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Ophthalmology and Visual Sciences

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Epithelial ingrowth after LASIK

Contributor: Jesse Vislisel, MD

Epithelial ingrowth occurs when the corneal epithelial cells grow within the lamellar interface beneath the LASIK flap.  This may result in an inflammatory response, corneal edema, irregular astigmatism, or melting of the LASIK flap.  When mild and peripheral, it may be observed.  When progressive or severe, the LASIK flap must be lifted and the epithelium scraped from the bed.  Recurrent cases may require suturing of the LASIK flap.

Figure 1. Nests of epithelium beneath LASIK flap

Contributor:Jesse Vislisel, MD

Nests of epithelium can be seen approaching the visual axis beneath the LASIK flap.  This case occured after microkeratome-assisted LASIK and multiple enhancement procedures

Nests of epithelium can be seen approaching the visual axis


Figure 2. Epithelial ingrowth under LASIK flap

Contributor: Jesse Vislisel, MD

Photographer: Brice Critser, CRA

Epithelial ingrowth after LASIK performed in the setting of epithelial basement membrane dystrophy.  The patient developed edema of the LASIK flap and recurrent erosion syndrome, requiring lifting of the flap and removal of the epithelial ingrowth

nests of epithelial cells can be seen growing underneath the inferior edge of the LASIK flap.

nests of epithelial cells can be seen growing underneath the inferior edge of the LASIK flap.


Figure 3. Epithelial ingrowth at the edges of a LASIK flap

Contributor: Matt Ward, MD

Epithelial ingrowth at the edges of a LASIK flap

Epithelial ingrowth can be a vision threatening complication of LASIK surgery. If it approaches the visual axis, the flap must be lifted and the bed scraped. Recurrent ingrowth may require suturing of the flap in the location of recurrence.


Figure 4. Postoperative Appearance

Contributor: Jesse Vislisel, MD

Photographer: Brice Critser, CRA

Postoperative appearance after lifting the LASIK flap, removing the ingrown epithelium, and suturing the flap back in place. Acuity corrected to 20/20 after the sutures were removed.

Flap Sutures, postoperatively


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Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

last updated: 10/10/2014; updated 3/15/2016
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