One Size Doesn’T Fit All - Multimodal Approach To Bilateral Extensive Post Lasik Epithelial Ingrowth.

To describe a unique and challenging case of bilateral extensive PLEI ( post LASIK epithelial ingrowth) and to demonstrate the multimodal approach to the handling of epithelial ingrowth using various techniques for a satisfactory outcome.

We report a case of PLEI post enhancement LASIK surgery of different severity and grading in both eyes. While one eye was managed surgically with mechanical debridement augmented with the use of fibrin glue, the other eye was managed more conservatively with the use of Nd-YAG laser treatment with optimal visual outcome. This case report serves as a good example of treatment combinations and tailored approach for managing post LASIK complications.

For the right eye, the plan of management included flap lift with manual debridement of epithelial ingrowth with fibrin glue and application of bandage contact lens (BCL) under topical anaesthesia. A hockey stick spatula was used to scrape off all epithelial cells from the stromal bed as well as undersurface of the flap.  In the left eye, even though the patient was asymptomatic, the epithelial ingrowth was noted to progress gradually. A decision to perform Nd:YAG laser treatment was made. PLEI was divided into three zones and 12- 15 Nd: YAG laser shots were delivered at 0.5mJ of energy on three separate visits thus managing conservatively.

Utilising different but tailored approaches to management of PLEI in the two eyes of the same patient, a successful outcome was achieved. The patient is currently under follow-up with a stable UDVA of 6/6 on the last visit. There is no sign of PLEI progression.

Although PLEI is a dreaded complication post-LASIK, a judicious and well-timed intervention may restrict the severity of the visual outcome for the patient. Through our case report, we advocate the safety and efficacy of the employment of multiple modalities of treatment within the same eye and also in the other eye of the same patient.