Slit Lamp Technique For Epithelial Ingrowth Removal After Lasik
Published 2023 - 41st Congress of the ESCRS
Reference: PP03.13 | Type: Free paper | DOI: 10.82333/kfb5-e904
Authors: Glenn Carp* 1 , Dan Reinstein 2 , Cory Lessner 3 , Timothy Archer 4 , Ruchi Gupta 4 , Joseph Potter 4
1London Vision Clinic,London,United Kingdom, 2Reinstein Vision,London,United Kingdom;London Vision Clinic,London,United Kingdom;Columbia University Medical Center,New York,United States;Sorbonne Université,Paris,France;Biomedical Science Research Institute,Ulster University,Coleraine,United Kingdom, 3Millennium Laser Eye Centres,Fort Lauderdale,United States, 4Reinstein Vision,London,United Kingdom;London Vision Clinic,London,United Kingdom
Purpose
To report the incidence of epithelial ingrowth after flap lift retreatments, and the incidence of recurrence after slit-lamp treatment over an 11-year period.
Setting
Millennium Laser Eye Centres, Fort Lauderdale, FL, USA
Methods
Retrospective analysis of 2039 LASIK flap lift retreatments done at Millennium Laser Eye Centres between 2004-2017. Cases of epithelial ingrowth were treated at the slit-lamp as follows: A sinskey hook was used to cleave 2 mm of the flap edge. A 27-gauge 3cc syringe of BSS was inserted and used to loosen the membrane of ingrowth. Epithelial cells were hydroextruded to the flap edge, and removed using forceps. Any remnant epithelial cells were detected with the slit-lamp, and removed using the same technique. A merocel sponge was used to ensure tight apposition of the flap edge. Incidence of epithelial ingrowth, treatment of ingrowth and recurrence were calculated. Recurrence was defined as ingrowth that required a second treatment.
Results
Overall incidence after flap lift retreatment was 41.2% for presence of epithelial ingrowth, 19.9% for ingrowth requiring treatment, 7.7% for ingrowth that was treated but recurred, and 1.3% for ingrowth that recurred after two slit-lamp interventions. Incidences are reported for 0-12 months, 13-24 months, 2-5 years, 5-10 years and >10 years respectively. Overall incidence: 21.0%, 43.0%, 52.1%, 67.1%, 70.1%. Incidence requiring treatment: 6.4%, 19.4%, 27.5%, 40.5%, 34.0%. During the study period, treatment was performed at the slit-lamp in 90.1% and in the OR in 9.9% of cases. Epithelial ingrowth recurred in 37.0% of cases treated at the slit-lamp, and 55.0% of cases treated in the OR.
Conclusions
Treatment of epithelial ingrowth at the slit-lamp is an efficient and effective modality, resulting in a low recurrence rate comparable to conventional operating theatre treatment. The incidence of epithelial ingrowth after flap lift retreatment is heavily dependent on flap lift timepoint after primary surgery.