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Ophthalmology and Visual Sciences

Epithelial ingrowth after LASIK

Epithelial ingrowth after LASIK

Category(ies): Cornea
Contributors: Jesse Vislisel, MD and Matt Ward, MD
Photographer: Brice Critser, CRA

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.

Nests of epithelium
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

Epithelial ingrowth under LASIK flap
Figure 2a. 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

Epithelial ingrowth under LASIK flap Slit lamp
Figure 2b. Epithelial ingrowth under LASIK flap

Contributor: Jesse Vislisel, MD
Photographer: Brice Critser, CRA

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

Contributor: Matt Ward, MD

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.

Postoperative appearance after lifting the LASIK flap
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.