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

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 105131-41.
• 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
  331376-1380.