Purpose:
To evaluate the corneal characteristics of patients who presented with epithelial ingrowth after Laser in situ keratomileusis (LASIK) surgery using in vivo laser confocal microscopy and anterior segment OCT.
Methods:
Consecutive case series. 3 eyes of 3 patients who underwent LASIK for myopic correction presented 15 days after surgery with epithelial ingrowth (grade 2). The patients underwent slit-lamp examination, visual acuity evaluation, confocal microscopy and anterior segment OCT assessment at baseline and at every follow-up visit.
Results:
The visual acuity at the first visit was 20/25 in one eye and 20/30 in the other 2 eyes. Slit-lamp examination revealed a faint gray line with finger-like pattern extending for 2 mm from the cap edge underneath the flap, not involving the visual axis. Anterior segment OCT revealed a hyperreflective line 140 µm (± 35 µm) beneath the epithelium corresponding to the flap along with clumps of hyperreflective tissue within a hyporeflective matrix corresponding to nests of cells immerged in necrotic tissue. In vivo confocal microscopy demonstrated the presence of nests of epithelial cells with picnotic nuclei, an increased citoplasmic volume and an increase cheratinization underneath the flap. The anterior stroma presented with a slight reduction of the density of keratocytes along with hyperreflective extracellular matrix.
Conclusions:
Complication may occur after refractive surgery. In such cases the understanding of the pathogenesis is pivotal. Information gathered with each instrument are complementary and essential. Data on cellular morphology on confocal planes are provided by confocal microscopy, whereas anterior segment OCT provides data on saggital scans, allowing the exact evaluation of the topographic localization of the lesion.
Keywords: refractive surgery: complications • refractive surgery: LASIK • imaging/image analysis: clinical