Eyeworld

I THERAPEUTIC REFRACTIVE CORNEAL SURGERY N FOCUS 74 | EYEWORLD | APRIL 2020 by Liz Hillman Editorial Co-Director P ost-LASIK complications are exceed- ingly rare. According to the American Refractive Surgery Council, less than 1% of LASIK patients experience surgical complications. Though rare, EyeWorld spoke with experts on how to handle some of these complications. First, there's the patient discussion. "You don't want to minimize the complica- tion; you don't want to ignore it," said Michael Gordon, MD. "I think the best time to handle any complication is the moment you notice it because … quickly handled, quickly forgotten." The most common complication that requires a therapeutic intervention after LASIK, said Francis Price, MD, and Robert Maloney, MD, is the need for an enhancement. While a surgeon might not consider this a complication, per se, both Drs. Price and Maloney said the patient often sees it as such because they need to return the OR. Dr. Price said his enhance- ment rate is less than 1%; Dr. Maloney said the enhancement rate at his practice is 4%. Outside of enhancements, the two most "common" reasons why a post-LASIK patient would need to return to the OR are a slipped flap or epithelial ingrowth. Overall, Dr. Maloney estimated that each occur in about 1% of cases. Management of rare post-LASIK complications At a glance • Post-LASIK complications, such as flap dislocation, recurrent erosion, epithelial ingrowth, and ectasia are extremely rare. The most com- mon post-LASIK complication is the need for enhancement, doctors said. • When addressing striae in a flap, note that epithelial wrinkles might still be visible after smoothing the stroma; they will disappear with time. • Epithelial ingrowth is more common after lifting the flap for an enhancement. • Recurrent erosion is often associated with underlying basement membrane dystrophy. Eye with areas of epithelial ingrowth superior nasally and inferior nasally Large area of epithelial ingrowth near inferior flap margin; note the irregularity to flap margin that commonly develops with epithelial ingrowth Source (all): Francis Price Jr., MD Handling flap dislocations, striae Slipped flaps usually occur within hours after surgery and are diagnosed on the first day post- op. The exception is trauma, Dr. Maloney said. "The key with repairing flap dislocations is after you lift and smooth it out, you'll still have visible striae in it because the epithelium thick- ens and thins in response to the wrinkles. Even when you get rid of the stromal wrinkles, there are still epithelium wrinkles. The mistake new doctors make is they try and smooth out the epithelial wrinkles," Dr. Maloney said. "Once the edges of the flap are lined up, the wrinkles will go away the next day, so you don't have to remove any of the epithelial wrinkles." Tackling epithelial ingrowth Overall, it would be rare to get primary epi- thelial ingrowth, Dr. Gordon said. The most common reason to get epithelial ingrowth, the doctors said, is from relifting the flap for enhancements. Overall, Dr. Price said improved treatment with newer platforms is reducing the number of enhancements needed and thus cutting down on problems like secondary epithelial ingrowth. Dr. Gordon said if the ingrowth is at the edge and not impacting vision, he will

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