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49 yo after LASIK

Q:

a 49 year old presents 2 months ago; she had Lasik in Ecuador early, 2014 and still doesn’t see well

her exam shows an interface as to what appears an incomplete flap OU, just nasal to the visual axis and many nests of old epithelial cells in the interface OU also out of the visual axis

her vision is 20/70 uncorrected in each eye but she corrects to 20/20 in each eye

her refraction is

OD plano + 1.75 x 40

OS +1.75+ 150 x 15

her topos are typical post lasik and pachymetry is normal

any additional suggestions other than eyeglasses or contact lenses

A:

If she refracts to 20/20 the epithelial ingrowth is obviously not visually significant
Assuming the epithelial cells are dead, like they look loculated and aren’t in a sheet w a communication to the outside world, why not  just perform a LASEK on top of the flap with MMC?
That’s my standard method of retreating all LASIKs no matter how recent or old, because you avoid even the possibility of epithelial ingrowth, and you won’t by definition increase the risk of ectasia (because you’re not decreasing RSB)
I’ve done several hundred of these cases and haven’t found any nomogram adjustment to be necessary compared to my regular nomogram for ASA (LASEK or epiLASEK)
I also add oral steroids postop and use pred acetate over Lotemax because it prevents scarring better, plus Vit C and UV protection for a few months
With this regimen (and a compliant patient) the incidence of scarring on our last 100 LASIK retreatments w LASEK of the flap is 0%. Although we of course consent the patient anyway that they’re at risk of scarring and loss of BCVA

 

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