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Clinical Course of Severe Central Epithelial Defect in LASIK

1Mirshahi A., 2Bühren J., 1Steinkamp G. W. K., 1Kohnen T.,
1Johann-Wolfgang-Goethe-Universität, Klinik für Augenheilkunde (Frankfurt/Main)
2Johann-Wolfgang-Goethe-Universität, Klinik für Augenheilkunde, Arbeitsgruppe für Refraktive Chirurgie (Frankfurt/Main)

Severe central epithelial defects are rare in laser-in-situ-keratomileusis. The purpose of this study was to investigate the course of visual rehabilitation in severe central epithelial defects.
Methods: The patient data records of 1600 LASIK operations in the department of ophthalmology of Frankfurt University were checked retrospectively for severe central epithelial defects. The surgery was performed using a scanning spot excimer laser (Technolas C-LASIK 217) and HansatomeTM microkeratome. The course of the visual acuity, of the corneal topography and of the slitlamp microscopy were analysed.
Results: A big central epithelial defect had occurred in 14 eyes (9 patients, 27 - 51 years, 5 m, 4 f, average follow-up 8.4 months). Five patients suffered bilaterally. A severe dry eye was demonstrable in 5 eyes. Preoperatively, the anterior segment and the corneal topography were unremarkable except of 2 cases of cornea guttata. All eyes developed a diffuse lamellar keratitis (DLK) I - II. Mild to moderate irregular astigmatism was observed in 13 eyes which lost in intensity during the course. 3 eyes were subject to an enhancement procedure. The average best spectacle corrected visual acuity had the following course: (log MAR): Preop.: 0,02 (0,2 - -0,1) 1 week postop.: 0,35 (0,7 - -0,1), 1 month postop.: 0,24 (0,5 - -0,08), last visit: 0,09 (0,24 - -0,1). The course of spherical equivalent (dpt.): Preop.: -5,7 (-1,75 - -10,13), 1 week postop.: -0,79 (0 - -2,5), 1 month postop.: -0,71 (0,25 - -2), last visit: -0,54 (0,25 - -1,13). The median loss of best spectacle corrected visual acuity on the last visit was one Snellen line. Five eyes did not experienced loss in visual acuity. The slitlamp microscopy revealed interface haze (1 case), microfolds (6), epithelial irregularity (4) and epithelial ingrowth (3). One patient developed recurrent corneal erosions with DLK in both eyes.
Conclusions: Big central epithelial defects are a serious intraoperative complication of LASIK. It leads to a distinctly protracted visual rehabilitation and in majority of cases to irregular astigmatisms and loss of best-corrected visual acuity. Those findings decline during the course.