -1case 20 "TH POSTOPDAY local antiglaucoma drops,stoppage of steroids 6/6 final vision infection -10 eyes 8/10 presented iin first 8 days & 2eyes presented >15 days early infection eyes were treated with flap lift & irrigation with fortified antibiotics,local antibiotics delayed infection treated with topical amikacin final visual acuity was 2 eyes loosing 2lines of ucva rest >6/9 epithelial ingrowth 15 eyes obseravtion

Conclusions:

lasik interface disorders can be unnerveing to patient as well as doctor,are rare & have overlapping presentations interface debris like small fibres,meibomian secretions,can be seen slitlamp intraoperatively can reduce this dlk was most common occuring in 25 eyes ,intraoperative epithelial defects,meibomian secretions,improper sterilisation are inciting factors ,infection is more dreaded, occuring from 5-25 days ,is associated with pain & conjunctival erythema,differentiating dlk from infection is vital main points are in dlk earlier onset,evolving to advanced stages (stage3/4)gradually,only foreign body sensation, appearance is granular interface opacities starting from periphery of flap & proceeding towards central area,rapid response to increased frequency of steroids while infection starts by 5"thday onwards associated with clumps of infiltrations anywhere in interface, association with pain,redness no response to steroids,infection once diagnosed needs stoppage of steroids ,starting broad spectrum 4"th generation fluroquinolones to be started 4 eyes treated by lifting flap & irrigation of bed with fortified antibiotics after taking sample for culture ctk was seen in one eye characterised by focal corneal haze with clear surrounding area significantly affecting vision,has to be differentiated from from stage 4 dlk,vision recovery was to 6/9 pisk was seen in one eye it is a steroid response resulting in high iop & fluid in interface, stoppage of steroids &topical antiglaucoma medications is the treatment final visual acuity was good epithelial ingrowth was seen in 15 eyes but none required any intervention as it was not invading visual axis or causing irregular astigmatism insummery lasik interface complications can present as overlapping clinical features with unique mechanisms,time course, careful history & focused clinical examination clinches diagnosis

Financial Disclosure:

NONE

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