Resolution of Rainbow Glare After LASIK via Mechanical Scraping and Phototherapeutic Keratectomy of Flap Undersurface.

Abstract

Purpose: To report a case of bilateral rainbow glare resolved by combined mechanical scraping and small ablation depth phototherapeutic keratectomy (PTK) of the laser in situ keratomileusis (LASIK) flap undersurface.

Methods: A 42-year-old man presented with symptoms of rainbow glare in both eyes after bilateral femtosecond laser-assisted LASIK 2 years prior. The LASIK flap in the left eye was relifted and PTK of 3 µm ablation depth was performed on the back surface of the flap. Symptoms were unresolved and 16 months later the patient underwent relift of the LASIK flap in the same eye with mechanical scraping and an additional 3 µm PTK of the flap undersurface. The right eye was then similarly treated with flap undersurface mechanical scraping and 3 µm PTK.

Results: The patient's rainbow glare symptoms persisted after initial LASIK flap relift and 3 µm PTK but immediately resolved after the second relift and mechanical scraping combined with 3 µm PTK polishing of left flap undersurface. Mild epithelial ingrowth occurred after the second relift of the left eye, which was managed by mechanical debridement and YAG laser epithelial lysis. Treatment of the right eye with LASIK flap relift and mechanical scraping with 3 µm PTK polishing of the flap undersurface similarly improved symptoms of rainbow glare.

Conclusions: Rainbow glare symptoms were successfully treated with combined mechanical scraping and small ablation depth PTK polishing of the LASIK flap undersurface. Epithelial ingrowth may be a consequence and require management. [J Refract Surg. 2025;41(3):e280-e287.].