I was informed yesterday that I have epithelial cells under my R flap. Upon looking in a mirror, when my pupils are dialated, I am able to see a 'mark' on my cornea nasally. This mark is within my pupil area. I have been experiencing some strange visual problems in this eye as well. Currently, my R eye experiences a backwards C when looking at anything that refracts light. This is less so during the day, which I believe is due to the fact that my pupils are then constricted, but as it becomes darker, the Backwards C is much more pronounced. To look at a clock, I see the time with a bunch of backwards C's through it, as all the lights bend that way. Very odd. I wouldn't call this a halo, but more a bending of light. It is as if the light goes around something. It is not fully correctable with refraction. Should I consider a flap lift and scaping to clean out these cells? Could the bending of light be caused by an astigmatism which is -.75 in the R eye? Upon topography, the surgeon noted that the cells were not causing my cornea to bend in any certain way as to cause this and she feels it's the astigmatism and can be enhanced even though I only have 10 microns remaining. Any insights before I more forward would be appreciated. I am in the Savannah, Georgia area.

Thanks to the highly publicized problems of a television actress, epithelial ingrowth has received a lot of attention lately. Of the complications that may occur with LASIK, epithelial ingrowth is one of the more benign.

You need to have your doctor examine the flap under a special lighting system that will show if you do have epithelial cells under your LASIK flap. If you do, the doctor will determine if the flap needs to be lifted and the cells removed, or if you simply need to be monitored to determine of the cells are multiplying or if they will resolve without treatment.

It is important that you pay attention to your doctor’s advice on this matter and keep your appointments. That TV actress apparently did not respond to her doctor’s requests for follow-up care and waited until the ingrowth was actually problematic. Don’t make the same mistake.

The physics of astigmatism correction with an excimer laser dictates that there will automatically be a small amount of myopic (nearsighted) vision correction with the astigmatic correction. The coupling ratio is about 0.24-0.35 diopters of myopic correction for every 1.00 diopter of astigmatic correction. Although the tissue at the edge of the cornea may be thick enough to handle the astigmatic component of the correction, it is clear that there is not enough untouched cornea to perform the surgery safely. With only an estimated (not actually measured) 10 microns of tissue error for margin, you have no margin of error. Additional surgery may cause the cornea to become unstable and bulge outward (ectasia) in an irregular shape. This may not be able to be corrected successfully with glasses or contacts.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

If the ingrowth is causing the problem, it needs to be scraped. If you don't know what is causing the problem, the ingrowth or a corneal refractive issue, you may be treating the wrong problem. Is the ingrowth active? If it is, fix that and then see what refraction you have. It increases one risk of having to lift twice but if the ingrowth is the problem and your surgeon removes it and does some corrective laser you may be treating something which isn't there which will create a new problem.
Leonard Friedman MD Washington DC ;;;;;;;;;;;;;;;;

Dear Dr. Leonard Friedman: Thank you for your response. My doctor had a topography taken of each eye. She stated that looking at that, it wasn't evident that the cells were causing my cornea to bend in any certain way, so she felt it had to do with the astigmatism (-.75). She has not mentioned flap wrinkles nor striae, so I would hope they were not an issue. In brightly lit areas, I do not notice this bending of light to the left. As it becomes darker, the bending of light is more pronounced. When looking through the pin hole viewer provided in the doctors office, I notice the bending of light is vastly reduced. However it is not fully correctable with refraction. Could this be irregular astigmatism that could clear with time, or should I have her lift the flap and scrape the cells first, to see what relief that brings? Thank you for all of your insight.

If the ingrowth is active it might be necessary to lift the flap and scrape. If it is not increasing it can be observed if it is not causing a problem. If your surgery was recent and the ingrowth is inactive, it might be prudent to wait to see if you are stable.
Leonard Friedman MD Washington DC<<<<<<<<<<<<<