Pericentral Epithelial Ingrowth Within A Smile Interface: Diagnosis And Surgical Management

To demonstrate the diagnosis and step-by-step surgical management of pericentral epithelial ingrowth within the SMILE interface and to discuss clinical decision-making between mechanical removal and Nd:YAG laser treatment.

High-volume tertiary refractive surgery center in the United States, specializing in small incision lenticule extraction (SMILE) and advanced corneal imaging.

A 23-year-old female presented with decreased vision and ocular discomfort one week following SMILE in the left eye. Slit-lamp examination and anterior segment OCT identified a localized pericentral epithelial nest within the SMILE interface. Given its visually significant location, surgical management was elected as an alternative to Nd:YAG laser disruption in order to preserve interface regularity and minimize the risk of refractive alteration. The interface was partially reopened through the original incision. A Sinskey hook was used to carefully dissect the epithelial tissue from stromal adhesions, followed by removal with microforceps and irrigation of the interface. Complete removal of the epithelial tissue was confirmed intraoperatively and with postoperative slit-lamp examination and OCT imaging. The interface remained clear without residual epithelial proliferation. At follow-up, uncorrected visual acuity returned to 20/20, with resolution of symptoms and no recurrence observed.

Pericentral epithelial ingrowth within a SMILE interface may compromise visual quality if untreated. Early identification and controlled surgical removal allow precise elimination of epithelial tissue while preserving refractive outcomes.