Case Reports

Management of recurrent epithelial ingrowth after femto-LASIK

Case Report Details

First Author: V.Lazaro SPAIN

Co Author(s):    V. Lázaro-Rodríguez   P. Sauvageot   J. Álvarez de Toledo              

Abstract Details

Purpose:

We report the surgical management of recurrent epithelial ingrowth after myopic femtosecond-assisted laser in situ keratomileusis (femto-LASIK). Post-LASIK epithelial ingrowth (EI) is an uncommon complication. Reports of incidence have ranged from 0% to 20%. The clinical presentation can be varied, ranging from asymptomatic to compromising vision. This complication has reported to be more frequent in cases of traumatisms, LASIK enhancement, flap instability, a history of recurrent corneal erosions and corneal epithelial basement membrane degeneration. Femto-LASIK flaps are thinner and more uniform which improves flap adhesion and thus reduces the incidence of flap dislocation and epithelial ingrowth.

Setting:

Cornea and Refractive Surgery Unit, Barraquer Ophthalmology Centre, Barcelona.

Report of Case:

We describe the case of a 36-year-old man with symptoms of progressive blurred vision in his right eye for one year. He underwent an uneventful bilateral myopic femto-LASIK surgery twelve years ago. As a personal history, he had a car accident one year ago. LogMAR best corrected visual acuity (BCVA) in the right eye was 0.5. The examination revealed a well-positioned flap and an epithelial ingrowth (EI) in the inferior cornea affecting the visual axis. The patient was treated surgically with flap lifting and EI mechanical debridement removing the epithelial cells of both stromal surfaces. LogMAR BCVA after surgery was 0,2. Eight months later the patient consulted for vision loss in the same eye. His logMAR BCVA was 0,3. The ophthalmological examination showed a recurrence of the EI affecting the visual axis with an entrance area at 8 o’clock hour. The epithelial ingrowth was mechanically debrided, both stromal surfaces carefully cleaned, the flap was repositioned and the edges sutured using several interrupted 10-0 nylon sutures in the epithelial ingrowth entrance area (video will be displayed). The patient achieved a logMAR BCVA of 0,2 with no recurrences observed after 24 months of follow-up.

Conclusion/Take Home Message:

Although the incidence of EI after femto-LASIK is low, clinical management can be challenging in some cases. Epithelial ingrowth is usually treated with mechanical debridement of both stromal surfaces removing the epithelial cells. Other techniques have also been used such as alcohol, fibrin glue, YAG laser, mitomycin C and amniotic membrane. Epithelial ingrowth morphology can help us to choose the more adequate surgical technique. When a clear entrance path is observed, cleaning the corneal interface and suturing the corneal flap in the entrance area seems an effective and safe technique to avoid further epithelial cells penetration.

Financial Disclosure:

None