Unusual visual impairment after enhancement refractive surgery

We reported a case of rapidly developed corneal epithelial in-growth (EI) deteriorating visual acuity (VA) within the initial postoperative day. A 37-year-old male presented with decreased VA for 2 years. He underwent LASIK surgery 13 years ago. After enhancement surgery, postoperative VA was much worse than preoperative best corrected visual acuity (BCVA) 20/20 and decreased rapidly. VA of OD was 20/40 on Day 1, and 20/70 on Day 5, OS 20/20 on Day 1, 20/25 on Day 10, and 20/50 on Day 13 postoperatively. Corneal topography and optical coherence tomography (OCT) showed distinctive features. The patient was diagnosed with corneal EI postoperatively. After scraping ectopic corneal epithelial cells, the cornea became transparent and VA improved. Despite its rarity, early postoperative EI can occur within 1 day after enhancement surgery and can progress rapidly. OCT and corneal topography provide distinctive manifestations aiding diagnosis.