Flap Amputation For Severe Epithelial Ingrowth Post-Lasik

This case report discusses flap amputation after repeated attempts to resolve persistent and severe epithelial ingrowth following LASIK surgery.

Epithelial ingrowth, where epithelial cells migrate under the LASIK flap, is a complication that can lead to visual disturbances and discomfort. While minor cases can often be managed with flap lifting and debridement, severe and recurrent epithelial ingrowth may require flap amputation to preserve corneal health and vision

In our clinic, Cairo, Egypt. A 31-year-old man presented with complaints of decreased vision and significant glare in his right eye after undergoing bilateral LASIK surgery 2 years ago. His initial postoperative course had flap repositioning 1 day after surgery followed by recurrent epithelial ingrowth 6 months later and the decision then was flap re lift, epithelial removal, mitomycin application and flap suturing for three weeks by his original surgeon.

The patient presented to our clinic with recurrent diminution of vision in the same eye for the third time with severe photophobia and blepharospasm. Slit-lamp examination revealed extensive epithelial ingrowth at the flap margin extending into the visual axis with lower flap melting.

Given the recurrent nature and extent of the ingrowth, the decision was made to proceed with flap amputation.

Surgical Procedure:
Under topical anesthesia, the epithelial ingrowth was seen and then the LASIK flap was carefully lifted, and the ingrown epithelium was debrided. Due to the extensive nature of the ingrowth and the previous failed attempts at management, the decision was made to amputate the flap. The flap was excised using a pair of microsurgical scissors, ensuring that no epithelial cells remained at the stromal interface. The corneal bed was smoothed, and a bandage contact lens was placed over the cornea.

Postoperative Course:
The patient was placed on a regimen of topical antibiotics and corticosteroids. He was followed closely over the next several weeks, with the bandage contact lens being removed after one week. The epithelial defect healed completely within two weeks, and the patient’s symptoms of glare and decreased vision resolved.

At the six-month follow-up, the patient’s corrected distance visual acuity (CDVA) in the right eye was 20/25. His manifest refraction was (plano /+0.75 axis 100).

Flap amputation should be considered in cases of severe and recurrent epithelial ingrowth following LASIK, especially when conservative measures fail. While it is a drastic step, it can result in good visual outcomes and resolution of symptoms in carefully selected patients