Flap lift LASIK re-treatment improves vision despite epithelial ingrowth, dry eye

Eur J Ophthalmol. 2011;21(1):5-11.

Issue: March 25, 2011

Flap lift LASIK re-treatment surgery for residual refractive errors resulted in a high incidence of epithelial ingrowth and dry eye, a study found.

"Despite this, reasonable visual and refractive outcomes were achieved at 6 months post-re-treatment," the study authors said.

The prospective study included 60 eyes of 48 patients who underwent flap lift re-treatment LASIK to correct residual refractive errors. Mean patient age was 36 years.

Wavefront-guided LASIK was performed with the Visx S4 Star excimer laser (Abbott Medical Optics). Primary outcome measures were predictability, safety, efficacy and stability.

Study data showed that, after re-treatment, epithelial ingrowth was identified in 14 eyes (23.3%). Four of those eyes required a flap lift and scrape procedure, and two eyes required a second flap lift and scrape procedure. Postoperative dry eye was identified in five eyes (8.3%).

Results at 6 months showed mean uncorrected visual acuity of 1.03, sphere of 0.08 D, cylinder of –0.53 D, spherical equivalent of –0.04 D, defocus equivalent of 0.29 D and best corrected visual acuity of 1.13.

UCVA was 1 or better in 44 eyes (73%); 53 eyes (88.3%) were within 0.5 D of spherical equivalent and 59 eyes (98.3%) were within 1 D of spherical equivalent. Two eyes (3.3%) lost one line of BCVA.

This study highlights the merits and potential drawbacks of lift flap LASIK enhancements. In addition to the benefit of quick visual recovery, LASIK allows surgeons to easily access the stromal bed in the event that an enhancement is indicated. A higher incidence of epithelial ingrowth exists after lift flap enhancements. To avoid this nuisance, many surgeons are considering surface ablation for excimer enhancement in higher risk cases. Like the original lamellar cut, corneal nerves will need to regenerate after the flap is lifted. Typically, neuroregeneration occurs without incident, and the ocular surface should be optimized in the perioperative period. Overall, lift flap enhancements provide excellent results and allow surgeons to optimize outcomes.

– George O. Waring IV, MD
Cornea, Cataract, Lens and Refractive Surgery ReVision Advanced Laser Eye Center, Columbus, Ga.
Medical Director, Division of Ophthalmology, St. Joseph’s Translational Research Institute, Atlanta
Disclosure: Dr. Waring has no financial interest in any products or procedures discussed in the study. He has a financial interest in AcuFocus, Topcon, SOOFT, RevitalVision and Ista.