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Chapter-20 Kim's LASIK Complications

BOOK TITLE: Lasik and Lasik Complications

Author
1. Kim Terry
ISBN
9788184482324
DOI
10.5005/jp/books/10443_20
Edition
1/e
Publishing Year
2008
Pages
8
Author Affiliations
1. Duke University School of Medicine Durham, NC – USA, Duke University Eye Center Durham, NC, USA, Duke Medicine, Durham, North Carolina, USA, Duke University School of Medicine; Duke University Eye Center, Durham, North Carolina, USA, Cornea, Cataract, and Refractive Surgery, Duke University Eye Center, Durham, North Carolina, USA
Chapter keywords

Abstract

Case 1: Recurrent epithelial ingrowth treated with Lasik flap suturing. Epithelial ingrowth is a complication that occurs in approximately 0.5–15% of LASIK cases. Treatment of primary epithelial ingrowth consists of lifting the entire flap, manual removal of the epithelium from the stromal bed and under surface of the flap with a spatula. Flap suturing using interrupted bites with 10-0 nylon suture can provide adequate tissue compression and successful management of recurrent ingrowth. More recently, fibrin glue has been shown to be effective at preventing recurrent epithelial ingrowth. Case 2: Treatment of traumatic Lasik flap dislocation and epithelial ingrowth with fibrin glue. Epithelial ingrowth may begin as early as several hours following the dislocation, and is typically treated with mechanical debridement, with careful attention to removing as much epithelium as possible from both the stromal and flap surfaces. More recently, a method of sealing the flap edges with fibrin glue in cases of recurrent ingrowth may help to prevent the invasion of epithelial cells while the flap adheres to the stromal bed. The glue is easy to apply, relatively inexpensive and spontaneously dissolves over a two-week time period. Case 3: medical and surgical treatment of atypical mycobacterial keratitis following Lasik. Staphylococci and atypical mycobacterial represent the most common organisms encountered following LASIK. A novel surgical approach to treat these infections was attempted and proved successful in debulking the infection and improving antibiotic penetration. This surgical procedure avoided the potential need for flap amputation, which is usually the next step in progressive atypical mycobacterial infections that prove unresponsive to therapy.

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