Epithelial Ingrowth After Small Incision Lenticule Exctraction

Epithelial ingrowth is a rare condition after small incision lenticule extraction (SMILE), only a small number of cases have been reported in the literature. In this case report, we present a case of epithelial ingrowth after SMILE that was managed with interface irrigation.

Liv Bona Dea Hospital, Baku, Azerbaijan.

A 37-year-old female patient presented with a request for refractive surgery. Manifest refraction values were -4.75 -0.25 x 45° and -5.0-0.75x 165° in the right and left eyes, respectively. The best corrected visual acuity was 10/10 in both eyes. Central corneal thickness was 581 μm in both eyes. Ophthalmological examinations including corneal topography were normal in both eyes. Bilateral SMILE was planned for the patient. The SMILE procedure was performed with the Visumax 500 femtosecond laser (Carl Zeiss Meditec AG, Jena, Germany). The cap diameter was 7.70 mm, with an intended thickness of 135 μm, and the optical zone in both eyes was 6.5 mm. Side cut was made of 3 mm long. The pulse energy was 140 NJ. After successfully removing the lenticule, we saw an epithelial defect in the side cut area but did not remove it. At postoperative 4 days, UDVA was 2/10 in the left eye. Also the refraction in the left eye was +0.25-2.25x7. The slit-lamp examination showed a small grayish-white intrastromal opacity similar to epithelial growth in the central corneal interface of the left eye. Optical coherence tomography B-scan, and corneal topographic examination also revealed a central irregularity immediately above the area of opacity. The epithelial ingrowth was manually scraped using a blunt spatula, after that, the interface pocket was irrigated with a balanced salt solution. Epithel in the side cut area was removed and bandage contact lenses were applied.

Our case showed that even SMILE, can cause epithelial ingrowth, resulting in significant visual disturbance. Epithelial ingrowth in the optic axis can easily be removed with interfacial irrigation and scraping. If a loose epithelial layer in the side cut area is seen, cleaning it and applying contact lenses would be the right choice.