Influence of original flap creation method on incidence of epithelial ingrowth after LASIK retreatment

To compare the rate of epithelial ingrowth after LASIK retreatment among eyes with flaps created by femtosecond laser and those created by mechanical microkeratome.

Postoperative results from 272 consecutive LASIK retreatments performed by a single surgeon over a 4-year period were reviewed retrospectively to identify cases that developed clinically significant epithelial ingrowth, defined as that which required surgical removal. Flaps for the original LASIK treatments were created using a mechanical microkeratome or femtosecond laser. The same technique to lift the flap at the time of retreatment was used in all eyes included in this study.

LASIK retreatment was performed in 132 eyes that had the initial flap created using a mechanical microkeratome (microkeratome group). Epithelial ingrowth was identified in 11 eyes of 9 patients. Surgical intervention to remove the epithelium from the stromal interface was required in 8 (6.1%) eyes. Femtosecond laser was used to create the initial LASIK flap in 140 eyes that required retreatment (femtosecond group). Epithelial ingrowth after LASIK retreatment was identified in 2 eyes of 1 patient in the femtosecond group (P=.004). Neither of these 2 eyes required surgical intervention to remove the epithelium from the stromal interface (P=.017).

Eyes with femtosecond laser-created flaps may be less likely to develop significant epithelial ingrowth after LASIK retreatment when compared with eyes in which the flap was created using a mechanical microkeratome. The difference in rate of epithelial ingrowth may be related to the geometry of the flap edge.