Abstract: Fresh dry eye after LASIK flap-lift retreatment

I have to confess I usually ignore the refractive journals & studies because they bother me. Doesn't matter anyway because, ironically enough, they rarely mention dry eye except in passing. But this one caught my eye. 8.3% of people who didn't get dry eye the first time got it in the retreatment. ... Though that kind of pales in comparison of a scary 23.3% incidence of epithelial ingrowth (shudder). Am I seriously expected to take comfort in the "reasonable visual and refractive outcomes"?

Retreatment of residual refractive errors with flap lift laser in situ keratomileusis.

Purpose.
To investigate the outcomes of flap lift laser-assisted in situ keratomileusis (LASIK) for residual refractive errors.

Methods.
In this prospective study, 60 eyes of 48 patients (mean age 36 years; age range 23-53 years) underwent flap lift retreatment surgery following initial LASIK for the correction of residual refractive errors. All treatments were wavefront guided using the VISX S4 Star excimer laser. The main outcome measures were predictability, safety, efficacy, and stability.

Results.
Following retreatment, epithelial ingrowth occurred in 23.3% (n=14) of eyes, which required a flap lift and scrape procedure in 4 eyes and a second flap lift and scrape procedure in 2 eyes. De novo dry eye occurred in 8.3% (n=5) of eyes. At 6 months, the mean (±SD) post-retreatment Snellen decimal uncorrected visual acuity (UCVA), sphere, cylinder, spherical equivalent (SE), defocus equivalent (DE), and best corrected visual acuity (BCVA) was 1.03±0.23, 0.08±0.34 diopters (D) (range -0.75 to +1.25 D), -0.53±0.37 D (range 0 to -1.75 D), -0.04±0.34 D (range -1.11 to +1.04 D), 0.29±0.41 D (range 0 to 1.94 D), and 1.13±0.15 (range 0.5 to 1.5), respectively. Seventy-three percent (n=44) of eyes had an UCVA equal to or greater than 1 (6/6), 88.3% (n=53) and 98.3% (n=59) of eyes were within ±0.50 D and ±1.00 D of SE, respectively, and 3.3% (n=2) of eyes lost 1 line of BCVA.

Conclusions.
A high incidence (23.3%, n=14) of epithelial ingrowth occurred following retreatment surgery and de novo dry eye occurred in 8.3% (n=5) of eyes. Despite this, reasonable visual and refractive outcomes were achieved at 6 months post-retreatment.

Eur J Ophthalmol. 2011 Jan-Feb;21(1):5-11.
McAlinden C, Moore JE.
School of Biomedical Sciences, University of Ulster, Coleraine - UK; and Cathedral Eye Clinic, University of Ulster, Belfast - UK.