NEWS & OPINION EWAP DECEMBER 2022 41 8.6±6.4 years. Relifting was successfully performed in 46 eyes (63%)>5 years and in 34 eyes (47%)>10 years after primary LASIK. Relifting was successful in 71 eyes (97.3%). The 2 eyes with failed relifting had successful recutting procedures without complications. Of the successfully relifted flaps, 12 (16.9%) developed EI. Of these, 3 (4.2%) were clinically significant. None of these lost CDVA after EI removal. EI only recurred in 1 of those 3 eyes but was clinically insignificant. Seven eyes (9%) lost one line of CDVA but no eyes lost >1 line. The association between pre-enhancement time intervals with relift success or EI development was not statistically significant, even after adjusting for patient characteristics like primary LASIK flap creation method, year of relift, or age at relift. There were also no direct associations found between relift success or EI development with sex, patient age at relift, year of relift, and primary LASIK flap creation method (microkeratome vs. femtosecond laser). Discussion Various studies have advised against relifting a LASIK flap after the 1-year postop mark.12,19 However, conflicting reports have demonstrated successful flap relifting after this time period, even up to 15–20 years after surgery.6,11 Before considering LASIK enhancement complications, the flap must first be successfully mobilized and lifted. This study reported a success rate of 97% with half of its cases occurring more than 10 years after primary LASIK surgery at a maximum of 22 years later. The feared complication of EI occurred in roughly 17% of patients, which is consistent with previously reported numbers of 0 to 18%.17,20 However, clinically significant EI occurred in only 4.2% of relifted flaps, none of which lost CDVA after treatment. Notably, a greater pre-enhancement time interval was not associated with increased EI. This study also could not confirm the previously suggested association between patient age and EI.21 This study suggests that loose epithelium may have been associated with epithelial ingrowth. However, this is often not clearly documented and needs further study. A microkeratome flap may theoretically have a higher EI risk compared to a femtosecond laser flap due to the >90-degree side cut angle. This same attribute may also decrease scarring and increase the ease of flap relift compared to a femtosecond laser flap. Interestingly, there were no significant differences in relift success and EI incidence between the two tools. The flap relift method itself may also influence EI incidence. The authors were concerned that using a probe at 180 degrees from the hinge and lifting the rest of the flap with forceps may lead to greater rates of EI. Therefore, they instead created an opening at the flap margin with a sharp needle into which a spatula was used to cleave and lift the flap. They hoped this method would decrease the number of epithelial cells introduced under the flap. The study is limited by short follow-up, poor documentation of loose epithelium prior to relifting, and lack of a clear definition of EI with which to compare with other studies. It is also limited by sample size factors that made comparison of variables (sex, flap creation method, successful vs. unsuccessful lifts) difficult. Lastly, this study’s inclusion of all EI cases makes it appear to have a higher EI incidence compared to other papers that only report clinically significant EI. Conclusion According to this study, LASIK Effect of time since primary laser-assisted in situ keratomileusis on flap relift success and epithelial ingrowth risk Chang JSM, et al. J Cataract Refract Surg. 2022;48:705–709. Purpose: To assess the association of time since primary laser-assisted in situ keratomileusis (LASIK) with flap relift success and risk for epithelial ingrowth (EI) in eyes undergoing flap relift after primary LASIK Setting: Hong Kong Sanatorium & Hospital, Hong Kong Special Administrative Region Design: Retrospective observational case series Methods: 73 eyes with flaps relifted for refractive enhancement LASIK were included. Main outcome measures included rate of relift success and EI; associations of time since primary LASIK, sex, age at relift, year of relift, and flap creation method in primary LASIK with relift success and EI Results: Of the 73 eyes included, relifting was successful in 71 eyes (97.3%). Among the successfully relifted eyes, 12 (16.9%) developed EI, of which 3 (4.2%) were clinically significant. No eyes lost more than 1 line of corrected distance visual acuity. The time since primary LASIK (up to 22 years), sex, age at relift, year of relift, and flap creation method in primary LASIK were not associated with relift success or EI. Conclusion: With the described surgical technique, flaps could be successfully relifted without much difficulty up to 22 years after primary LASIK with a low incidence of EI.
RkJQdWJsaXNoZXIy Njk2NTg0