Article Impact Level: HIGH Data Quality: STRONG Summary of MedComm – Future Medicine, 3(3), e99. https://doi.org/10.1002/mef2.99 Dr. Miao Zhang et al.
Points
- Corneal epithelial ingrowth (EI) is a rare complication of SMILE surgery, often linked to microchannels formed by the opaque bubble layer (OBL) during the procedure.
- This study analyzed four cases of EI post-SMILE and found that OBL-induced microchannels, rather than trauma to corneal flap edges, may play a key role in EI development.
- Preventive measures, such as precise suction cone positioning and removal of sub-flap debris, significantly improved patient outcomes, with no EI recurrence observed after follow-up.
- Patients experienced notable improvements in visual acuity and corneal transparency post-surgery, with one patient’s visual acuity improving from 0.5 to 1.0 three months after EI removal.
- The study highlights the need for precise surgical techniques and further investigation into OBL-induced EI mechanisms to reduce EI incidence in SMILE surgery patients.
Summary
Corneal epithelial ingrowth (EI) is a rare but significant complication that can occur after Small Incision Lenticule Extraction (SMILE) surgery, commonly used to correct refractive errors. This study investigated the potential mechanisms contributing to EI, specifically the role of the opaque bubble layer (OBL) formed during the SMILE procedure. The analysis included four cases of EI post-SMILE, diagnosed using anterior segment optical coherence tomography (AS-OCT) and corneal tomography. The study found that EI may result from microchannels created by the OBL, challenging the previous notion that EI is primarily caused by trauma to the corneal flap edges. Preventive measures, such as careful suction cone positioning during surgery, were employed to minimize OBL formation, and the surgical removal of sub-flap debris led to significant improvement in patient outcomes without recurrence of EI.
Results showed that patients experienced notable improvements in visual acuity and corneal transparency post-surgery. For instance, one patient’s visual acuity improved from 0.5 to 1.0 three months after EI removal. The study further highlighted that epithelial migration through OBL-induced microchannels plays a crucial role in EI development. Unlike traditional causes such as trauma or epithelial defects at the flap edge, the findings suggest that microtrauma from the OBL during surgery allows epithelial cells to enter and proliferate beneath the corneal surface. No recurrences of EI were observed after six months to 1 year of follow-up in any of the four cases.
The study underscores the importance of precise surgical techniques and postoperative care to prevent EI, particularly in SMILE surgery. While EI remains a rare complication, understanding its mechanisms and improving surgical methods can lead to better patient outcomes. The research also suggests further investigation using animal models and advanced imaging techniques to fully confirm the proposed mechanisms and reduce the incidence of EI in refractive surgery patients.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/mef2.99
References Zhang, M., Chong, I., Chen, X., Yang, J., Cheng, L., & Yan, Z. (2024). Corneal epithelial ingrowth after small incision lenticule extraction surgery: Insights from a case series and mechanistic studies. MedComm – Future Medicine, 3(3), e99. https://doi.org/10.1002/mef2.99
