Case Report: Managing corneal Interface Epithelial Ingrowth after - - PowerPoint PPT Presentation

Case Report:

Managing corneal Interface Epithelial Ingrowth after SMILE

Irene Nijdam, Boptom; Hans Ockels, Boptom; EduardTimmerman, MD; Marieke Versteegh, MD; and Otto Wolter, MD.

Corneal Interface Epithelial Ingrowth after ReLex-SMILE,

Corneal Interface Epithelial Ingrowth

Interface Epithelialization related to LASIK:

It has two physiopathogenic mechanism; 1- Invasion of Interface by corneal epithelium at the periphery

• f the flap incision.

2- Planting of epithelial cells beneath the flap or CAP, spread during the course of the Lasik surgery or SMILE.

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Corneal Interface Epithelial Ingrowth

• Incidence C.I.E.I. after LASIK

– Between 0,2 – 12 % after primary cases. – Up to 32 % in cases requiring retreatments. – Only 3% with clinical significant problems

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Corneal Interface Epithelial Ingrowth in SMILE

• Incidence very rare.
• There are only two publications or case report on C.I.E.I. in SMILE
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Risks Factors for C.I.E.I.

• Diabetes Mellitus type I and II.
• Epithelial defects during laser surgery.
• Epithelial Breakthrough.
• History of recurrent corneal erosions.
• Corneal basement membrane epithelial dystrophy.
• History of Epithelial Ingrowth in the other eye.
• Hyperopic Lasik correction.
• Flap striae or folds related to flap dislocates, trauma or poor adhesion.
• Flap instability.
• Repeated Lasik surgery and flap-lifting technique.
• Surgeons learning curve in Lasik and now also SMILE.
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Possible treatments for C.I.E.I.

• Observation till clinical significant visual loss.
• Flap-lifting or CAP opening and

– manual removal, – Scraping, – washing, – PTK, – flap suturing, – Application of ethanol, mitomycin C, fibrin glue or proparacaine, – Amniotic membrane as a biological patch, – Nd: Yag-laser, – Penetrating Keratoplasty due to severe corneal melting. .

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Primary SMILE OD

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Our Case Report

• Caucasian male farmer, 30 years old and without risks factors for C.I.E.I.
• SMILE for moderate Myopia RE
• There was a minimal epithelial defect at the cap-side cut incision
• A bandage lens was not placed
• First day postop no Corneal Interface debris were observed and BCVA was 1,0
• First week post op was the same and BCVA was 1,2
• At first month postop a C.I.E.I. in the central pupillary area and BCVA decreased to

0,9

• Monthly follow-up and FML drops were prescribed.
• At 6 months post-op there was a well organized central C.I.E.I. BCVA of 0,8 –
• Irritation symptoms, conjunctiva redness and central punctate keratitis.
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C.I.E.I. OD 3m Post op SMILE

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C.I.E.I. OD 6m. Post-op SMILE

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1 day postop C.I.E.I. removal

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Direct after Nd-YAG laser of rests C.I.E.I.

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3 m. Post-op removal and Nd-Yag laser

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Conclusions

• C.I.E.I. might occur after SMILE
• However less frequent than in Lasik; due the side-cut size in Smile versus

the flap circumference in Lasik.

• This case was successfully treated by removal, scraping, wash and Nd-Yag

laser directed to focal rests of C.I.E.I. inducing its apoptosis at low laser energy in combination with the anti-inflammatory steroids effect.

• There was no recurrence after 4m. post-op of the E.I. removal.
• Our technique was safe and there was no loss of BCVA 1,2.
• Take home message:

Use a bandage lens whenever you have a corneal epithelial defect.

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Thank You

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