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 of the flap incision. 2- Planting of epithelial cells beneath the flap or CAP, spread during the course of the Lasik surgery or SMILE. o.j.wolter@gmail.com OMCHanze-Oogkliniek
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 o.j.wolter@gmail.com OMCHanze-Oogkliniek
Corneal Interface Epithelial Ingrowth in SMILE • Incidence very rare. • There are only two publications or case report on C.I.E.I. in SMILE o.j.wolter@gmail.com OMCHanze-Oogkliniek
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. o.j.wolter@gmail.com OMCHanze-Oogkliniek
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. . o.j.wolter@gmail.com OMCHanze-Oogkliniek
Primary SMILE OD o.j.wolter@gmail.com OMCHanze-Oogkliniek
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. o.j.wolter@gmail.com OMCHanze-Oogkliniek
o.j.wolter@gmail.com OMCHanze-Oogkliniek
C.I.E.I. OD 3m Post op SMILE o.j.wolter@gmail.com OMCHanze-Oogkliniek
C.I.E.I. OD 6m. Post-op SMILE o.j.wolter@gmail.com OMCHanze-Oogkliniek
o.j.wolter@gmail.com OMCHanze-Oogkliniek
1 day postop C.I.E.I. removal o.j.wolter@gmail.com OMCHanze-Oogkliniek
Direct after Nd-YAG laser of rests C.I.E.I. o.j.wolter@gmail.com OMCHanze-Oogkliniek
3 m. Post-op removal and Nd-Yag laser o.j.wolter@gmail.com OMCHanze-Oogkliniek
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. o.j.wolter@gmail.com OMCHanze-Oogkliniek
Thank You o.j.wolter@gmail.com OMCHanze-Oogkliniek
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