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Impressum
Corneal histology: Epithelial ingrowth after LASIK and LASIK on a corneal Transplant - A report of 2 cases.
1Richter M. N., 1Wachtlin J., 2,3Clark B. J.
1Augenklinik, Klinikum Benjamin Franklin, Freie Universität Berlin, 2Department of Pathology, Institute of Ophthalmology, University College London; 3Moorfields Eye Hospital, London
Introduction: Laser in situ keratomileusis (LASIK) is a common
technique to correct myopia and hyperopia with less reported complications
than other methods. We report the cases of two patients with complications
after LASIK, which required a penetrating keratoplasty. Clinicopathological
correlations are demonstrated.
Case reports: Patient 1: In1996 bilateral LASIK was performed in
South Africa to correct myopia of -3 dpt. In 1997 a keratoplasty was necessary
on the left eye because of keratectasia and in 1998 LASIK was repeated
on the graft. In June 1999 graft rejection was suspected and a repeat
keratoplasty was performed. Patient 2: In 1997 LASIK was performed on
the right eye to correct a Myopia of -2.5 dpt. Postoperatively the eye
showed overcorrection (+4,0) and massive epithelial invasion resulting
in irregular astigmatism and irritation of the eye. Because of these disturbances,
a keratoplasty was performed on the eye in 1998.
Histology: The corneal buttons of both patients underwent routine
histopathological examination. The cornea of Patient 1 was thinned after
LASIK with a detectable surgical flap/stromal interface, containing apoptotic
debris. Furthermore a mild epithelial ingrowth and an epithelial ingrowth
cyst were seen. More apoptotic cells were detected within the epithelium
overlying the interface. Endothelial cell density was reduced. The cornea
of patient 2 was thinned after LASIK and showed a massive irregular epithelial
ingrowth as well as an irregular surface.
Discussion: Epithelial ingrowth is described with an incidence
of 2-14 % in the literature The consequences are irritation, irregular
astigmatism and visual deterioration. Complications after LASIK are rare,
but as in these cases can lead to a keratoplasty on formerly healthy eyes.