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Why do we do PRK enhancements?

posted Jan 24, 2012, 6:14 PM by Jen Weigel
While not that many of Dr. Holzman's patients actually need an enhancement, you'll find that those that proceed with one will often have PRK instead of just lifting the original flap.

Those that are just a few months out from their primary surgery are likely to have a LASIK enhancement by flap lift.  However, those that are a few years out often have two choices:  creation of a new Intralase sidecut to do a LASIK enhancement or, more likely, a PRK enhancement.

Whenever we do an enhancement on a LASIK patient by lifting their flap, there is an increased chance of epithelial ingrowth.  According to this article, the rate of clinically significant ingrowth on enhancement is 34.2%!  Yikes!  That's a lot of ingrowth which can cause discomfort, blurred vision, irregular topographies, etc .... 

When you see ingrowth, be sure to document both the clock hours that it occurs (example:  4 to 6 o'clock) and the amount of maximal advancement from the flap margin (example:  1.5 mm in).  Here are some other nice ways to document ingrowth:

-  "stable"
-  "no advancement"
-  "(-) edge melt"
-  "(-) stain"
-  "(-) edge lift"

If you ever wonder if ingrowth is affecting your patient, just give TLC Tysons Corner a call!  The cool thing about doing a PRK enhancement is that we avoid the issue of epithelial ingrowth altogether.

While PRK enhancements help us avoid epithelial ingrowth, it is still possible to have DLK within the original flap.  I have personally never seen that happen (only read about it), so let's keep it that way!  - jw
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