Posters

Management of epithelial ingrowth following vertical gas breakthrough: a case report

Poster Details

First Author: A.Agrawal INDIA

Co Author(s):    J. Reddy                    

Abstract Details

Purpose:

Laser in situ keratomileusis (LASIK) has emerged as a popular keratorefractive procedure. It involves creation of an interface between the flap and the underlying corneal stroma which is a critical step. Though complications are rare, flap creation can lead to flap-related and stromal interface complications which may adversely affect the clinical outcome. Post-LASIK epithelial ingrowth (PLEI) is a rare complication that is characterised by the ingrowth of corneal epithelium into the interface between the flap and stromal bed, leading to a range of symptoms and signs. Here, we report a case of PLEI secondary to intra operative vertical gas breakthrough.

Setting:

Sankara Eye Hospital, a tertiary eye care centre located in southern part of India in Coimbatore.

Methods:

24 year old female presented to our hospital for refractive correction. Her BCVA was 6/6 OU with manifest refraction of -5.25/-0.75*170 OD and -5.25/-0.50*180 OS. She was planned for Femtosecond assisted LASIK OU with 100m flap. Intraoperatively OD surgery was uneventful with subsequent OS surgery where during flap creation, vertical gas breakthrough occurred in infero-nasal part of flap which was managed intraoperatively with minimal dissection. Epithelial ingrowth was noted adjacent to the button hole. The epithelial ingrowth was removed after careful lifting of the flap, and tissue adhesive was used to act as a barrier to further ingrowth.

Results:

Postoperatively, the patient’s corrected distance visual acuity was 20/20 and the subsequent follow-ups showed no evidence of recurrent epithelial ingrowth. Hence, this case presents a novel approach to the management of a buttonhole defect due to vertical gas breakthrough.

Conclusions:

With the continuing rise of LASIK procedures, it is important for all ophthalmologists to become competent in recognising and/or managing post-LASIK complications, including PLEI. Understanding of both modifiable and non-modifiable risk factors helps reduce the incidence of PLEI and also enables better patient counselling preoperatively. When appropriately managed, good visual prognosis can be achieved in patients with PLEI.

Financial Disclosure:

None