Epithelial ingrowth (EI) is a rare complication of LASIK surgery. In fact, while it’s been reported in up to 20% of patients, only approximately 1% to 2% of cases are visually significant, and only between 0.92% and 3.2% require surgical treatment.1-3 But when patients do require intervention, the surgeon has a few options. The first, and most common, is to lift the flap and scrape the epithelium off the stromal bed and underside of the flap itself. Other options add to the first by applying suturing of the flap, application of ethanol or mitomycin C, phototherapeutic keratectomy or application of a sealant to the flap interface (or a combination). Depending on severity, treatments may also include laser Nd:YAG lasers (for less severe cases) or flap amputation and transepithelial topography-guided ablation (for more severe cases).1 However, according to newly published research, the first option—scraping alone—provides significantly better initial visual outcomes, but higher recurrence rates than scrape–suturing; and long-term visual outcomes for each are nearly identical.1
A team of Bascom Palmer researchers reviewed the records of all patients who underwent surgical treatment for EI after LASIK between July 1999 and July 2015 at the Miami-based institute (A total of 67 eyes of 54 patients).1 Fifty-six eyes underwent the lift-scrape technique while 11 underwent lift-scrape-suturing.1 The lift-scrape patients experience significantly improved visual outcomes at one month and one year after surgery, whereas eyes treated with the lift-scrape-suture technique did not show significantly improved visual outcomes at one month.1 However, they caught up at the one-year follow-up, where results appeared even, according to the investigators. They attribute the difference at one month to the effect of the sutures embedded in the cornea, which they say caused a temporary astigmatism.1
1. Yesilirmak N, Chhadva P, Cabot F, et al. Post-laster in situ keratomileusis epithelial ingrowth: treatment, recurrence, and long-term results. Cornea. 2018;37(12):1517-21.
2. Wang MY, Maloney RK. Epithelial ingrowth after laser in situ keratomileusis. Am J Ophthalmol. 2000;129(6):746-51.
3. Asano-Kato N, Toda I, Hori-Komai Y, et al. Epithelial ingrowth after laser in situ keratomileusis: clinical features and possible mechanisms. Am J Ophthalmol. 2002;134(6):801-7.