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Epithelial Scraping Instead of Retreatment in LASEK Patients: 5 Case Reports

Epithelial Scraping Instead of Retreatment in LASEK Patients: 5 Case Reports. Anita Ravi, BS 1 S.A. Erzurum, MD, FACS 2,3,4. 1. College of Arts and Sciences, Youngstown State University, Youngstown, OH

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Epithelial Scraping Instead of Retreatment in LASEK Patients: 5 Case Reports

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  1. Epithelial Scraping Instead of Retreatment in LASEK Patients: 5 Case Reports Anita Ravi, BS1 S.A. Erzurum, MD, FACS2,3,4 1. College of Arts and Sciences, Youngstown State University, Youngstown, OH 2, 3. Section of Ophthalmology in the Department of Surgery at Forum Health and St. Elizabeth Health Center, Youngstown, OH 4. Department of Surgery, Northeastern Ohio Universities College of Medicine, Rootstown, OH Co-authors disclose a lack of any financial relationships in this report.

  2. Purpose • To evaluate the efficacy and safety of scraping the corneal epithelium in patients to retreat unsuccessful myopic and hyperopic laser sub-epithelial keratectomy (LASEK)

  3. Methods • Single-surgeon retrospective case series of 5 eyes in 5 patients • Age ranged from 50 to 64 years (average 56.2 years) • All underwent LASEK that resulted in refractive error • Corneal epithelial scraping 1-5 months after initial LASEK procedure (average 2.6 months) to correct residual refractive error and epithelial irregularities in lieu of laser retreatment

  4. Methods • Manifest refraction, uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA) using Snellen eye chart before and after corneal epithelium scraping were reported. • Scraping was performed under topical anesthesia at the slit lamp with smooth tip forceps. • Bandage contact lenses were worn over scraped eyes until cornea epithelialized. • The use of moxifloxacin, ketorolac, tromethamine, and fluorometholone was applied to prevent infection and inflammation.

  5. Cases • Case 1 • 69 y/o F, myopia , anisocoria, and astigmatism of OS • Pre-op BCVA 20/30- • Post-op BCVA 20/60, with mild epithelial irregularity • Scrape BCVA 20/25 • Gained 1 line of BCVA • Case 2 • 57 y/o M, myopia and astigmatism of OS • Pre-op BCVA 20/20 • Post-op BCVA 20/25- • Mild map dot fingerprint appearance to epithelium • Scrape BCVA 20/20

  6. Cases Case 3 • 53 y/o M, hyperopia of OD after already having laser retreatment • Mild epithelial irregularity • Scrape BCVA 20/20 Case 4 • 52 y/o F, myopia of OS • Post-op UCVA 20/40 and hyperopic • Scrape BCVA and UCVA 20/20 Case 5 • 50 y/o F, myopia and astigmatism of OS • Post-op BCVA 20/25- • Basement membrane disturbances to epithelium • Scrape BCVA 20/20

  7. Cases Schematic depicting the scraping performed Mild map dot fingerprint defects

  8. Results

  9. Results • All five eyes showed improvement in UCVA. • All patients maintained or showed an improvement in their BCVA. • Mean change in UCVA was 0.51 and in BCVA was 0.12 LogMar. • Average pre-scrape UCVA was 0.57 LogMar, and BCVA was 0.14 LogMar. Average post-scrape UCVA was 0.06 LogMar and BCVA was 0.02 LogMar. • No patient progressed to laser retreatment; no complications were noted. Follow-up time was 1 to 10 months (average 6.6 months).

  10. Conclusion • Scraping instead of laser enhancement appears safe and effective for retreatment of LASEK patients suffering residual error, improving UCVA and BCVA without complication. • To our knowledge, this method of retreatment has not been reported before. • In future trials, scraping may be a viable and preferable option to laser retreatment in selected patients.

  11. Photos and Bio Sergul Erzurum, MD, FRCS Dr. Erzurum is Chief of Ophthalmology in the Department of Surgery at Forum Health in Youngstown, Ohio and Professor of Surgery at NEOUCOM. Dr. Erzurum is in private practice at Eye Care Associates in Youngstown, Ohio. Anita Ravi, BS Anita Ravi is a graduate of the College of Arts and Sciences, Youngstown State University, Youngstown, Ohio and a second year medical student at the Northeastern Ohio Universities College of Medicine (NEOUCOM).

  12. References 1. Spadea L, Di Gregorio A. Enhancement Outcomes after Photorefractive Keratectomy and Laser in situ Keratomoleusis Using Topographically Guided Excimer Laser Photoablation. J Cataract Refract Surg. 2005; 31: 2306-12. 2. Garty DS, Larkin DFP, Hill AR et al. Retreatment for significant regression after excimer laser photorefractive keratectomy: a prospective, randomized, masked trial. Ophthalmology 198; 105:131-41. 3. Hersh PS, Fry KL, Bishop DS. Incidence and associations of retreatment after LASIK. Ophthalmology 2003; 112: 748-54. 4. Taneri S, Feit R, Azar D. Safety efficacy, and stability indices of LASEK correction in moderate myopia and astigmatism. J Cataract Refract Surg. 2004; 30: 2130-7. 5. Spadea L, Colucci S, Bianco G, Balestrazzi E. Long-term results of excimer laser photorefractive keratectomy in high myopia: a preliminary report. Ophthalmic Surg Lasers. 1998: 29: 440-96. 6. Pop M, Aras M. Photorefractive keratectomy for Regression : one year follow-up. Ophthalmology 1996; 103: 1979-84. 7. Harter D, Hardten D. Retreatment after LASIK using epithelial ablation alon. J Refract Surg. 2007; 23: 528-20. 8. Das S, Sullivan L. Comparison of Residual Stromal Bed and Flap Thickness in Primary and Repeat Laser in situ Keratomileusis in Myopic Patients. J Cataract Refract Surg. 2006; 32: 2080-3. 9. Arshinoff S et al. Use of Topical Nonsteroidal Anti-Inflammatory Drugs in Excimer Laser Photorefractive Keratectomy. J Cataract Refractive Surgery. 1994; 20: 216-222. 10. Beerthuizen J, Siebelt E. Surface ablation after laser in situ keratomileusis: Retreatment on the flap. J Cataract Refract Surg. 2007; 33:1376-1380.

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