Potential for Corneal Recovery During Nonstandard Rehabilitation After LASIK

Laser in situ keratomileusis (LASIK) provides predictable refractive outcomes, but clinically silent epithelial basement membrane dystrophy (EBMD) may become apparent during flap creation and lead to epithelial sloughing, delayed epithelial recovery, and postoperative ocular surface instability. This case report describes the management of a 30-year-old man with bilateral moderate myopia and astigmatism who underwent microkeratome-assisted LASIK after a routine preoperative examination showed no corneal epithelial abnormalities. The baseline Ocular Surface Disease Index score was 6, tear breakup time was 7 seconds in the right eye and 8 seconds in the left eye, and anterior-segment optical coherence tomography showed tear meniscus heights of 304 and 299 micrometers, respectively. During flap repositioning, the epithelium demonstrated abnormal mobility, folding, and focal sloughing. On postoperative day 1, the right eye had uncorrected visual acuity of 0.6-0.7, diffuse epithelial edema, and a central epithelial defect; the left eye had uncorrected visual acuity of approximately 1.0. Subconjunctival dexamethasone was administered because of the risk of diffuse lamellar keratitis. At 1 week, persistent grade 1-2 epitheliopathy and early epithelial ingrowth were observed. Treatment was supplemented with three weekly bilateral subconjunctival injections of 1% low-molecular-weight sodium hyaluronate, followed by monthly injections, together with topical corticosteroids and hyaluronic-acid lubricants. During follow-up, epithelial staining decreased, epithelial morphology on optical coherence tomography became more uniform, visual acuity remained stable, and subjective discomfort improved. At 2 months, the Ocular Surface Disease Index score decreased to 3, Schirmer test values increased to 26 and 28 mm, tear breakup time increased to 9 and 10 seconds, and tear meniscus height increased to 476 and 504 micrometers. This case suggests that multimodal regenerative therapy including subconjunctival low-molecular-weight sodium hyaluronate may support corneal epithelial recovery after intraoperative manifestation of EBMD during LASIK; controlled studies are required to determine efficacy.