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Decrease of visual acuity in a patient with laser in situ keratomileusis (LASIK) surgery who suffered ocular trauma with corneal epithelial ingrowth: casual finding or consequence?

Poster Details

First Author: S.Miraflores SPAIN

Co Author(s):    H. Fukumitsu Miyamoto   L. Garcia Padilla   F. Salvador Salvador   B. Garcia-Valcarcel Gonzalez   A. Baeza Autillo   P. Balado Vazquez     

Abstract Details

Purpose:

The purpose is to achieve a literature review of the pathogenesis of corneal epithelial ingrowth after LASIK surgery, in regard to a clinical case, with the aim of improving the understanding of this pathology in order to prevent or treat this post-surgical complication with greater success. It is interesting to notice that the interface between flap and corneal stroma presents a virtual space where cellular and fluid buildup can lead to numerous complications. Currently in the literature there are two etiopathogenic hypotheses.

Setting:

This case was observed in a university hospital under the supervision of corneal sub-specialists. Furthermore, as a result of the literature review, we can found that this complication has a variable incidence (1% - 20%) and it seems to change from surgeon to surgeon.

Methods:

A 45-years-old woman with hyperopic LASIK surgery ten years ago, who refers a progressive decrease in visual acuity (VA) after a blunt trauma in the right eye (OD) about six months ago. Moreover, the patient recounts a painful postoperative with several episodes of corneal ulcers and a final refractive defect of +0.25 diopters in both eyes. The current auto-refractometry reveals a defect of +2.25 of hypermetropia and -2.50 of astigmatism at 32ยบ in OD. She has spontaneous VA of 20/25 and a corrected VA of 20/22 in OD with vision of 20/20 in OS.

Results:

Biomicroscopy of OD shows an epithelial ingrowth in the interface of the upper nasal flap reaching pupillary border with no signs of dislocation of the flap with a fluorescein negative cornea. Fundus examination of OD reveals a yuxtafoveal injury that seems to be a retina pigment epithelium detachment which is confirmed with an optical coherence tomography. We decided an expectant attitude given the time of surgery, the fact that epithelial ingrowth does not affect visual axis, and also due to the presence of a macular lesion caused by trauma. The patient in further reviews is stable clinically in our hospital.

Conclusions:

With our case we concluded that the etiology of the epithelial ingrowth may be multifactorial. On the one hand, the history of a painful postoperative speaks in favor of epithelial defects that could have caused an alteration of the edge of the flap and the induction of cell migration from the surface to the interface. In this way, the patient could have this complication previously presented asymptomatically. On the other hand, a history of trauma could have generated an acute distortion of the flap without dislocation, reactivating the process with further evolution of the refractive defect in a few months.

Financial Disclosure:

NONE

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