Refractory interface haze developing after epithelial ingrowth following laser in situ keratomileusis and small aperture corneal inlay implantation

PURPOSE: To report the occurrence and the management of refractory interface haze that developed after epithelial ingrowth following small aperture inlay implantation. OBSERVATIONS: A 52 year-old man with sub-clinical anterior basement membrane dystrophy (ABMD) underwent combined hyperopic laser in situ keratomileusis and KAMRA corneal inlay implantation to correct presbyopia. Post-operatively, epithelial ingrowth developed requiring debridement and KAMRA removal. Significant diffuse interface haze, ground-glass in texture, involving the central 6 mm of the cornea developed the next day, and was refractory to topical and systemic steroids, necessitating flap irrigation, gentle scraping, and MMC application to the residual stromal bed after 12 days. The interface haze gradually improved to near complete resolution over 12-months. CONCLUSIONS AND IMPORTANCE: Epithelial ingrowth can lead to flap interface haze refractory to medical therapy. Early surgical intervention is key to haze resolution.