Incidence and prevention of epithelial growth within the interface after laser in situ keratomileusis.
OBJECTIVE
To analyze the incidence of epithelial growth within the interface after laser in situ keratomileusis (LASIK) and describe a technique that may prevent its occurrence.


METHODS
Results were reviewed for all LASIK procedures performed by two surgeons using identical surgical technique with either the Automated Corneal Shaper or Hansatome microkeratome. After laser ablation, the bed and posterior surface of the flap were irrigated with 0.2 microM filtered basic salt solution, and the surfaces were swept with lint-free sponges to clear the interface of epithelial and other debris. An aspirating lid speculum connected to suction was used to evacuate irrigation fluid and debris from the field. After the flap was smoothed into position, a bandage contact lens was used for the first day after surgery to prevent lifting of the flap edge during blinking.


RESULTS
Seven hundred eighty-three eyes of 419 patients had primary LASIK, and 108 eyes had LASIK reoperation. Three eyes developed epithelial growth within the interface, with a minimum of 3 months of follow-up. The interface opacity appeared within 1 month of surgery in all three eyes. Two epithelial nests were small (1.0 and 1.5 mm in diameter, respectively) and did not increase in size on subsequent visits. Neither peripheral epithelial nest affected best-corrected visual acuity or caused any other sequelae. One ingrowth occurred early postoperatively in a case with a donut-shaped flap and was eliminated by transepithelial photorefractive keratectomy (PRK).


CONCLUSIONS
Irrigating, wiping the stromal interface with sponges. aspirating irrigation fluid and debris with a suctioning lid speculum, and use of a bandage contact lens for the first day after surgery during LASIK and LASIK enhancement may markedly reduce the incidence of epithelial growth within the interface.
Walker
M B
MB
Department of Ophthalmology, The University of Washington School of Medicine, Seattle 98195-6485, USA.
Wilson
S E
SE
D000085:Acetates / Q000008:administration & dosage; D003263:Contact Lenses, Hydrophilic; D003318:Corneal Opacity / Q000209:etiology / Q000473:pathology* / Q000517:prevention & control*; D004338:Drug Combinations; D019573:Epithelium, Corneal / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D054018:Lasers, Excimer; D008903:Minerals / Q000008:administration & dosage; D009216:Myopia / Q000601:surgery; D009883:Ophthalmic Solutions; D018903:Photorefractive Keratectomy; D012086:Reoperation; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage; D012965:Sodium Chloride; D015503:Surgical Sponges; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014792:Visual Acuity
D000085:Acetates; C030660:BSS solution; D004338:Drug Combinations; D008903:Minerals; D009883:Ophthalmic Solutions; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride