The "Advancement" And "Regression" Of Severe Epithelial Intraepithelial Ingrowth In The Corneal Stroma After Lasik Trauma

To analyze and explore the therapeutic approaches and timings for  corneal epithelial ingrowth resulting from traumatic LASIK flap displacement, in order to offer guiding thoughts for clinicians.

Traumatic injury is a risk factor for epithelial ingrowth after LASIK. Currently, the standard approach for managing epithelial ingrowth entails elevating the LASIK flap and subsequently removing the ingrowth via mechanical debridement. However, safely lifting the LASIK flap without inducing tears or compromising the integrity of the flap may present significant challenges. How to select between surgical intervention and watchful waiting for optimal treatment prognosis and key considerations.

One 40-year-old female patient was poked by a child's finger six years after LASIK surgery, causing corneal flap displacement. After repositioning the flap under slit lamp, epithelial ingrowth beneath the corneal flap emerged within two months, gradually aggravated, accompanied by corneal dissolution, increased astigmatism, and significantly decreased vision. This finding was confirmed by corneal topography and anterior segment OCT. An aggressive treatment of uncovering the original flap combined with scraping of the corneal epithelium was carried out, with mild postoperative responses and vision recovery. However, the epithelial ingrowth recurred one month after the surgery. Continual observation until three months after the surgery revealed no persistent aggravation.

This case demonstrates that there is a high possibility of epithelial ingrowth after traumatic LASIK flap displacement. Clinicians should remain vigilant regarding such complications and be familiar with basic treatment techniques or promptly refer the cases to experts in corneal refractive surgery. Aggressive uncovering of the original flap combined with scraping of the corneal epithelium can assist patients in recovering their vision to a certain extent. For mild recurrent corneal epithelial ingrowth, close follow-up and observation are advisable.