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Epithelial ingrowth following laser in situ keratomileusis (LASIK): prevalence, risk factors, management and visual outcomes
  1. Darren Shu Jeng Ting1,
  2. Sathish Srinivasan2,3,
  3. Jean-Pierre Danjoux1
  1. 1 Sunderland Eye Infirmary, Sunderland, UK
  2. 2 Department of Ophthalmology, University Hospital Ayr, Ayr, UK
  3. 3 Faculty of Medicine, University of Glasgow, Glasgow, UK
  1. Correspondence to Sathish Srinivasan; sathish.srinivasan{at}


The number of laser in situ keratomileusis (LASIK) procedures is continuing to rise. Since its first application for correcting simple refractive errors over 25 years ago, the role of LASIK has extended to treat other conditions, including postkeratoplasty astigmatism/ametropia, postcataract surgery refractive error and presbyopia, among others. The long-term effectiveness, predictability and safety have been well established by many large studies. However, due to the creation of a potential interface between the flap and the underlying stroma, interface complications such as infectious keratitis, diffuse lamellar keratitis and epithelial ingrowth may occur. Post-LASIK epithelial ingrowth (PLEI) is an uncommon complication that usually arises during the early postoperative period. The reported incidence of PLEI ranged from 0%–3.9% in primary treatment to 10%–20% in retreatment cases. It can cause a wide spectrum of clinical presentations, ranging from asymptomatic interface changes to severe visual impairment and flap melt requiring keratoplasty. PLEI can usually be treated with mechanical debridement of the affected interface; however, additional interventions, such as alcohol, mitomycin C, fibrin glue, ocular hydrogel sealant, neodymium:yttriumaluminum garnet laser and amniotic membrane graft, may be required for recurrent or refractory cases. The aims of this review are to determine the prevalence and risk factors of PLEI; to describe its pathogenesis and clinical features and to summarise the therapeutic armamentarium and the visual outcome of PLEI.

  • cornea
  • ocular surface
  • treatment lasers
  • treatment surgery

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  • Contributors DSJT is involved in the conception and planning of the study, review of the literature, manuscript drafting and final approval of the manuscript. SS is involved in the review of the literature, critical appraisal and final approval of the manuscript. J-PD is involved in the review of the literature, critical appraisal and final approval of the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Not commissioned; externally peer reviewed.