A Multipronged Approach For The Management Of Recurrent Epithelial Ingrowth And Flap Necrosis After Repeated Laser-Assisted In Situ Keratomileusis

To describe a clinical scenario of a rare complication after repeated LASIK and a multipronged approach for management of the same, with a good clinical evolution. 

L V Prasad Eye Institute, Hyderabad (India)

We report a clinical case of a 38-year-old female with recurrent epithelial ingrowth and flap necrosis in both eyes following repeated LASIK, done elsewhere and referred to our hospital for further management. Patient complained of blurring of vision, pain, watering and a foreign body sensation in the right eye (RE) since 5 days which was initially diagnosed as viral keratitis elsewhere and treated with topical antiviral medication. Vision was noted as 20/50 RE and 20/30 in the left eye (LE). On slit lamp examination, epithelial ingrowth was noted in both eyes, with grade 3 flap necrosis in the RE and grade 2 in LE. Patient was advised alcohol keratoepitheliectomy RE, following which she was started on topical steroids, lubricants and antibiotics, and observation for the LE. Recurrence was noted inferiotemporally and inferionasally in the RE during follow-up, which was managed by a non-invasive destruction of epithelial cell nests, using YAG laser in the inferiotemporal region. Patient was continued on topical lubricants and steroids, and kept on close observation. Slit Lamp images were taken during follow up. The epithelial ingrowth appeared to be stable at the 5 month follow up in the RE and her BCVA has improved to 20/30 in the RE. Only observation has been advised for the LE, and it is stable at present.

Post LASIK Epithelial Ingrowth is a rare complication following LASIK. It can produce a wide spectrum of clinical presentations, ranging from asymptomatic interface changes to severe visual impairment, discomfort and flap necrosis, as was seen in our patient, and requires a timely and multipronged approach for its management along with counselling regarding the risk of recurrence. The treatment modalities used for our patient included alcohol keratoepitheliectomy in the RE initially, followed by a non-invasive YAG laser destruction of epithelial nests subsequently, when recurrence was noted, which yielded a favourable outcome.