Q:
I would be most thankful if you could give me your precious input in this case. The 35 yo patient had a LASIK in both eyes 8 months ago, in her 1st post op day, she had both eyes dislocated flaps and epithelial ingrowth after that.
However, the bilateral weird lesions were found in addition to the epithelial ingrowth. There is no eye inflamation, no complaints at all, no soreness and even the V/A is 6/5 with prescription. Is this an infections crystalline keratopathy (ICK)?
There is an indolent course and in stereoscopic view, looks like a cyst under the flaps with some cristal like shape material inside.
Please, find the picture from both eyes attached. I look forward to receiving your opinion!
Thank you.
There is an indolent course and in stereoscopic view, looks like a cyst under the flaps with some cristal like shape material inside.
Please, find the picture from both eyes attached. I look forward to receiving your opinion!
Thank you.
A by Emil Chynn, MD:
i would do this myself:
1. lift up flap very atraumatically
2. scrape very aggressively, both the bed and undersurface of the flap, need a lot of pressure or won’t remove the tissue
3. when you scrape the underside of the flap it helps to put something underneath or the flap will slide around and you will unintentionally debride all the epithelium which would again predispose to epi ingrowth
4. apply alcohol afterwards to kill off the many epi cells you aren’t going to be able to scrape off
5. may need to apply hypotonic saline to swell up the flap as a good scraping takes several minutes, during which time the flap dehydrates, and if that happens too much you’ll get a mismatch between flap and bed, which would again predispose to epi ingrowth. an additional benefit is the hypotonic saline will remove any striae that might be present (which is common)
6. stretch flap out so you don’t have flap/bed size mismatch
7. put in sutures where the epi ingrowth was, don’t tie too tight or will induce a lot of astigmatism, but tight enough that it secures the edge to prevent recurrance, what i like to do is tie them a bit tight to induce a tiny bit of cyl, which then mostly goes away when you later cut the sutures, i usually use interrrupted bc that is a LOT easier than running, but i have seen excellent and possibly more astimatically-neutral running sutures by surgeons who might be more dextrous than myself;)
and, my final plug for my sub-sub-specialty:
EPITHELIAL INGROWTH IS IMPOSSIBLE AFTER LASEK!:)
hope this helps and good luck
