Management Of The Central Epithelial Implantation Following Femtosecond Lasik- Case Report

To report a case of visually significant central epithelial implantation involving the pupillary zone two weeks after primary femtosecond LASIK performed using the SCHWIND AMARIS excimer laser system, successfully managed with surgical debridement and adjunctive mitomycin C (MMC).

This case was managed at a refractive surgery center following uneventful femtosecond LASIK for myopia. Postoperative evaluation identified central epithelial implantation within the pupillary zone. Surgical debridement with adjunctive mitomycin C was performed with close follow-up to monitor visual recovery and recurrence.

A 35-year-old female patient presented two weeks after uneventful femtosecond LASIK with complaints of blurred vision and glare. Uncorrected distance visual acuity (UDVA) had decreased to 0.3. Slit-lamp examination revealed epithelial implantation extending centrally into the pupillary zone. Anterior segment OCT (AS-OCT) demonstrated hyperreflective epithelial nests within the flap interface corresponding to the visual axis. Given the central involvement and marked visual deterioration, surgical intervention was performed. The flap was carefully lifted, and meticulous mechanical debridement of epithelial cells was carried out from both the stromal bed and the posterior surface of the flap. The interface was irrigated thoroughly. Adjunctive mitomycin C 0.02% was applied locally to reduce recurrence risk before careful flap repositioning.

Results:

On the first postoperative day, the interface appeared clear. Remarkably, UDVA improved to 1.0. The patient reported complete resolution of visual disturbances. During follow-up, the interface remained transparent with no evidence of recurrent epithelial implantation.

Central epithelial implantation involving the pupillary zone may cause profound visual  impairment even after uneventful femtosecond LASIK. Prompt surgical intervention with meticulous debridement and adjunctive MMC can restore excellent visual acuity and may reduce recurrence risk. Early recognition is critical to prevent permanent interface irregularity and optical degradation.