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Photo Essay |

Treatment of Macrostriae and Epithelial Ingrowth Following Laser In Situ Keratomileusis With Interrupted Sutures

Patricia S. Tsai, MD; Stephen D. McLeod, MD
Arch Ophthalmol. 2003;121(12):1800-1801. doi:10.1001/archopht.121.12.1800.
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A 42-YEAR-OLD woman who had undergone bilateral simultaneous laser in situ keratomileusis 2 weeks earlier at another institution was referred to our service for management of bilateral macrostriae and epithelial ingrowth after failed repositioning of dislocated flaps, which had been noted on the first day following surgery (Figure 1 and Figure 2). At our examination, uncorrected visual acuity was 20/60 OD and 20/200 OS, and best-corrected visual acuity was 20/50 OD and 20/80 OS. One month later, the flap was elevated completely, epithelial ingrowth was removed by scraping, and 14 and 7 radial interrupted flap sutures were placed in the right and left corneas, respectively, to secure the flap edge and treat the macrostriae (Figure 3). Sutures were removed after 2 weeks, resulting in an uncorrected visual acuity of 20/25 OU and a best-corrected visual acuity of 20/20 OU (Figure 4 and Figure 5). At the examination 2 months following suture removal, epithelial ingrowth had failed to reappear.

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Figures

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Figure 1.

Slitlamp photograph demonstrates folds and macrostriae in the left eye.

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Figure 2.

Slitlamp photograph demonstrates epithelial ingrowth in the right eye.

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Figure 3.

Slitlamp photograph illustrates radial interrupted 10-0 nylon sutures securing the flap in the right eye approximately 1 week following placement. After the flap was relifted, it was gently stretched perpendicular to the major macrostriae. The epithelial ingrowth was scraped from the underside of the flap and from the stromal bed. The flap was then repositioned and sutured in place.

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Figure 4.

Serial corneal topographic changes are illustrated with the Topographic Modeling System–2N (TMS-2N; Tomey Corp, Phoenix, Ariz). Corneal maps were taken prior to flap repositioning and suturing in the right eye (A), prior to flap repositioning and suturing in the left eye (B), with interrupted sutures in place in the right eye (C), immediately after suture removal in the right eye (D), 1 week after suture removal in the right eye (E), and 1 month after suture removal in the left eye (F). The surface asymmetry index (SAI) and surface regularity index (SRI) improved in the right eye from 0.64 and 1.11 to 0.07 and 0.12. The SAI and SRI improved in the left eye from 2.23 and 1.21, respectively to 0.71 and 0.25, respectively. CYL indicates cylinder; Min K, minimum keratometry; PVA, predicted visual acuity; and Sim K, simulated keratometry.

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Figure 5.

Resolution of the macrostriae in the left eye is shown with fluorescein (A) and without fluorescein (B) approximately 1 week following suture removal.

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