Two cases of epithelial ingrowth after small incision lenticule extraction

PURPOSE: To report two cases of epithelial ingrowth after small incision lenticule extraction (SMILE) successfully treated without lifting the corneal cap. OBSERVATIONS: A 34-year-old woman and a 37-year-old man who both had undergone bilateral SMILE procedures earlier at another institution, developed visually significant epithelial ingrowth into the interface pocket with an incisional tear. In both patients, the interface pocket was meticulously irrigated with a balanced salt solution to facilitate separation of the epithelial ingrowth from the interface. After that, the epithelial ingrowth was manually scraped using a blunt spatula, and removed from the pocket using 27-gauge vitreous forceps. 10–0 nylon sutures and soft bandage contact lenses were placed for 1 week. The best spectacle-corrected visual acuity improved to 20/16 or more 1-month postoperatively. No significant complications occurred. CONCLUSIONS AND IMPORTANCE: SMILE with incisional tear may cause epithelial ingrowth, resulting in significant visual disturbance. This can be successfully treated with meticulous surgical debridement of the corneal epithelium, even without lifting the corneal cap.