title: Flap amputation with phototherapeutic keratectomy (PTK) and adjuvant mitomycin C for severe post-LASIK epithelial ingrowth.
abstract: OBJECTIVE
  To report a patient with severe post-laser in situ keratomileusis (LASIK) epithelial ingrowth and keratolysis treated with flap amputation and phototherapeutic keratectomy (PTK) with adjuvant intraoperative mitomycin C (MMC).
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 55-year-old woman was referred to our department due to severe post-LASIK epithelial ingrowth with corneal melting 2 years after primary LASIK. The patient had had two previous attempts for epithelial ingrowth treatment (flap lift and epithelial ingrowth manual removal) that were unsuccessful. Slit lamp biomicroscopy and anterior segment optical coherence tomography showed extensive epithelial ingrowth and keratolysis (thinning of the LASIK flap) while the patient had photophobia and could not tolerate contact lenses. Flap amputation with subsequent PTK (in order to smooth out the corneal irregularities caused by the keratolysis and/or variations in flap thickness) and adjuvant intraoperative MMC application for 2 minutes was performed. There were no intra- or postoperative adverse events seen during the follow-up period. Six months after the procedure, uncorrected visual acuity improved to 20/40 compared with 20/50 preoperatively, while best spectacle-corrected visual acuity improved from 20/40 to 20/32. The topographic astigmatism was decreased from 3.24 diopters (D) to 1.00 D.
  
  
  CONCLUSIONS
  Flap amputation with PTK and adjuvant intraoperative MMC is an option for the management of severe post-LASIK epithelial ingrowth with keratolysis.
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami University, Miami, FL 33136, USA. kymionis@med.uoc.gr
authors.forename: George
authors.initials: G
authors.lastname: Kymionis
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ide
authors.forename: Sonia
authors.initials: S
authors.lastname: Yoo
mesh_terms: D000477:Alkylating Agents / Q000008:administration & dosage; D000671:Amputation, Surgical / Q000379:methods*; D003131:Combined Modality Therapy; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery*; D003319:Corneal Stroma; D019573:Epithelium, Corneal / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D018903:Photorefractive Keratectomy / Q000379:methods*; D011183:Postoperative Complications; D013524:Surgical Flaps; D041623:Tomography, Optical Coherence; D014792:Visual Acuity
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin