Incidence and management of epithelial loosening after LASIK

Oruçoğlu, Faik; Kendüşim, Mahir; Ayoğlu, Buket; Toksu, Berrin; Göker, Sinan

doi:10.1007/s10792-012-9557-x

Cited by 6 publications

(10 citation statements)

References 24 publications

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“…Many large-scale studies do not report a single case of RCE, while other studies involving a significant number of eyes report only isolated cases [ 12 , 21 , 42 ]. Two large studies of 1,873 and 1,650 eyes report one case of RCE each, and a study of 5,566 eyes reports a 0.14% incidence [ 11 , 38 , 43 ]. Although RCE is rare in the context of LASIK, LASIK itself is a common cause of RCE.…”

Section: Reviewmentioning

confidence: 99%

A Literature Review of the Incidence, Management, and Prognosis of Corneal Epithelial-Related Complications After Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE)

Moshirfar,

Santos,

Wang

et al. 2023

Cureus

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Our purpose is to provide a comprehensive investigation into the incidence, treatment modalities, and visual prognosis of epithelial-related complications in corneal refractive surgeries, including laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE). A systematic search of multiple databases was conducted by two independent examiners using various search terms related to epithelial-related complications and corneal refractive surgeries. A total of 91 research articles were included, encompassing a sample size of 66,751 eyes across the three types of surgeries. The average incidence of epithelial-related complications varied across the different types of corneal refractive surgeries. LASIK had an average incidence of 4.9% for epithelial defects, while PRK and SMILE had lower rates of 3.3% and 3.9%, respectively. Our findings indicate that SMILE has a lower incidence of epithelial defects compared to LASIK, potentially due to the less invasive nature of lenticule incision in SMILE. Visual prognosis after epithelial complications (EC) is generally favorable, with various supportive care and surgical interventions leading to significant improvements in postoperative visual acuity and full recovery. Understanding the incidence rates and management approaches for epithelial-related complications can guide clinicians in enhancing patient safety, refining surgical techniques, and optimizing postoperative outcomes in corneal refractive surgeries.

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Section: Reviewmentioning

confidence: 99%

A Literature Review of the Incidence, Management, and Prognosis of Corneal Epithelial-Related Complications After Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE)

Moshirfar,

Santos,

Wang

et al. 2023

Cureus

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“… 10 Pérez-Santonja et al and Oruçoğlu et al report that the development of such epithelial-related complications after LASIK may be a diagnostic marker for underlying epithelial basement membrane disease that was not diagnosed prior to the procedure. 10 , 12 This is also an important consideration when evaluating patients for SMILE. Our study reported incidences of 1.2% for ABM changes and 0.2% for corneal erosion.…”

Section: Discussionmentioning

confidence: 99%

“…These two patients were classified into the corneal erosion category, with an incidence of 0.46%, compared to 0.05–0.14% in LASIK, as reported by various studies. 11 , 12 , 19 …”

Section: Discussionmentioning

confidence: 99%

“…These two patients were classified into the corneal erosion category, with an incidence of 0.46%, compared to 0.05-0.14% in LASIK, as reported by various studies. 11,12,19 The corneal epithelium is composed of various structures, including hemidesmosomes, which contribute to adhesion mechanisms between the epithelium and the underlying basement membrane. 20 When the hemidesmosomal connection is compromised, patients are predisposed to disturbances of the epithelium.…”

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confidence: 99%

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Incidence and Management of Epithelial-Related Complications After SMILE

Moshirfar,

Zhang,

Pandya

et al. 2023

OPTH

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To investigate the incidence and management of only epithelial-related complications following small incision lenticule extraction (SMILE). Patients and Methods: A retrospective, single-site study analyzed patients who underwent SMILE at Hoopes Vision Clinic in Draper, Utah, from June 2017 to February 2023. Demographic data and preoperative parameters were reviewed. Postoperatively, patients were assessed for visual acuity and complications at different time points. Statistical analyses were conducted between the control and complication groups. Results: Four hundred and thirty-two eyes of 220 patients received SMILE. Postoperative epithelial-related complications were indicated in 68 (15.7%) eyes, including anterior basement membrane (ABM) changes (five [1.2%]) eyes), epithelial ingrowth (nine [2.1%] eyes), erosion (two [0.5%] eyes), rough epithelium (18 [4.2%] eyes), epithelial defect (12 [2.8%] eyes), diffuse lamellar keratitis (DLK) secondary to epitheliopathy (two [0.5%] eyes), microstriae secondary to epitheliopathy (four [0.9%] eyes), interface debris (21 [4.9%] eyes), and incisional fibrosis (one [0.2%] eye). There was a statistically significant difference in age, with older patients more likely to develop epitheliopathy postoperatively (P = 0.001). Additionally, patients with epithelial-related complications were more likely to receive photorefractive keratectomy (PRK) enhancement after SMILE than the control (P = 0.001). However, there was no statistical difference in uncorrected distance visual acuity (UDVA) better than 20/20 and corrected distance visual acuity (CDVA) between the complications group and the control at the last postoperative visit (P = 0.974 and 0.310, respectively). There was no statistically significant difference in the safety and efficacy indices between the complications and control group (P = 0.281 and 0.617, respectively). Conclusion: In our study, epithelial-related complications were more prevalent in older patients and predisposed patients to require PRK enhancements after recovery from SMILE. Despite the incidence of epithelial-related complications, visual prognoses were favorable and achieved through various management strategies.

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“…All of these eyes healed in 1-3 days; 3 eyes with 4− 5 mm defect were left with visually symptomatic irregular or against-the-rule astigmatism that was successfully treated with transepithelial phototherapeutic keratectomy. Another report of 5566 eyes that underwent LASIK using a microkeratome evaluated over a one-year period eight eyes that had recurrent epithelial loosening [117]. Lubrication and BSCLs were used in 4 eyes with the remaining 4 requiring anterior stromal puncture plus wear of BSCL for 1 month for resolution of symptoms.…”

Section: Laser Assisted In Situ Keratomileusis (Lasik)mentioning

confidence: 99%

BCLA CLEAR – Medical use of contact lenses

Jacobs

Carrasquillo²,

Cottrell

et al. 2021

Contact Lens and Anterior Eye

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The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.

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Incidence and management of epithelial loosening after LASIK

Cited by 6 publications

References 24 publications

A Literature Review of the Incidence, Management, and Prognosis of Corneal Epithelial-Related Complications After Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE)

A Literature Review of the Incidence, Management, and Prognosis of Corneal Epithelial-Related Complications After Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE)

Incidence and Management of Epithelial-Related Complications After SMILE

BCLA CLEAR – Medical use of contact lenses

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