HOW TO TREAT LASIK-INDUCED NEUROTROPHIC EPITHELIOPATHY. SECOND CHANCES EXIST.

Our purpose is to present a case report of a patient who presented a LASIK-induced neurotrophic epitheliopathy (LINE) of 3 months of evolution with no response to topical treatment, whose solution was found by surgical means; Flap lift.

Refractive Surgery Unit, Clínica Novovisión, Madrid, Spain.

The following is a case of a 52-year-old woman with no history of interest who underwent FemtoLASIK surgery for hyperopia correction (planned monovision, right eye dominant). The surgery was uneventful. Soon after the procedure the patient began with dry eye symptoms and severe discomfort in her left eye and keratitis punctata superficialis was easily seen at the slit lamp. Right eye showed no relevant findings. The patient was treated with topical lubricants and cyclosporine 0.05%, with no improvement observed at 3 months postop.

At this point and knowing how infrequent LINE is, it was decided to lift the left flap so that a new corneal nerve cutting could induce a more physiological corneal re-innervation. Soon after flap lifting without any laser ablation, the punctate keratitis improved and eventually disappeared, as well as the patient's symptoms.

LINE is a rare LASIK complication with several mechanisms involved in its pathogenesis: cutting of the corneal nerve endings, leading to a nerve re-growth sometimes creating an abnormal sub-basal nerve plexus that shows abnormal responses to stimuli (dysesthesia). It is a rare entity with an incidence lower than 5%, and we believe that given the fact that the chances of having an abnormal corneal nerve regeneration are small, they should be even smaller if a second chance is given.