title: [Risk factors and management for inadvertent stromal dissection of Epi-LASIK].
abstract: OBJECTIVE
  To investigate the risk factors of inadvertent cornea stromal dissection during mechanical epikeratome separation of the corneal epithelium using a Moria Epi-keratome and to explore the best procedure for the treatment of this complication.
  
  
  METHODS
  We retrospectively reviewed inadvertent stromal dissections in central or peri-central areas of the cornea during mechanical epi-keratome separation of the corneal epithelium from a series of 708 eyes (355 patients) who received myopic Epi-laser-assisted in situ keratomileusis (Epi-LASIK) procedures during the past five years. The best spectacle corrected visual acuities (BCVA) and topographies at the final follow-up after the last procedures were compared.
  
  
  RESULTS
  From the total of treated eyes, 4 eyes of 4 patients (0.56%) suffered inadvertent stromal dissection. In two of them, an excimer laser ablation under the flaps was performed immediately. One patient was treated with LASIK 6 month after the first procedure and another one received an excimer laser photo-therapeutic keratectomy (PTK) removing the corneal epithelium and photorefractive keratectomy (PRK) for refractive correction 1 month after Epi-LASIK. Postoperatively, BCVA lost one line in one eye which received immediate excimer laser ablation under complicated flap. Topography demonstrated irregularity corresponding to the site of stromal dissection. Two eyes (one received immediate excimer laser ablation and another received LASIK 6 month after stromal dissection) recovered to the pre-Epi-LASIK BCVA. One eye that received PTK and PRK 1 month after Epi-LASIK obtained an increase of one line in BCVA. Topography in all three eyes showed regular patterns in the middle of the cornea.
  
  
  CONCLUSIONS
  Stromal dissection during mechanical separation of the corneal epithelium with Moria Epi-K epikeratome is a potential complication of Epi-LASIK. One month postoperative PTK and PRK turned out to be the option of proper management for good recovery without severe visual impairment.
authors.affiliation: Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ying-jie
authors.initials: YJ
authors.lastname: Xia
authors.forename: Yue-guo
authors.initials: YG
authors.lastname: Chen
mesh_terms: D000328:Adult; D003315:Cornea / Q000601:surgery; D003319:Corneal Stroma / Q000601:surgery*; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects* / Q000379:methods; D054018:Lasers, Excimer; D008297:Male; D019300:Medical Errors; D009216:Myopia / Q000601:surgery*; D018903:Photorefractive Keratectomy; D012307:Risk Factors; D055815:Young Adult