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[Risk factors and management for inadvertent stromal dissection of Epi-LASIK]
Yu Zhang1, Ying-jie Xia, Yue-guo Chen
1Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China.
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.
Insights
Stromal dissection is a rare complication during Epi-LASIK surgery. Prompt treatment with photorefractive keratectomy (PRK) and phototherapeutic keratectomy (PTK) can lead to good visual recovery.
Area of Science:
- Ophthalmology
- Refractive Surgery
- Corneal Surgery
Context:
- Epi-LASIK (Epipolis Laser-Assisted In Situ Keratomileusis) is a refractive surgical procedure.
- Mechanical separation of the corneal epithelium is a critical step in Epi-LASIK.
- Moria Epi-K is a common instrument used for epithelial separation.
Purpose:
- To identify risk factors for inadvertent cornea stromal dissection during Epi-LASIK.
- To evaluate treatment options for this complication.
- To determine the optimal management strategy for stromal dissection during Epi-LASIK.
Summary:
- A retrospective review of 708 eyes undergoing Epi-LASIK identified 4 cases (0.56%) of inadvertent stromal dissection.
- Treatment varied, including immediate excimer laser ablation, LASIK, and phototherapeutic keratectomy (PTK) with photorefractive keratectomy (PRK).
- One eye treated with PTK and PRK one month post-procedure showed improved visual acuity and regular corneal topography.
Impact:
- Stromal dissection is a potential complication of Epi-LASIK using the Moria Epi-K.
- Prompt PTK and PRK offer a viable management option for good visual recovery.
- This study provides insights into managing a rare but significant complication in refractive surgery.
