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 Table of Contents  
PHOTO ESSAY
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 249-250

Spontaneous regression of progressive epithelial ingrowth following femto laser-assisted in situ keratomelusis


1 Cornea and Refractive Services, Aravind Eye Hospital, Pondicherry, India
2 Cornea and Refractive Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India

Date of Submission11-Mar-2021
Date of Acceptance30-Jun-2021
Date of Web Publication07-Jan-2022

Correspondence Address:
Dr. Josephine S Christy
Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Cuddalore Road, Thavalakuppam, Puducherry - 605 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_569_21

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  Abstract 


Keywords: Epithelial ingrowth, post Femto LASIK, spontaneous resolution


How to cite this article:
Christy JS, Gurnani B, Manohar D. Spontaneous regression of progressive epithelial ingrowth following femto laser-assisted in situ keratomelusis. Indian J Ophthalmol Case Rep 2022;2:249-50

How to cite this URL:
Christy JS, Gurnani B, Manohar D. Spontaneous regression of progressive epithelial ingrowth following femto laser-assisted in situ keratomelusis. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 24];2:249-50. Available from: https://www.ijoreports.in/text.asp?2022/2/1/249/334959



A 22-year-old female underwent uneventful femtosecond-assisted laser in situ keratomileusis (Femto LASIK; Intralase, Abbott Medical Optics) in both eyes. Intraoperative epithelial disturbance due to difficult flap lifting was documented in the right eye. One week later, faint interface opacity [Figure 1]a suggestive of Grade 1 epithelial ingrowth (EI) was noted, which organized into inconspicuous pearls at 1 month [Figure 1]b with uncorrected visual acuity (UCVA) of 20/20. Eighteen months later, the patient presented with blurred vision in dim light and a whitish lesion in the right eye. EI had progressed into a thick plaque (3 × 3 mm) [Figure 2]a with UCVA of 20/30 in mesopic light. The patient refused surgical intervention due to the risks involved and chose to follow up closely for progression. Twenty months later (after pregnancy) EI had regressed significantly with faint haze [Figure 2]b and UCVA was 20/20 in both mesopic and bright light.
Figure 1: (a) Faint interface opacity suggestive of Grade 2 epithelial ingrowth at first postoperative week. (b) Dot-like pearls above the superior pupillary border at first postoperative month.

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Figure 2: (a) Plaque-like epithelial ingrowth at 18 months post Femto LASIK. (b) Spontaneously regressed epithelial ingrowth after pregnancy with a faint white haze.

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  Discussion Top


EI is a rare complication that can occur after primary LASIK or following enhancement procedure. Clinical presentations range from asymptomatic interface changes to severe visual impairment and even flap melt in untreated EI. Indications for conservative/surgical treatment are guided by the patient's symptoms, location/severity of EI, and presence of associated flap dislocation. Rapuano[1] reported that 64% of EI did not require any intervention. According to the Probst/Machat classification, treatment is generally recommended for Grade 2/3 EI (>2 mm from flap edge involving visual axis).[2] However, surgical treatment has its own set of disadvantages such as high recurrence (44%), postoperative folds/irregular astigmatism, and infection.[3]

EI post primary LASIK is usually not progressive, as the implanted epithelial cells during primary flap creation usually have a minimal proliferative ability.[4] These EI might have an initial progressive phase but subsequently regress thereafter. The literature search revealed two other similar reports of spontaneous regression following microkeratome-assisted LASIK.[3],[5] One followed a flap repair that regressed 20 months later and another that progressed at 23 months regressed 6 months later. Hence, we conclude that EIs do not always need an aggressive surgical management. Close follow-up of patients with EI regardless of its grade for a longer period of time is mandatory.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rapuano CJ. Management of epithelial ingrowth after laser in situ keratomileusis on a tertiary care cornea service. Cornea 2010;29:307-13.  Back to cited text no. 1
    
2.
Zhang R, Jhanji V, Sun L, Zhang M. Spontaneous resolution of delayed epithelial ingrowth after LASIK. Eye Contact Lens 2013;39:400-1.  Back to cited text no. 2
    
3.
Ting DS, Srinivasan S, Danjoux JP. Epithelial ingrowth following laser in situkeratomileusis (LASIK): Prevalence, risk factors, management and visual outcomes. BMJ Open Ophthalmol 2018;3:e000133.  Back to cited text no. 3
    
4.
Naoumidi I, Papadaki T, Zacharopoulos I, Siganos C, Pallikaris I. Epithelial ingrowth after laser in situ keratomileusis: A histopathologic study in human corneas. Arch Ophthalmol 2003;121:950-5.  Back to cited text no. 4
    
5.
Lin JM, Tsai YY, Tseng SH. Spontaneous regression of dense epithelial ingrowth after laser in situ keratomileusis. J Refract Surg 2005;21:300-2.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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