I was intrigued by Drs Vroman and Karp's case report in the September
2001 issue of the ARCHIVES.1 The authors
used a very effective technique specifically for recrudescent epithelial ingrowth:
two 10-second applications of absolute alcohol beneath the elevated flap.
Was the flap sutured in place after the first debridement for epithelium and
after the alcohol treatment? I would suggest that the epithelial ingrowth
recurred and contributed to this corneal melting in the face of the alcohol
treatment. Figure 2 clearly shows 2 to 3 layers of epithelial cells beneath
the flap 48 hours after treatment.1(p1378)
The alcohol may be contributing to poor adhesion of the flap by breaking the barrier function of the surface
epithelium. This allows fluid to enter the stroma, compromising the imbibition
pressure of the stromal collagen. Excess stromal fluid causes the flap edge
to elevate and allows for easy ingress of epithelium.
Rowsey J. Suture Laser-Assisted In Situ Keratomileusis Flaps After Epithelial Ingrowth Removal. Arch Ophthalmol. 2002;120(11):1601. doi: