helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2023-16-3-136-140helmholtzeyeinstitute-1311Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУFOR OPHTHALMOLOGY PRACTITIONERSСлучай докоррекции вторичной аметропии с подъемом ламеллярного лоскута в отдаленные сроки после ЛАСИКSecondary ametropia retreatment with flap lifting performed long after LASIK surgery: a clinical caseХоджабекянН. В.KhodzhabekyanN. V.

Нарине Владимировна Ходжабекян - канд. мед. наук, ведущий научный сотрудник отдела патологии рефракции, бинокулярного зрения и офтальмоэргономики

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Narine V. Khodzhabekyan - Cand. of Med. Sci., leading researcher, department of refraction pathology, binocular vision and ophtalmoergonomics

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

ХанджянА. Т.KhandzhyanA. T.

Ануш Тиграновна Ханджян - канд. мед. наук, старший научный сотрудник отдела патологии сетчатки и зрительного нерва

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Anush T. Khandzhyan - Cand. of Med. Sci., senior researcher, department of pathology of retina and optic nerve

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

ИвановаА. В.IvanovaA. V.

Анастасия Владимировна Иванова - канд. мед. наук, научный сотрудник отдела патологии рефракции, бинокулярного зрения и офтальмоэргономики

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Anastasiya V. Ivanova - Cand. of Med. Sci., researcher, department of refraction pathology, binocular vision and ophtalmoergonomics

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

nastya911@list.ruСкляроваА. С.SklyarovaA. S.

Анна Сергеевна Склярова - канд. мед. наук, врач-офтальмолог отдела патологии сетчатки и зрительного нерва

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Anna S. Sklyarova - Cand. of Med. Sci., ophthalmologist, department of pathology of retina and optic nerve

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

МанукянИ. В.ManukyanI. V.

Инесса Вартановна Манукян - канд. мед. наук., врач-офтальмолог отдела дневного стационара

ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Inessa V. Manukyan - Cand. of Med. Sci., ophthalmologist, department of day hospital

14/19, Sadovaya-Chernogryazskaya St., Moscow, 105062

ФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава РоссииРоссияHelmholtz National Medical Research Center of Eye DiseasesRussian Federation202312102023163136140Copyright © Ходжабекян Н.В., Ханджян А.Т., Иванова А.В., Склярова А.С., Манукян И.В., 20232023Ходжабекян Н.В., Ханджян А.Т., Иванова А.В., Склярова А.С., Манукян И.В.Khodzhabekyan N.V., Khandzhyan A.T., Ivanova A.V., Sklyarova A.S., Manukyan I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://roj.igb.ru/jour/article/view/1311

Цель работы - представить клинический случай докоррекции вторичной аметропии с подъемом лоскута в отдаленные сроки после ранее проведенной операции ЛАСИК.Материал и методы. Пациентке с регрессом рефракционного эффекта после операции ЛАСИК, перенесенной 18 лет назад, проведен подъем роговичного лоскута с кератоабляцией. В раннем послеоперационном периоде отмечалось осложнение — врастание эпителия в подлоскутное пространство. Был произведен повторный подъем лоскута и удаление эпителиальных пленок.Результаты. Достигнут ожидаемый рефракционный эффект с запланированной бинокулярной гипокоррекцией.Заключение. Повторный подъем лоскута через 3 года и более после первой хирургии ЛАСИК и ФемтоЛАСИК увеличивает риск возникновения осложнения — врастания эпителия в подлоскутное пространство. В таких случаях во избежание осложнений предпочтительнее проводить повторную операцию методом фоторефракционной кератэктомии. Скарификация и элиминация вросшего эпителия должны проводиться в ранние сроки после вмешательства.

Purpose: to present a clinical case of secondary ametropia retreatment with flap lifting, which was performed long after a LASIK surgery.Material and methods. A female patient who experienced a regression of the refraction effect after a LASIK surgery, received a flap lifting with keratoablation 18 years after the primary LASIK surgery. 8 days following this procedure, the patient developed a complication, namely an epithelial ingrowth. Another flap lifting procedure was performed and the epithelial ingrowth was removed.Results. The expected refractive effect was achieved with binocular hypocorrection as planned.Conclusion. A repeated flap lifting undertaken 3 years or more after the first LASIK or FemtoLASIK surgery increases the risk of a complication — an epithelial ingrowth into the space under the flap. To avoid the complication in such cases, the retreatment by PRK is preferable. Scarification and elimination of the in-grown epithelial should be performed early after the surgery.

ЛАСИКлоскутврастание эпителияLASIKflapepithelial ingrowthReferencesPallikaris IG, Papatzanaki ME, Stathi EZ. Laser in situ keratomileusis. Lasers Surg Med. 1990; 10 (5): 463–8. doi: 10.1002/lsm.1900100511Pallikaris IG, Papatzanaki ME, Stathi EZ. Laser in situ keratomileusis. Lasers Surg Med. 1990; 10 (5): 463–8. doi: 10.1002/lsm.1900100511Kuryan J, Channa P. Refractive surgery after corneal transplant. 2010; 21: 1–64. Current Opinion in Ophthalmology. 2010; 21 (4): 259–64. doi: 10.1097/ICU.0b013e32833a9abbKuryan J, Channa P. Refractive surgery after corneal transplant. 2010; 21: 1–64. Current Opinion in Ophthalmology. 2010; 21 (4): 259–64. doi: 10.1097/ICU.0b013e32833a9abbAcar BT, Utine CA, Acar S, Ciftci F. Laser in situ keratomileusis to manage refractive errors after deep anterior lamellar keratoplasty. Journal of Cataract & Refractive Surgery. 2012; 38: 1020–7. doi:10.1016/j.jcrs.2011.12.034Acar BT, Utine CA, Acar S, Ciftci F. Laser in situ keratomileusis to manage refractive errors after deep anterior lamellar keratoplasty. Journal of Cataract & Refractive Surgery. 2012; 38: 1020–7. doi:10.1016/j.jcrs.2011.12.034Kim P, Briganti EM, Sutton GL, et al. Laser in situ keratomileusis for refractive error after cataract surgery. Journal of Cataract & Refractive Surgery. 2005; 31: 979–86. doi: 10.1016/j.jcrs.2004.08.054Kim P, Briganti EM, Sutton GL, et al. Laser in situ keratomileusis for refractive error after cataract surgery. Journal of Cataract & Refractive Surgery. 2005; 31: 979–86. doi: 10.1016/j.jcrs.2004.08.054Chan TC, Kwok PS, Jhanji V, et al. Presbyopic correction using monocular Bi-aspheric ablation profile (PresbyMAX) in hyperopic eyes: 1-year outcomes. Journal of Refractive Surgery. 2017; 33: 37–43. doi:10.3928/1081597X-20161006-03Chan TC, Kwok PS, Jhanji V, et al. Presbyopic correction using monocular Bi-aspheric ablation profile (PresbyMAX) in hyperopic eyes: 1-year outcomes. Journal of Refractive Surgery. 2017; 33: 37–43. doi:10.3928/1081597X-20161006-03Sandoval HP, Donnenfeld ED, Kohnen T, et al Modern laser in situ keratomileusis outcomes. 2016; 42: 1224–34. Journal of Cataract & Refractive Surgery. doi:10.1016/j.jcrs.2016.07.012Sandoval HP, Donnenfeld ED, Kohnen T, et al Modern laser in situ keratomileusis outcomes. 2016; 42: 1224–34. Journal of Cataract & Refractive Surgery. doi:10.1016/j.jcrs.2016.07.012Dirani M, Couper T, Yau J, et al. Long-term refractive outcomes and stability after excimer laser surgery for myopia. 2010; 36: 1709–17. doi:10.1016/j.jcrs.2010.04.041Dirani M, Couper T, Yau J, et al. Long-term refractive outcomes and stability after excimer laser surgery for myopia. 2010; 36: 1709–17. doi:10.1016/j.jcrs.2010.04.041Ali JL, Ortiz D, Muftuoglu O, et al. Ten years after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for moderate to high myopia (control-matched study). British Journal of Ophthalmology. 2009; 93: 1313–8. doi:10.1136/bjo.2007.131748Ali JL, Ortiz D, Muftuoglu O, et al. Ten years after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for moderate to high myopia (control-matched study). British Journal of Ophthalmology. 2009; 93: 1313–8. doi:10.1136/bjo.2007.131748Ting DSJ, Srinivasan S, Danjoux JP. Epithelial ingrowth following laser in situ keratomileusis (LASIK): prevalence, risk factors, management and visual outcomes. BMJ Open Ophthalmol. 2018; 3:e000133. doi: 10.1136/bmjophth-2017-000133Ting DSJ, Srinivasan S, Danjoux JP. Epithelial ingrowth following laser in situ keratomileusis (LASIK): prevalence, risk factors, management and visual outcomes. BMJ Open Ophthalmol. 2018; 3:e000133. doi: 10.1136/bmjophth-2017-000133Mohamed TA, Hoffman RS, Fine IH, Packer M. Post-laser assisted in situ keratomileusis epithelial ingrowth and its relation to pretreatment refractive error. Cornea. 2011; 30: 550–2. doi:10.1097/ICO.0b013e3182000ac3Mohamed TA, Hoffman RS, Fine IH, Packer M. Post-laser assisted in situ keratomileusis epithelial ingrowth and its relation to pretreatment refractive error. Cornea. 2011; 30: 550–2. doi:10.1097/ICO.0b013e3182000ac3Caster AI, Friess DW, Schwendeman FJ. Incidence of epithelial ingrowth in primary and retreatment laser in situ keratomileusis. Journal of Cataract & Refractive Surgery. 2010; 36: 97–101. doi:10.1016/j.jcrs.2009.07.039Caster AI, Friess DW, Schwendeman FJ. Incidence of epithelial ingrowth in primary and retreatment laser in situ keratomileusis. Journal of Cataract & Refractive Surgery. 2010; 36: 97–101. doi:10.1016/j.jcrs.2009.07.039Gell JL, Verdaguer P, Mateu-Figueras G, et al Epithelial ingrowth after LASIK: visual and refractive results after cleaning the interface and suturing the lenticule. Cornea. 2014; 33: 1046–50. doi:10.1097/ICO.0000000000000214Gell JL, Verdaguer P, Mateu-Figueras G, et al Epithelial ingrowth after LASIK: visual and refractive results after cleaning the interface and suturing the lenticule. Cornea. 2014; 33: 1046–50. doi:10.1097/ICO.0000000000000214Ortega-Usobiaga J, Llovet-Osuna F, Katz T, et al. Comparison of 5468 retreatments after laser in situ keratomileusis by lifting the flap or performing photorefractive keratectomy on the flap. Archivos de la Sociedad Espa ola de Oftalmolog a. 2018 93: 30161–2. doi:10.1016/j.oftal.2017.05.007Ortega-Usobiaga J, Llovet-Osuna F, Katz T, et al. Comparison of 5468 retreatments after laser in situ keratomileusis by lifting the flap or performing photorefractive keratectomy on the flap. Archivos de la Sociedad Espa ola de Oftalmolog a. 2018 93: 30161–2. doi:10.1016/j.oftal.2017.05.007Schallhorn SC, Venter JA, Hannan SJ, Hettinger K A, Teenan D. Flap lift and photorefractive keratectomy enhancements after primary laser in situ keratomileusis using a wavefront-guided ablation profile: Refractive and visual outcomes. Journal of Cataract & Refractive Surgery. 2015; 41: 2501–12. doi:10.1016/j.jcrs.2015.05.031Schallhorn SC, Venter JA, Hannan SJ, Hettinger K A, Teenan D. Flap lift and photorefractive keratectomy enhancements after primary laser in situ keratomileusis using a wavefront-guided ablation profile: Refractive and visual outcomes. Journal of Cataract & Refractive Surgery. 2015; 41: 2501–12. doi:10.1016/j.jcrs.2015.05.031Dalal RR, Raber I, Dunn SP, et al. Epithelial ingrowth following endothelial keratoplasty. Cornea. 2016; 35: 465–70. doi:10.1097/ICO.0000000000000775Dalal RR, Raber I, Dunn SP, et al. Epithelial ingrowth following endothelial keratoplasty. Cornea. 2016; 35: 465–70. doi:10.1097/ICO.0000000000000775Ghosh S, Mukhopadhyay S. Epithelial ingrowth following surgery of recurrent pterygium. 2008; 28: 63–5. International Ophthalmology. doi:10.1007/s10792-007-9107-0Ghosh S, Mukhopadhyay S. Epithelial ingrowth following surgery of recurrent pterygium. 2008; 28: 63–5. International Ophthalmology. doi:10.1007/s10792-007-9107-0K chle M, Green WR. Epithelial ingrowth: a study of 207 histopathologically proven cases. Ger J Ophthalmol. 1996 Jul; 5 (4): 211–23. PMID: 8854105.K chle M, Green WR. Epithelial ingrowth: a study of 207 histopathologically proven cases. Ger J Ophthalmol. 1996 Jul; 5 (4): 211–23. PMID: 8854105.Chan CC, Boxer Wachler BS. Comparison of the effects of LASIK retreatment techniques on epithelial ingrowth rates. Ophthalmology. 2007; 114: 640–2. doi:10.1016/j.ophtha.2006.06.062Chan CC, Boxer Wachler BS. Comparison of the effects of LASIK retreatment techniques on epithelial ingrowth rates. Ophthalmology. 2007; 114: 640–2. doi:10.1016/j.ophtha.2006.06.062Jhanji V, Chan TC, Li WY, et al Conventional versus inverted side-cut flaps for femtosecond laser-assisted LASIK: Laboratory and clinical evaluation. Journal of Refractive Surgery. 2017; 33: 96–103. doi:10.3928/1081597X-20161102-02Jhanji V, Chan TC, Li WY, et al Conventional versus inverted side-cut flaps for femtosecond laser-assisted LASIK: Laboratory and clinical evaluation. Journal of Refractive Surgery. 2017; 33: 96–103. doi:10.3928/1081597X-20161102-02Asano-Kato N, Toda I, Hori-Komai Y, Takano Y, Tsubota K. Epithelial ingrowth after laser in situ keratomileusis: clinical features and possible mechanisms. Am Journ of Ophthalmol. 2002; 134: 801–7. doi:10.1016/S0002-9394(02)01757-9Asano-Kato N, Toda I, Hori-Komai Y, Takano Y, Tsubota K. Epithelial ingrowth after laser in situ keratomileusis: clinical features and possible mechanisms. Am Journ of Ophthalmol. 2002; 134: 801–7. doi:10.1016/S0002-9394(02)01757-9Xiao J, Jiang C, Zhang M, et al. When case report became case series: 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis and review of Chinese literature. British Journal of Ophthalmology. 2014; 98: 1282–6. doi:10.1136/bjophthalmol-2013-304422Xiao J, Jiang C, Zhang M, et al. When case report became case series: 45 cases of late traumatic flap complications after laser-assisted in situ keratomileusis and review of Chinese literature. British Journal of Ophthalmology. 2014; 98: 1282–6. doi:10.1136/bjophthalmol-2013-304422Holt DG, Sikder S, Mifflin MD. Surgical management of traumatic LASIK flap dislocation with macrostriae and epithelial ingrowth 14 years postoperatively. Journal of Cataract & Refractive Surgery. 2012; 38: 357–61. doi:10.1016/j.jcrs.2011.10.024Holt DG, Sikder S, Mifflin MD. Surgical management of traumatic LASIK flap dislocation with macrostriae and epithelial ingrowth 14 years postoperatively. Journal of Cataract & Refractive Surgery. 2012; 38: 357–61. doi:10.1016/j.jcrs.2011.10.024Vaddavalli PK, Yoo SH, Diakonis VF, et al Femtosecond laser-assisted retreatment for residual refractive errors after laser in situ keratomileusis. Journal of Cataract & Refractive Surgery. 2013; 39: 1241–7. doi:10.1016/j.jcrs.2013.03.018Vaddavalli PK, Yoo SH, Diakonis VF, et al Femtosecond laser-assisted retreatment for residual refractive errors after laser in situ keratomileusis. Journal of Cataract & Refractive Surgery. 2013; 39: 1241–7. doi:10.1016/j.jcrs.2013.03.018Kamburo lu G, Ertan A. Epithelial ingrowth after femtosecond laserassisted in situ keratomileusis. Cornea. 2008; 27: 1122–5. doi:10.1097/ICO.0b013e3181731439Kamburo lu G, Ertan A. Epithelial ingrowth after femtosecond laserassisted in situ keratomileusis. Cornea. 2008; 27: 1122–5. doi:10.1097/ICO.0b013e3181731439Letko E, Price M, Price FW. Influence of original flap creation method on incidence of epithelial ingrowth after LASIK retreatment. Journal of Refractive Surgery. 2009; 25: 1039–41. doi: 10.3928/1081597X-20090617-13Letko E, Price M, Price FW. Influence of original flap creation method on incidence of epithelial ingrowth after LASIK retreatment. Journal of Refractive Surgery. 2009; 25: 1039–41. doi: 10.3928/1081597X-20090617-13

The authors declare that there are no conflicts of interest present.