Transcript salk in refractive surgery induced corneal opacity

SALK IN REFRACTIVE SURGERY INDUCED CORNEAL
OPACITY- A VIABLE OPTION
Anita Ganger, Radhika Tandon, Murgesan Vanathi
Cornea & Ocular Surface Services, Dr R P Centre for Ophthalmic Sciences
ALL INDIA INSTITUTE OF MEDICAL SCIENCES, New Delhi 110029, INDIA
THE AUTHORS HAVE NO FINANCIAL INTERESTS TO DISCLOSE
SALK IN REFRACTIVE SURGERY INDUCED
CORNEAL OPACITY- A VIABLE OPTION
BACKGROUND
• Post LASIK (Laser in situ keratomileusis) traumatic flap displacement is
a known possible complication.[1]
• In 1%-2% of cases approximately it happens in first 24 h after surgery.[2]
• Whereas, late flap dislocations, occurring more than 1 week after the
procedure, have been reported.
1.Lin RT, Maloney RK. Flap complications associated with lamellar refractive surgery. Am J
Ophthalmol. 1999;127:129–36.
2.Gimbel HV, Penno EE, van Westenbrugge JA, Ferensowicz M, Furlong MT. Incidence and
management of intraoperative and early postoperative complications in 1000 consecutive laserin
situ keratomileusis cases. Ophthalmology. 1998;105:1839–47.
CASE REPORT
History and Clinical Picture
• 32 year-old female underwent LASIK 2.5 years back.
• Presented with gradual painless diminution of vision OD since 5 months
after blunt trauma to the right eye in a road traffic accident.
• LASIK has been done for refractive error of -6.00 DS both eyes.
• Unaided visual acuity (VA) of 6/6 in both eyes was documented post
LASIK.
• Patient presented to us with VA of 1/60 and 6/6 in OD and OS respectively.
SLIT LAMP EXAMINATION
OD
OS
• Descmet folds with scarring (due
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to flap dehiscence at the time of
accident)
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• Small macular scar over para
foveal region post macular edema
A faint flap margin (an evidence of
previously performed LASIK)
The anterior segment was within
normal limits and there was
absence of any treatable lesion in
the fundus
Flap dislocation with macrostriae. Preoperative clinical
picture of OD
MANAGEMENT
• As the folds were long standing with scarring, Flap repositioning with
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interface wash was not an option.
Superficial Anterior Lamellar Keratoplasty (SALK) OD done.
On ASOCT noted depth of scarring was 154 µm, so dissection till 160 µm
has been done.
Interface has been cleared with thorough washing to avoid any epithelial
ingrowth in future.
Donor tissue has been cut by using automated lamellar microkeratome by
using microkeratome head of 200 µm.
Donor tissue trephined with 8 mm trephine, donor anterior lamella than put
on the host dissected area with the help of fibrin glue
At the end of surgery bandage contact lens was placed.
Post Operative Care
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Topical eye drops
• Moxifloxacin hydrochloride 0.5% TID
• Prednisolone acetate 1% eyedrops TID
• Carboxymethylcellulose 0.5% eye drops
QID have been prescribed to the patient in
OD
After 4 days post op bandage contact lens has
been removed.
Vision of 6/36 was noted in 1st week post op.
Vision of 6/18 was noted in 4th week post op.
No further improvement in vision due to
presence of macular scar over para foveal
region pre operatively.
Post Operative Day 1 after SALK
Post Operative Day 14 after SALK
SALK IN REFRACTIVE SURGERY INDUCED CORNEAL
OPACITYA VIABLE OPTION
CONCLUSION
Superficial anterior lamellar keratoplasty is a viable and effective alternative
for anterior stromal scars post refractive surgery. Whereas if patient present
early prompt treatment with flap lifting, debridement of epithelial ingrowth if
any, reposition and sealing of the flap with fibrin glue is the main stay of
management with good outcomes.
Dr Anita Ganger
MD, FAICO
Senior Resident
Cornea & Ocular Surface Services
[email protected]