Transcript Epithelial Scraping Instead of Retreatment in LASEK

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.
Purpose
• To evaluate the efficacy and safety of scraping
the corneal epithelium in patients to retreat
unsuccessful myopic and hyperopic laser subepithelial keratectomy (LASEK)
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
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.
Cases
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Case 1
69 y/o F, myopia , anisocoria, and astigmatism of OS
Pre-op BCVA 20/30Post-op BCVA 20/60, with mild epithelial irregularity
Scrape BCVA 20/25
Gained 1 line of BCVA
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Case 2
57 y/o M, myopia and astigmatism of OS
Pre-op BCVA 20/20
Post-op BCVA 20/25Mild map dot fingerprint appearance to epithelium
Scrape BCVA 20/20
Cases
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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 20/25Basement membrane disturbances to epithelium
Scrape BCVA 20/20
Cases
Schematic depicting the
scraping performed
Mild map dot
fingerprint defects
Results
Pt Name
Prescrape VA
UC
BC
1
69 years
10 mos f/u
MONO, OS
20/400
1.3
logMAR
20/60
.48
logMAR
2
57 years
1 mos f/u
MONO, OS
20/50
.4
logMAR
3
53 years
2 mos f/u
OD
Pre-scrape
refraction
Final VA
Final
refraction
Change
In sph
equiv
UC
BC
-2.00+.5x60
20/200
J2
1.0 logMAR
20/25
.1
logMAR
-2.25+.25x97
0D
20/25-2
.12
logMAR
-.75+.50x11
sph eq:-.50
20/100
J1
.7 logMAR
20/20
0logMAR
-1.50+.50x85
sph eq: -1.25
-.75 D
20/100
.7
logMAR
20/20
0
logMAR
+1.25+.25x25
sph eq: +1.37
20/25
.1 logMAR
20/20
0logMAR
+.5+.5x70
-.63 D
4
52 years
10 mos f/u
OS
20/40
.3
logMAR
20/20,
0
logMAR
+1.00+.25x149
sph eq:+1.13
20/20
0 logMAR
20/20
0 logMAR
+.25
sph eq +.25
-.88 D
5
50 years
9 mos f/u
MONO, OS
20/50
.4
logMAR
20/25
.10
logMAR
-1.50+1.00x93
sph eq:
-1.00
20/70
J1+
.54 logMAR
20/20
0logMAR
-1.75+75x105
sph eq: -1.37
-.37 D
Results
• All five eyes showed improvement in UCVA.
• All patients maintained or showed an improvement in
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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).
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.
Photos and Bio
Anita Ravi, BS
Sergul Erzurum, MD, FRCS
Anita Ravi is a graduate of the College
Dr. Erzurum is Chief of
of Arts and Sciences, Youngstown
State University, Youngstown, Ohio
and a second year medical student
at the Northeastern Ohio
Universities College of Medicine
(NEOUCOM).
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.
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