Management of corneal epithelial defects following laser in situ keratomileusis

PURPOSE: To determine the main principles of postoperative management in patients with epithelial defects following LASIK. METHODS: Patients with myopia and myopic astigmatism (N=2972; refraction from -1.25 to -15.50 D) were treated with the Nidek EC-5000 excimer laser, using the Chiron Vision HT-230 Hansatome microkeratome, We observed 95 cases with intraoperative epithelial damage among 5896 operations (1.6%). Patients received traditional topical medical treatment (Tobramycin 0.3%, five times a day; Lacrisifi, six to eight times a day). In eyes with an epithelial defect less then 3 mm, no additional medical care was needed. In eyes with epithelial defects more then 3 mm, soft therapeutic contact lenses were used until total re-epithelialization occurred. RESULTS: Total re-epithelialization was observed the day following surgery in patients with small defects (less then 3 mm), Visual acuity achieved preoperative level 4 to 7 days after surgery. Total re-epithelialization in patients with soft contact lenses occurred 1 to 3 days after LASIK. On the next day examination, Solcoseryl 20% eye gel was added to topical therapy for corneal healing. In these patients visual acuity achieved preoperative level 10 to 14 days after surgery. In three eyes with large epithelial defects (4 to 5 mm), irregular astigmatism (one eye; 0.02%) or against-the-rule astigmatism (two eyes; 0.03%) occurred. Patients complained of blurred and double vision. Transepithelial phototherapeutic keratectomy was performed after 3 months for epithelial smoothing, with good visual results. CONCLUSION: Management of epithelial defects following LASIK can be concentrated on avoiding epithelial hyperplasia, Epithelial defects less than 3 mm do not appear to produce epithelial hyperplasia, Irregular astigmatism induced by LASIK can result in reduced best spectacle-corrected visual acuity. A common cause of irregular astigmatism is corneal epithelial remodeling and corneal thickening secondary to corneal epithelial defects created at the time of the LASIK procedure.