case reports Epithelial defect, diffuse lamellar keratitis, and epithelial ingrowth following post-LASIK epithelial toxicity Nisha Sachdev, MBChB, Charles N. McGhee, PhD, FRCS, FRCOphth, FRACO, Jennifer P. Craig, PhD, MCOptom, Kathryn H. Weed, MSc, MCOptom, J. Jane McGhee, BSc 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  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 resid- ual refraction of +0.50 +0.50  90. J Cataract Refract Surg 2002; 28:1463–1466 © 2002 ASCRS and ESCRS L aser in situ keratomileusis (LASIK) has become a widely accepted and successful method for the correction of myopia and hyperopia. 1,2 However, the surgery is occasionally associated with complications peculiar to lamellar refractive surgery. 3–9 This case highlights an uncommon association between epithe- lial toxicity, epithelial defect, diffuse lamellar keratitis (DLK), 4,5,9 and epithelial ingrowth into the interface. 6–8,10 Case Report A 57-year-old man was assessed for LASIK. The uncor- rected visual acuity (UCVA) was 6/36 in the right eye and 6/60 in the left eye, and the preoperative keratometry was 46.1@100/45.1@10 and 46.5@80/44.6@170, respectively. The manifest refractive error was +2.50 diopters (D) in the right eye and +2.75 +1.75  70 in the left. The left eye exhibited mild amblyopia, and the preoperative best specta- cle-corrected visual acuity was 6/9 in the left eye and 6/5 in the right. The only significant observation on full ophthalmic assessment was mild bilateral seborrheic blepharitis. The pa- tient was using no regular topical ocular medication in either eye, nor had in the past, and there was no history of recurrent corneal erosion syndrome or corneal trauma. Specifically, no clinical evidence of epithelial basement membrane disorder was identified in either eye. Accepted for publication October 25, 2001. From the Discipline of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand (Sachdev, C. McGhee, Craig, J. McGhee), and the Corneal Diseases and Excimer Laser Research Unit, University Department of Ophthalmology, Nin- ewells Hospital and Medical School, Dundee, Scotland (Sachdev, C. McGhee, Craig, Weed, J. McGhee). Supported in part by an unrestricted grant from the Speed Pollock Me- morial Research Fund (Craig) and a Medical Research Council (UK) clinical fellowship award (Weed). None of the authors has a proprietary or financial interest in any product mentioned. Reprint requests to Professor Charles N.J. McGhee, Discipline of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1, New Zealand. E-mail: c.mcghee@auckland.ac.nz. © 2002 ASCRS and ESCRS 0886-3350/02/$–see front matter Published by Elsevier Science Inc. PII S0886-3350(02)01236-1