Fibrin adhesives another approach to epithelial ingrowth post-LASIK
Usage effective, associated with few complications
Minnetonka, MN—Got adhesives? Adhesives for post-LASIK epithelial ingrowth, that is.
The use of fibrin adhesives can help surgeons manage this common complication of LASIK surgery, which occurs in 0.5% to 15% of cases, said David R. Hardten, MD.
“Epithelial ingrowth is usually observed in the first few weeks, it may be nonprogressive or progressive, and in the most advanced stage it may result in flap melt,” said Dr. Hardten, Minnesota Eye Consultants, Minnetonka, MN.
Common signs of epithelial ingrowth are isolated nests or sheets of cells, decreased visual acuity, induced astigmatism on refraction, and irregular astigmatism on topography.
Two common treatments for epithelial ingrowth are removal and neodymium:YAG laser treatment, Dr. Hardten said.
Removal usually consists of lifting and scraping epithelial cells, using a blunt spatula and Merocel sponge, and then using ethanol to supplement complete removal. Neodymium: YAG laser treatment is helpful when there are stable pockets of ingrowth where the elevation of the cornea causes changes in comfort or vision, he explained.
To help prevent the recurrence of epithelial ingrowth, surgeons can consider suturing the flap edges, although Dr. Hardten has found that this can induce striae, irregular astigmatism, and require suture removal. This also has a longer recovery. The use of a fibrin adhesive application is useful for recurrent cases but also has a longer recovery.