A case of bilateral epithelial ingrowth managed with a multimodal approach using flap lift with mechanical debridement and fibrin glue and Nd: YAG laser

A 36-year-old, reported to have undergone microkeratome-assisted primary LASIK surgery a decade back, followed by an enhancement procedure 5 years later, presented with complaints of glare, discomfort, and gradually progressive, painless diminution of vision for 3 years. The patient was diagnosed with Grade 3 post-LASIK epithelial ingrowth (as per the Probst and Machat Classification) in both eyes. Both eyes of the same patient were managed for the epithelial ingrowth using different but standard and recommended treatment options. For the right eye, the plan of management included a flap lift with manual debridement of epithelial ingrowth with adjunctive fibrin glueing of the flap, followed by bandage contact lens application under topical anesthesia. In the left eye, the epithelial ingrowth was divided into zones and treated with Nd: YAG (neodymium-doped yttrium aluminum garnet) laser in multiple sittings. After 3 months, recurrence was noted in the right eye and was managed with a single sitting Nd: YAG laser. The patient has been under observation for 3 years now with stable refraction and no recurrence in both eyes.