Flap amputation for severe epithelial ingrowth presenting as a corneal cyst; Case report

Epithelial ingrowth is one of the relatively uncommon complications that can occur post-LASIK surgery. The incidence of epithelial ingrowth is about 1–2% in primary and microkeratome-assisted flap creation cases. The incidence is lower in Femtosecond assisted flap cases. Multiple risk factors associated with ingrowth have been identified and classified into pre-operative and post-operative risk factors. The pathogenesis of epithelial ingrowth remains unclear; however, poor apposition of the flap may lead to the migration of epithelial cells to the space between the flap and the underlying stroma. The surgical intervention for epithelial ingrowth removal involves lifting the flap with a mechanical scraping of the epithelial cells from the underlying stroma and the posterior part of the flap. Flap related complications can develop anytime from the surgery to years after, most of these complications can be managed conservatively, however, in rare circumstances flap amputation is inevitable. In this study, we present an unusual case of epithelial ingrowth post-LASIK refractive surgery requiring flap amputation and discuss the diagnostic process, treatment, and clinical implications.