Incidence and prevention of epithelial growth within the interface after laser in situ keratomileusis

Purpose, To analyze the incidence of epithelial growth within the interface after laser in situ keratomileusis (LASIK) and describe a technique that may prevent its occurrence. Methods. Results were reviewed for all LASIK procedures performed by two surgeons using identical surgical technique with either the Automated Corneal Shaper or Hansatome microkeratome. After laser ablation, the bed and posterior surface of the nap were irrigated with 0.2 mu M filtered basic salt solution, and the surfaces were swept with lint-free sponges to clear the interface of epithelial and other debris. An aspirating lid speculum connected to suction was used to evacuate irrigation fluid and debris from the field. After the flap was smoothed into position, a bandage contact lens was used for the first day after surgery to prevent lifting of the flap edge during blinking. Results, Seven hundred eighty three eves of 419 patients had primary LASIK, and 108 eyes had LASIK reoperation. Three eyes developed epithelial growth within the interface, with a minimum of 3 months of follow-up. The interface opacity appeared within 1 month of surgery in all three eyes. Two epithelial nests were small (1.0 and 1.5 mm in diameter, respectively) and did nor increase in size on subsequent visits. Neither peripheral epithelial nest affected best-corrected visual acuity or caused any other sequelae. One ingrowth occurred early postoperatively in a case with a donut-shaped flap and was eliminated by transepithelial photorefractive keratectomy (PRK). Conclusion. Irrigating, wiping the stromal interface with sponges, aspirating irrigation fluid and debris with a suctioning lid speculum, and use of a bandage contact lens for the first day after surgery during LASIK and LASIK enhancement may markedly reduce the incidence of epithelial growth within the interface.