Severe Epithelial Ingrowth Management

To present the treatment of a severe and recurrent epithelial ingrowth after Femto-LASIK.

Instituto Oftalmológico Hoyos, Sabadell, Barcelona (Spain).

39-year-old female myopic patient operated on with Femto-LASIK, resulting in a residual error. Two years later she was treated again by lifting the flap, developing a severe epithelial ingrowth. The complication was treated 5 months later resulting in a new recurrence and a decrease in visual acuity to 20/40. One month later she was referred to our clinic. We treated this case by lifting the flap and scraping the epithelium on the stromal bed and in the stromal face of the flap. Irrigation with balanced saline solution was used to facilitate the release of this epithelium ingrowth. The flap border was found rolled (maybe the cause of this complication) and we solved it by scraping with a corneal scarifier. During the surgery we used profuse irrigation-aspiration to avoid an epithelial sowing and a new recurrence. To decrease the recurrence risk, we scraped the epithelium on the bed until the corneal limbus, and in this way the re-epithelialization occurs from both the flap border and the limbus, coinciding halfway and far from the border of the flap. Finally, we prescribed antibiotic/steroid eye drops, artificial tears and a bandage with therapeutic contact lens for 3-5 days. One year later this patient has maintained a clean interface without epithelial recurrence and has recovered her 20/20 vision.

The points to avoid a recurrence when we are treating an epithelial ingrowth are: 1- Thorough cleaning on the stromal bed and in the stromal face of the flap; 2- Make sure you do not leave any rolled edge; 3- Profuse irrigation-aspiration to avoid an epithelial sowing; 4- Facilitate a good coaptation of the flap on its bed and scrape the epithelium on the bed until the corneal limbus, to avoid the ingrowth of epithelium under an oedematose flap.