Resolution of epithelial ingrowth after combined photorefractive keratectomy and corneal crosslinking in a patient with post-LASIK ectasia.

A 34-year-old man was referred to our institute for evaluation of the left eye because of corneal ectasia 10 years after bilateral laser in situ keratomileusis (LASIK). Three months before his referral, the patient had a flap lift for the management of interface fluid accumulation. Topography demonstrated post-LASIK corneal ectasia and slitlamp evaluation revealed epithelial ingrowth in the stromal interface inferiorly. The patient underwent uneventful combined photorefractive keratectomy (PRK) and corneal crosslinking (CXL) to stabilize the corneal ectasia and improve his functional vision. One month after the treatment, slitlamp evaluation revealed complete resolution of stromal interface epithelial ingrowth. At 12 months postoperatively, significant visual and topographic improvement was noted without any evidence of epithelial ingrowth recurrence or corneal ectasia progression. Combined PRK-CXL seemed to not only treat the corneal pathology of this patient successfully, resulting in visual and topographic improvement, but it also resolved the stromal interface epithelial ingrowth.

Keratoconus Treatment Algorithm.

Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.