To Amputate or Not to Amputate: Management of Iatrogenic LASIK Flap Dehiscence and Epithelial Ingrowth with Overlying Pseudopterygium

A 73-year-old male with a history of myopic laser-assisted in situ keratomileusis (LASIK) 20 years earlier presented with a late LASIK flap dehiscence, epithelial ingrowth, conjunctivalization, and the development of a pseudopterygium in the right eye. The findings were consistent with surgical trauma, likely occurring after corneal epithelial debridement to improve visualization during pars plana vitrectomy for retinal detachment repair 3 months earlier. The patient underwent epithelial ingrowth debridement, LASIK flap reapproximation and suturing, and a conjunctival limbal autograft from the contralateral eye. The surgery was completed successfully without the need for flap amputation. Postoperatively, the patient had an uneventful course with a well-healing conjunctival graft and no interface opacity or evidence of recurrent pseudopterygium of the right eye. The graft and corneal topography remained stable after subsequent cataract surgery.

Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty as a Treatment Modality for Recalcitrant Post-Laser in situ Keratomileusis Epithelial Ingrowth

The purpose is to present the outcomes of anterior lamellar keratoplasty for a case of post-laser in situ keratomileusis (LASIK) epithelial ingrowth. A 40-year-old male patient presented with epithelial ingrowth 14 years after primary LASIK with a microkeratome blade in the right eye following trauma. Multiple stromal bed washing was done over a period of 3 years, but recurrence of epithelial ingrowth was seen every time. Femtosecond laser-assisted anterior lamellar keratoplasty was performed in the right eye. Twelve months after the procedure, the patient’s corrected distance visual acuity improved to 6/9, and no recurrence was noted. Femtosecond laser-assisted anterior lamellar keratoplasty is an effective treatment modality in cases of recurrent recalcitrant epithelial ingrowth seen after LASIK.