Refractive regression after corneal refractive surgery associated with epithelial hyperplasia: a case report and management approach

Background. With the expansion of indications for corneal refractive surgery and the increasing number of procedures performed, the risk of postoperative complications has also increased. One of the clinically significant complications is refractive regression caused by postoperative corneal epithelial hyperplasia. Currently, there are no standardized treatment protocols for this corneal condition. Purpose: To describe a case of refractive regression associated with epithelial hyperplasia after corneal refractive surgery and to evaluate the clinical effectiveness of a proposed conservative treatment regimen. Materials and methods. Using the clinical case presented in this article, we demonstrated the effectiveness of our proposed conservative treatment approach for corneal epithelial hyperplasia in a patient after corneal refractive surgery. The treatment regimen included a course of topical ophthalmic therapy consisting of hyaluronidase (1 vial, 64 IU), dexamethasone eye drops, and 3 % hypertonic sodium chloride solution. Hyaluronidase promotes the degradation of hyaluronic acid, improves tissue permeability, and facilitates normalization of corneal regenerative processes. Results. During treatment, a significant reduction in epithelial thickness was observed on anterior segment optical coherence tomography following completion of therapy. The mean epithelial thickness within the ablation zone decreased from 68 to 56 μm in the right eye and from 71 to 56 μm in the left eye. The patient also reported a marked improvement in visual quality, with no adverse effects observed. The described management strategy demonstrated both efficacy and safety in the treatment of postoperative corneal epithelial hyperplasia after corneal refractive surgery. Conclusion. The proposed conservative treatment approach using hyaluronidase appears to be a promising option for managing postoperative complications after corneal refractive surgery. Further studies and additional clinical observations are needed to refine the indications and optimize the treatment protocol.

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