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Using an Amniotic membrane Pressure patch to treat the LASIK flap with a Central defect and Epithelial ingrowth

¹ Institute of Vision Research, Dept. Ophthalmology, Yonsei Univ College of Med, Seoul, Republic of Korea
² Brain Korea 21 Project for Medical Science, Yonsei University, Seoul, Republic of Korea
³ Daegu Yonsei Eye Clinic, Daegu, Republic of Korea
⁴ Dept. Ophthalmology, Emory Univ., Atlanta, GA

Commercial Relationships: E. Kim, None; S. Jung, None; J. Park, None; S.M. Cristol, None; C.Y. Im, None; K.Y. Seo, None; H. Lee, None.

Grant Identification: 02–PJ1–PG1–CH02–0003

Abstract

Purpose: To report a new successful treatment of epithelial ingrowth occuring under a LASIK flap with a central defect by pressure patching with amniotic membrane.

Methods: Two cases of epithelial ingrowth through a central defect in the LASIK flap were referred after failure of therapeutic contact lens treatment. In patient 1, the flap was bisected by a poor microkeratome incision 5 days earlier. The cut margin was elevated by the epithelium under the flap (Fig., upper left). In patient 2, the microkeratome had produced a very thin flap with only the epithelial layer in the central flap. Laser ablation had been done at the remaining posterior stroma. The central flap had melted and perforated; the epithelium had been growing into the interface for 5 months (Fig., upper right). Each flap was lifted and the epithelium was removed. In patient 2, phototherapeutic keratectomies of 6 mm in diameter were performed on the posterior flap and on the stromal bed for 30 pulses. An amniotic membrane pressure patch (epithelial side against the cornea) was sutured to the episclera under tension, using interrupted 10–0 nylon sutures. The amniotic membrane patch was removed 5–6 days after application.

Results: Both flaps were attached to the remaining posterior stroma without recurrent epithelial ingrowth after removal of amniotic membrane. Visual acuity improved in patient 1 from 20/70 to 20/25 (Fig., lower left) and in patient 2 from 20/100 to 20/25 (Fig., lower right).

Conclusions: Epithelial ingrowth in the central cornea following LASIK can be treated with amniotic membrane pressure patch. The elasticity of the membrane maintains the anatomic relationship between the flap and the stromal bed and prevents recurrence of the epithelial ingrowth.

Key Words: refractive surgery: LASIK • refractive surgery: complications • cornea: stroma and keratocytes

© 2004, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. For permission to reproduce any part of this abstract, contact the ARVO Office at arvo{at}arvo.org.