Giant epithelial ingrowth induced by blunt injury after automated lamellar keratoplasty

Epithelial ingrowth may develop after automated lamellar keratoplasty due to traumatic wound disruption. It can be treated with flap relifting, removal of the epithelial sheet, and repositioning the flap with anti-torque suture. The right eye of a 37-year-old woman was treated during automated lamellar keratoplasty for myopia 6 years prior to her presentation after suffering a blunt striking injury involving her infant son's hand. Epithelial ingrowth from flap edge was found 2 weeks later and progressed to 6 x 6 mm in size with deterioration of visual acuity. This condition was treated with flap lifting and scraping of the epithelial tissue at the flap-stroma interface, and by application of 50% alcohol. An anti-torque corneal suture was used for augmented repositioning and then removed after 2 weeks. One month after treatment, best corrected visual acuity was 20/20 in her right eye, and there was no more ingrowth tissue noted. Giant epithelial ingrowth may occur subsequent to automated lamellar keratoplasty and cause catastrophic flap complications. The flap can be saved by immediate and proper management.