Characteristic clinical findings and visual outcomes.
OBJECTIVE
To describe a potentially serious complication of laser in situ keratomileusis (LASIK) that can masquerade as a persistent epithelial defect.


METHODS
Refractive surgery centers in academic institutions.


METHODS
Charts of 4 eyes in which epithelial-defect-masquerade syndrome was diagnosed were reviewed to determine the time to diagnosis and the presence of associated features that may have contributed to the delay in diagnosis. Clinical findings and outcomes of medical and surgical intervention were recorded.


RESULTS
All eyes developed an epithelial defect involving the edge of the flap during surgery. The diagnosis of epithelial ingrowth was delayed because of the presence of stromal edema (n = 4), diffuse lamellar keratitis (n = 3), and contraction of the flap leading to gutter widening (n = 4). Epithelial ingrowth was diagnosed 5, 7, 15, and 60 days after LASIK. All eyes satisfied the following criteria: convexity of the peripheral epithelium at the edge of the flap associated with light reflections at the end of the flap, fluorescein pooling in the gutter, stromal edema, reduced best spectacle-corrected visual acuity (<20/60 in 3 eyes), and partial healing of the epithelial defect limited to the flap hinge. One eye developed stromal scarring and ulceration that required fortified antibiotics. Surgical repair included epithelial scraping after the flap was lifted and ironing followed by placement of a contact lens after surgery. The epithelial defect healed 5, 7, 21, and 24 days after surgery. The final uncorrected visual acuity ranged from 20/15 to 20/100.


CONCLUSIONS
Epithelial ingrowth following LASIK-associated epithelial defects may masquerade as stromal edema associated with a persistent epithelial defect. A high index of suspicion for epithelial ingrowth is essential to avoid a delayed diagnosis, which can result in irreversible visual loss due to stromal melting and infectious keratitis.
Azar
Dimitri T
DT
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA. dazar@meei.harvard.edu
Scally
Amy
A
Hannush
Sadeer B
SB
Soukiasian
Sarkis
S
Terry
Mark
M
D000328:Adult; D003316:Corneal Diseases / Q000175:diagnosis* / Q000209:etiology; D015715:Corneal Edema / Q000175:diagnosis / Q000209:etiology; D003319:Corneal Stroma / Q000473:pathology; D003937:Diagnosis, Differential; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013524:Surgical Flaps / Q000473:pathology*; D013577:Syndrome; D014792:Visual Acuity