Article
Clinical supervisions and morphological confirmation of epithelial ingrowth after lamellar refractive surgery
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Authors
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V. Y. Usov
- The Filatov Institute of Eye Diseases and Tissue Therapy, Odessa/UA
| Published: | September 22, 2004 |
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Outline
Text
Objective
Automated lamellar keratoplasty (ALK) is en effective procedure to correct myopia, which involves a second keratectomy in the bed of the recipient cornea to allow flattering of the central cornea after replacing the corneal cap. Performing surgery can result in complications-and ALK surgery is no exception to that rule. Epithelial ingrowth under the flap and stromal melt is a frequent complication, affecting between 2 and 10% of the operated eyes.
Methods
We report on a six patient (8 eyes) who developed extensive epithelial ingrowth and partial keratolysis of the flap following ALK. Each eye was examined by slit-lamp biomicroscopy, and corneal topography. Three eyes had an early surgical intervention, and five eyes were observed. The flap was lifts, irrigates and scrapes the stromal bed and flap undersurface, and then repositions the flap.
Results
Epithelial ingrowth and progressive stromal melt can result in irregular astigmatism, lost at least one line of best spectacle-corrected visual acuity and ciliary injection. A review of specular microscopy confirmed the presence in the interface opacities epithelial cells.
Conclusions
The presence of epithelium within the lamellar interface is a significant complication after refractive lamellar surgery. In some cases, interfase epithelium may be associated with early postoperative inflammation and associated with melting of the edge of the flap. Histological research is informing method of determination the nature of interface opacities. This undesirable complication can be successfully managed with early surgical removal of the epithelium and proper attachment of the flap.
