POST LASIK EPITHELIAL INGROWTH AFTER IOL EXCHANGE

To describe the mechanism of epithelial ingrowth formation after intraocular lens exchange.

Naval and Veterans Hospital, Athens, Greece

A 62-year-old Caucasian female with no significant past medical history presented to our department with dysphotopsia and decreased vision in the right eye (OD). The patient had undergone bilateral uneventful refractive lens exchange (RLE) with trifocal intraocular lens implantation by an outside ophthalmologist, 7 months before presentation. Three months after RLE, uncomplicated femtosecond LASIK was performed by the same ophthalmologist in order to correct residual astigmatism. Two months after LASIK surgery, the trifocal IOL was replaced by a monofocal IOL in OD (by the same outside ophthalmologist), due to persisting significant dysphotopsia (significant glare and halos). Best spectacle corrected visual acuity (BSCVA) at presentation was 0.2 and 0.7 in OD and OS, respectively. Intraocular pressure (IOP) was 11 mmHg in both eyes. Localized inferonasal stromal edema was noticed in OD. A small gap at the inferotemporal edge of the LASIK flap was noticed at the slit lamp, alongside with diffuse opacification at the level of the LASIK flap interface. Anterior Segment Swept Source Optical Coherence Tomography (AS-SS-OCT) and AS - Spectral Domain - OCT (AS-SD-OCT) revealed accumulation of fluid in the interface resulting in localized edema and irregular astigmatism. The small secondary gap at the edge of the LASIK flap was also confirmed by AS-SD-OCT. Over the next 4 months, despite absorption of interface fluid, epithelial ingrowth started to form in the same area, that progressed further over the following 3 months. Interface fluid accumulation was attributed to iatrogenic endothelial cells distortion during IOL exchange procedure. However, the presence of fluid at the interface caused small dehiscence at the edge of the LASIK flap, that allowed epithelial cells to migrate and proliferate at the interface, resulting in the formation of epithelial ingrowth. 

 

 

Endothelial damage is a known complication of cataract surgery and IOL exchange.¹ Interface fluid syndrome (IFS) and epithelial ingrowth following LASIK procedure have been described and are usually seen within the first month post-surgery.² We postulate that even temporary endothelial distortion at any time point after LASIK surgery may result in LASIK flap edge dehiscence and secondary epithelial ingrowth formation. Clinicians should reverse endothelial insufficiency as early as possible and prevent ingrowth formation in such cases.

References: 1.Goemaere J, Trigaux C, Denissen L, et al. Fifteen years of IOL exchange: indications, outcomes, and complications. J Cataract Refract Surg. 2020;46(12):1596-1603./2. Sahay P, Bafna RK, Reddy JC, Vjpayee RB, Sharma N Complications of laser-assisted in situ keratomileusis.Indian J Ophth 2021;69(7):1658-1669