Management of recalcitrant epithelial ingrowth after laser in situ keratomileusis

Abstract

Rationale:Surgically lifting and scraping, mitomycin C, fibrin glue, Nd:YAG laser, hydrogel ocular sealant, and amniotic membrane patch are the reported methods for treating epithelial ingrowth after laser in situ keratomileusis (LASIK). Here we report the management of a rare case of recalcitrant epithelial ingrowth using a combined scraping/laser ablation that occurred after LASIK.Patient concerns:A female patient underwent uncomplicated bilateral LASIK 10 years before incurring trauma to the right eye. Approximately 2.5 years later, she presented with a complaint of blurred vision and a foreign body sensation.Diagnoses:The patient was diagnosed with epithelial ingrowth because of the presence of corneal melting, wrinkling, and scarring. Approximately 6 months after injury, the patient underwent corneal scraping to remove the epithelial ingrowth. Even after 2 more scraping procedures, the epithelial ingrowth recurred. Corneal densitometry was performed (Oculus Pentacam), which revealed a maximum corneal densitometry value of 87.4 gray scale units (GSUs) in the inferonasal quadrant. This reading highly elevated compared to readings from normal cornea (approximately 20 GSU).Interventions:We used a combination scraping/laser ablation procedure to correct astigmatism and eliminate any undetected residual corneal epithelial cells.Outcomes:Two days following the procedure, the patient developed a mild corneal opacity in the area where the epithelial ingrowth had been located. At this time, visual acuity was 20/40, refractive error (manifest refraction) was −0.50 Diopter (D) sph, and the maximum corneal densitometry value was 79.2 GSU. After 2 months, the central cornea remained slightly blurred, but visual acuity was 20/25. No signs of recurrent epithelial ingrowth were present and the maximum corneal densitometry reading had decreased to 55.4 GSU.Lessons:This case demonstrates that epithelial ingrowth should be treated as soon as possible after trauma and that thorough scraping combined with laser ablation is effective for treating recalcitrant epithelial ingrowth. Additionally, corneal densitometry can be used to assess epithelial ingrowth severity and treatment efficacy.

Corneal optical density: Structural basis, measurements, influencing factors, and roles in refractive surgery

“…This result indicates that LASIK has less effect on corneal transparency than does PRK ( Gadde et al, 2020 ). Some scholars have found that the COD of patients with epithelial ingrowth after LASIK is significantly increased, suggesting that COD could be used as an objective measurement of the level and progression of epithelial ingrowth following LASIK ( Adran et al, 2017 ; Tian, 2018 ).…”