Epithelial Ingrowth After Lasik Retreatment Flap Lift: Comparison Of Three Techniques To Identify The Lowest Subsequent Ingrowth Rate And Optimal Approach
Published 2026 - 44th Congress of the ESCRS
Reference: FP07.07 | Type: Free paper | DOI: 10.82333/tfc0-x273
Authors: Dr Michael Rossiter-Thornton* 1 , Prof. Dan Reinstein 2 , Dr Barbara Czarnota-Nowakowska 3 , Dr Timothy Archer 4 , Joseph Potter 4 , Ruchi Gupta 4 , Prof. Tara Moore 5
1School of Medicine,University of Sydney,Sydney,Australia;Reinstein Vision,London,United Kingdom;Ulster University,Biomedical Science Research Institute,Coleraine,United Kingdom, 2Reinstein Vision,London,United Kingdom;London Vision Clinic,London,United Kingdom;Ulster University,Biomedical Science Research Institute,Coleraine,United Kingdom;Columbia University Medical Center,New York,United States;Sorbonne Université,Paris,France, 3Optegra Eye Health Care,Poznan,Poland, 4Reinstein Vision,London,United Kingdom;London Vision Clinic,London,United Kingdom, 5Ulster University,Biomedical Science Research Institute,Coleraine,United Kingdom
Purpose
To compare epithelial ingrowth incidence and severity after LASIK retreatment flap lift across three surgical techniques, using study periods before and after the introduction of epithelial edge recession, and to identify the technique associated with the lowest subsequent ingrowth rate.
Setting
Private Practice academic unit (Reinstein Vision), London Vision Clinic, EuroEyes Group, UK, with published protocols and 24 years of electronic medical record (EMR) database including videos of all treatments performed between 2002 and 2026.
Methods
Retrospective EMR review identified LASIK retreatment flap lifts in two study periods chosen around introduction of epithelial edge recession: Dec 2021–Jul 2022 (before) and Aug 2024–Mar 2025 (after). Operative videos classified technique as standard lift, gutter scraping, or edge recession; hybrid/unclassifiable cases were excluded from comparisons. Procedure time, resistance at entry/edge/bed separation, and epithelial defect size were recorded. Follow-up graded ingrowth by Probst/Machat (any and III–IV), time to diagnosis, and re-interventions (Nd:YAG or repeat lift). Categorical data used contingency tables/OR; continuous data Welch t-test.
Results
260 flap-lift retreatments were included. Techniques: standard lift (n=73), gutter scraping (n=53), epithelial edge recession (n=80); remaining cases were hybrid/unclassifiable. Mean follow-up 400±292 days (7–1325). By Probst/Machat grading, any ingrowth [III–IV] occurred in 79.5% [28.5%], 64.2% [11.3%], and 57.5% [6.3%], respectively. Only edge recession showed lower rates for both categories (p<.05) and a 65% reduced risk versus standard (OR 0.35, 95% CI 0.17–0.75; p=.004). Ingrowth was unrelated to resistance grading, epithelial defect size, or other variables.
Conclusions
Epithelial edge recession was associated with the lowest rates of epithelial ingrowth after LASIK retreatment flap lift, with a significantly reduced risk compared with standard flap lift. No other intraoperative factors, including graded flap-lift resistance or epithelial defect size, were associated with ingrowth. The absence of an association between lift difficulty and ingrowth suggests that, with these techniques, later enhancements may not intrinsically confer higher ingrowth risk, although this requires dedicated study.