1Epithelial Scraping Instead of Retreatment in LASEK Patients: 5 Case Reports Anita Ravi, BS1S.A. Erzurum, MD, FACS2,3,41. College of Arts and Sciences, Youngstown State University, Youngstown, OH2, 3. Section of Ophthalmology in the Department of Surgery at Forum Health and St. Elizabeth Health Center, Youngstown, OH4. Department of Surgery, Northeastern Ohio Universities College of Medicine, Rootstown, OHCo-authors disclose a lack of any financial relationships in this report.
2PurposeTo evaluate the efficacy and safety of scraping the corneal epithelium in patients to retreat unsuccessful myopic and hyperopic laser sub-epithelial keratectomy (LASEK)
3MethodsSingle-surgeon retrospective case series of 5 eyes in 5 patientsAge ranged from 50 to 64 years (average 56.2 years)All underwent LASEK that resulted in refractive errorCorneal 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
4MethodsManifest 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.
5Cases 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 irregularityScrape BCVA 20/25Gained 1 line of BCVACase 257 y/o M, myopia and astigmatism of OSPre-op BCVA 20/20Post-op BCVA 20/25-Mild map dot fingerprint appearance to epitheliumScrape BCVA 20/20
6CasesCase 353 y/o M, hyperopia of OD after already having laser retreatmentMild epithelial irregularityScrape BCVA 20/20Case 452 y/o F, myopia of OSPost-op UCVA 20/40 and hyperopicScrape BCVA and UCVA 20/20Case 550 y/o F, myopia and astigmatism of OSPost-op BCVA 20/25-Basement membrane disturbances to epitheliumScrape BCVA 20/20
7Schematic depicting the scraping performed CasesSchematic depicting the scraping performedMild map dot fingerprint defects
8Results Pt Name Prescrape VA Pre-scrape refraction Final VA Final ChangeIn sphequivUCBC169 years10 mos f/uMONO, OS20/4001.3logMAR20/60.48x6020/200J21.0 logMAR20/25.1x970 D257 years1 mos f/u20/50.420/25-2.12x11sph eq:-.5020/100J1.7 logMAR20/200logMARx85sph eq: -1.25-.75 D353 years2 mos f/uOD.7x25sph eq: +1.37.1 logMAR+.5+.5x70-.63 D452 yearsOS20/40.320/20,x149sph eq:+1.130 logMAR+.25sph eq +.25-.88 D550 years9 mos f/u.10x93sph eq:-1.0020/70J1+.54 logMARx105sph eq: -1.37-.37 D
9Results 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).
10ConclusionScraping 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.
11Photos and Bio Sergul Erzurum, MD, FRCS Anita Ravi, BS 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, BSAnita 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).
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