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Title

27-year-old man with "corneal opacity" after a branch injury

Purpose	Case of a patient with epithelial ingrowth after injury and laser in situ keratomileusis (LASIK).
Methods	A 27-year-old patient was referred for "corneal opacity" after a branch injury in the left eye. The patient reported a decrease in visual acuity in the affected eye. He had undergone a LASIK surgery on both eyes to treat a moderate hyperopia. The best corrected visual acuity (BCVA) was 0.4 in the affected left eye. Slit-lamp biomicroscopy showed an isle-like invasion of epithelial cells under the LASIK flap from the nasal flap edge to the optical axis as well as a paracentral lenticular fold. We made the diagnosis "posttraumatic LASIK flap folding with epithelial ingrowth (grade 4 according to Probst/Machat)".
Results	Mechanical removal of the epithelium from the bed and flap posterior surface in combination with 0.02% mitomycin C for 60 seconds was performed. Additionally, the flap margins were fixed with 3 temporary 10-0 nylon single sutures. Postoperative therapy consisted of topical and systemic steroids. BCVA increased to 1.0. No recurrence of epithelial invasion occurred after 4 months.
Conclusion	Epithelial ingrowth is a rare postoperative complication after LASIK. The term "corneal opacity" should be avoided as a finding or diagnosis. In cases of progressive epithelial ingrowth, urgent surgical intervention is indicated, regardless of the degree of visual loss. Diffuse lamellar keratitis (DLK) should always be excluded as a differential diagnosis.
Conflict of interest	No

Authors 1

Last name	HAMON
Initials	L
Department	Saarland University Medical Center (UKS)
City	Homburg/Saar, Germany

Authors 2

Last name	FLOCKERZI
Initials	E
Department	Saarland University Medical Center (UKS)
City	Homburg/Saar, Germany

Authors 3

Last name	ARDJOMAND
Initials	N
Department	Sehzentrum für Augenlaser und Augenchirurgie
City	Graz, Austria

Authors 4

Last name	SEITZ
Initials	B
Department	Saarland University Medical Center (UKS)
City	Homburg/Saar, Germany

Authors 5

Last name	DAAS
Initials	L
Department	Saarland University Medical Center (UKS)
City	Homburg/Saar, Germany