Laser in situ keratomileusis induced corneal perforation and recurrent corneal epithelial ingrowth

We report a rare complication of recurrent corneal epithelial cell ingrowth after corneal perforation induced by laser in situ keratomileusis. A corneal flap was made uneventfully with an automatic SCMD microkeratome (Howard Instruments, Inc.). During laser ablation, instead of random burning over the stromal bed, repeated ablation at a single location occurred because of a machine malfunction, resulting in corneal perforation. The flap was replaced and sutured to prevent leakage of aqueous humor. As the cornea healed, the patient's vision was compromised by scar formation, high irregular astigmatism, and epithelial ingrowth. The flap was reopened, and the epithelial cells were removed by thoroughly scraping the flap and stromal bed. However, corneal epithelial ingrowth recurred within a week. The recurrent and progressive epithelial ingrowth further decreased vision, and penetrating keratoplasty was recommended.