title: Transepithelial photorefractive keratectomy for treatment of thin flaps or caps after complicated laser in situ keratomileusis.
abstract: OBJECTIVE
  To report transepithelial photorefractive keratectomy treatment of corneal irregularities produced during laser in situ keratomileusis (LASIK) in which there is a thin flap or cap associated with central corneal scarring or epithelial ingrowth that threatens vision.
  
  
  METHODS
  Case reports. The thickness of the abnormal corneal flap or cap and associated scarring or epithelial ingrowth is estimated at the slit lamp or measured with an optical pachymeter. If residual myopia is sufficiently high to allow complete ablation of the flap or cap in the central cornea, a transepithelial photorefractive keratectomy is performed in which the epithelium is completely ablated with the excimer laser in phototherapeutic keratectomy mode; residual myopia is corrected using photorefractive keratectomy.
  
  
  RESULTS
  This method was used successfully in two eyes of two patients in which a thin cap was associated with a transverse cut through the central cornea or a donut-shaped flap associated with epithelial ingrowth in the central cornea. In both cases, the abnormal cap or flap was ablated, central corneal clarity restored, and visual function improved.
  
  
  CONCLUSIONS
  Transepithelial photorefractive keratectomy may be effective in treating central corneal thin cap or flap abnormalities associated with LASIK.
authors.affiliation: Eye Institute and Department of Cell Biology, The Cleveland Clinic Foundation, Ohio, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Kapadia
authors.forename: S E
authors.initials: SE
authors.lastname: Wilson
mesh_terms: D000328:Adult; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery*; D003319:Corneal Stroma / Q000601:surgery*; D019573:Epithelium, Corneal / Q000601:surgery; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D018903:Photorefractive Keratectomy; D012086:Reoperation; D013524:Surgical Flaps