Epithelial ingrowth after laer in itu keratomileui

PURPOE: To report the incidence and rik factor for clinically ignificant epithelial ingrowth after laer in itu keratomileui a well a the recurrence rate and viual outcome after it treatment. METHOD: We defined clinically ignificant epithelial ingrowth a that which required urgical removal. From a cohort of 3,786 eye that underwent primary laer in itu keratomileui from February 1996 to Augut 1998 and it derivative of 480 eye that later underwent enhancement laer in itu keratomileui by one urgeon (R.K.M.), we identified all eye with clinically ignificant epithelial ingrowth. REULT: The incidence of ignificant epithelial ingrowth after primary treatment wa 35 (0.92%) of 3,786 eye. The incidence after enhancement treatment wa eight (1.7%) of 480 eye (p = N). Fourteen of 43 eye had a potoperative epithelial defect aociated with ubequent development of epithelial ingrowth. ix of 43 eye had looe epithelium intraoperatively, uggeting epithelial baement membrane dytrophy. Epithelial ingrowth wa treated by lifting the flap, craping the bed and the poterior urface of the flap, and replacing the flap without the ue of cautic agent. In 42 of 43 eye, the epithelial ingrowth under the flap wa continuou with the urface epithelium. Clinically ignificant ingrowth recurred in 10 of 43 eye after the initial urgical removal. CONCLUION: Clinically ignificant epithelial ingrowth i an infrequent complication of laer in itu keratomileui. We hypotheize that epithelial ingrowth i econdary to potoperative invaion under the flap by urface epithelial cell rather than intraoperative implantation of epithelial cell. Treatment hould conit of complete mechanical removal of epithelium from the poterior urface of the corneal flap and keratectomy bed and enuring tight appoition of the flap with the bed.