Epithelial ingrowth post small incision lenticule extraction: CIRCLE software to the rescue

Small Incision Lenticule Extraction (SMILE) is one of the most recent forms of surface-based refractive surgery, with epithelial ingrowth being extremely rare and infrequently reported as a complication. A 22-year-old male patient presented with a case of compound myopic astigmatism and underwent SMILE in both eyes, achieving excellent postoperative visual recovery (20/20 in both eyes). Six months later, he reported decreased vision, Best Corrected Visual Acuity (BCVA) 20/30 (+0.50 DS and -3.50 DC × 125°) alongside a whitish opacity. Upon evaluation, epithelial ingrowth was observed at the pupillary axis during slit lamp examination, and Anterior Segment Optical Coherence Tomography (ASOCT) also confirmed this, alongside excessive corneal steepening and aberrations on the topography map. With documented serial progression (BCVA: 20/30 with +0.75 DS/-5.50 DC), surgical management was undertaken using a femtosecond laser with CIRCLE software on the ZEISS VisuMax 500. The SMILE cap was converted into a lifted flap, and the epithelial ingrowth debridement was performed on the stromal bed, augmented with 0.02% Mitomycin C. A bandage contact lens was placed postoperatively, and the patient exhibited complete recovery with a BCVA of 20/20P (-1.25 DC X 125°). The patient was monitored periodically for six months postoperatively, showing no signs of recurrence. Thus, this case report highlights the use of CIRCLE software as a relatively new and advanced approach for managing this rare but potentially sight-threatening complication following SMILE surgery.