title: Epithelial defect, diffuse lamellar keratitis, and epithelial ingrowth following post-LASIK epithelial toxicity.
abstract: This case reports an association between 2 uncommon flap complications in 1 eye related to epithelial toxicity and subsequent epithelial defect secondary to prolonged intraoperative exposure to topical anesthesia. A patient had hyperopic laser in situ keratomileusis (LASIK) for the correction of +2.75 +1.75 x 70 in the left eye. Because of the patient's anxiety and movement, additional topical local anesthesia was used and the flap remained reflected for 5 minutes. Immediately postsurgery, a toxic appearance was noted in the epithelium of the LASIK flap; 24 hours later, a large central epithelial defect was identified. Three days post- LASIK, the epithelial defect had healed but diffuse lamellar keratitis was noted in the interface, particularly underlying the location of the original epithelial defect. Over 6 weeks, a self-limiting epithelial ingrowth developed in the inferior interface. Fourteen months post-LASIK, the uncorrected visual acuity was 6/9 with a residual refraction of +0.50 +0.50 x 90.
authors.affiliation: Discipline of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1, New Zealand.
authors.forename: Nisha
authors.initials: N
authors.lastname: Sachdev
authors.forename: Charles N
authors.initials: CN
authors.lastname: McGhee
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: Craig
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Weed
authors.forename: J Jane
authors.initials: JJ
authors.lastname: McGhee
mesh_terms: D019573:Epithelium, Corneal / Q000473:pathology*; D006801:Humans; D006956:Hyperopia / Q000503:physiopathology / Q000601:surgery; D007634:Keratitis / Q000209:etiology* / Q000473:pathology; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps / Q000009:adverse effects / Q000473:pathology; D013997:Time Factors; D014792:Visual Acuity