Large Intrastromal Corneal Cyst Following Lasik In A Patient With Low Endothelial Cell Count, A Case Report.

Laser-assisted in situ keratomileusis (LASIK) is one of the most performed refractive surgeries worldwide with high safety and efficacy profiles. Here we present a case of a corneal intra-stromal cyst in a patient with low endothelial cell count after 9 years of performing LASIK surgery without history of trauma or flap manipulation.

The Anterior Segment outpatient clinics of King Khaled Eye Specialist Hospital, a tertiary eye care center in Riyadh, Saudi Arabia.

A 45-year-old man presented to the clinic, seeking evaluation for vision loss in his left eye over three years. He had a history of successful LASIK for myopia correction nine years ago. Family history included keratoconus but no endothelial corneal dystrophy. On examination, the left eye showed a central intra-stromal cyst with mild scarring beneath the LASIK flap, while the right eye had corneal guttae. High-resolution anterior segment optical coherence tomography (AS-OCT) of the left eye confirmed the presence of an intrastromal cyst. No signs of corneal ectasia was detected on corneal tomography. The final diagnosis was epithelial ingrowth cyst. Surgical intervention was offered however, the patient opted for using hard contact lens in the left eye with visual acuity of 20/25.

Impaired endothelial function could compromise LASIK flap adhesion, leading to the migration of epithelial cells and subsequent cyst formation within the interface. Conducting comprehensive pre-operative evaluation including screening for endothelial dysfunction is of high importance before undergoing LASIK surgery. Moreover, the utilization of advances in imaging technology; such as high-resolution anterior segment OCT, proves to be essential in reaching conclusive diagnosis when in doubt. Also, a conservative approach to post-LASIK epithelial ingrowth is satisfactory to some patients. A step-wise approach could prevent unnecessary surgical interventions.