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Rare complication of epithelial ingrowth after SMILE in a young pseudophakic patient: a case report
First Author: A. Mirescu ROMANIA
Co Author(s): I. Ungureanu M. Filip
We report a case of epithelial ingrowth after refractive lenticule extraction (ReLEx) through a small incision (SMILE), in a young pseudophakic patient. Epithelial ingrowth is a rare complication after SMILE, where the epithelial tissue gets out to the stromal interface through the small incision. This complication only requires surgical intervention in 0-3% cases.
We present a case report, a 24-year old, pseudophakic female patient, who came to the Ophthalmology Clinic ﾓAMA Optimexﾔ for refractive surgery. We followed up her evolution after ReLEx-SMILE and managed the complication that appeared after surgery.
At the first visit, our patient presented high myopia and mild astigmatism. The visual acuity (VA) of right eye (RE) was 0.9 with correction of -10 spherical diopters (SphD) and the VA of left eye (LE) was 0.05 without correction. At the age of 2, the patient had surgery for congenital cataract. Subsequently, the slit-lamp examination revealed posterior chamber intraocular lenses in the both eyes, and the fundus examination showed bilateral myopic conus and coroidosis. The preoperative examination revealed no contraindication for the refractive surgery. The patient underwent ReLEx-Smile surgery for the right eye. The target was -2.50 SphD.
The post-operative evolution was favorable. The RE refraction was -1.50/-2.50/132ﾰ and the VA of RE was 0.7 without correction, 0.9 with correction of -1.50 SphD. The slit-lamp examination was normal. One week later, the VA of RE improved, but the slit-lamp examination revealed epithelial ingrowth. The pandemic delayed surgical removal of the epithelial ingrowth by 8 months. The surgery was a real success, with improvements of both refraction and the VA of RE. The slit-lamp examination revealed clear stromal interface with a small perilesional corneal oedema, without microstriae. The aspect after 1 and 2 months was stationary.
Our patient is pseudophakic after having surgery for congenital cataract at the age of 2. We therefore aimed for a target of -2.5 SphD, because our patient has a monofocal lens with a complete lack of accommodation. Evolution after the SMILE procedure was favourable, with improvement of RE refraction and VA. Despite overall lower risk of postoperative complications after SMILE, our patient developed epithelial ingrowth, which was managed surgically. Surgery for epithelial ingrowth should be performed immediately, in order to have a fast and complete recovery. The pandemic delayed the procedure, but the patient had a good outcome, nonetheless.
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