J Refract Surg. 2026 Sep;42(9):e924-e932. doi: 10.3928/1081597X-20260702-01. Epub 2026 Sep 1.
ABSTRACT
PURPOSE: To compare the risk of recurrent corneal erosion syndrome requiring therapeutic treatment in eyes undergoing laser in situ keratomileusis/small incision lenticle extraction (LASIK/SMILE) with preoperatively diagnosed asymptomatic epithelial basement membrane dystrophy (EBMD) versus eyes in which EBMD was only detected intraoperatively.
METHODS: This was a retrospective analysis of 25,204 eyes that underwent femtosecond laser-assisted LASIK or SMILE at London Vision Clinic between February 2009 and March 2019. All eyes underwent preoperative slit-lamp examination with fluorescein screening for EBMD. Eyes with moderate or symptomatic EBMD were treated with primary photorefractive keratectomy (PRK) and excluded from the LASIK/SMILE epithelial safety analysis. Eyes with mild asymptomatic EBMD and no signs or history of recurrent corneal erosion were considered for LASIK/SMILE with additional informed consent. An epithelial stress test was performed at the clinician's discretion based on the severity and location of map-dot-fingerprint changes or other features suggestive of epithelial instability; marked epithelial displacement prompted triage to PRK. Eyes with no preoperative signs of EBMD that developed an intraoperative epithelial slide were classified as intraoperatively detected (subclinical) EBMD. The incidence of recurrent erosion syndrome requiring phototherapeutic keratectomy (PTK), the success rate of initial PTK, and the rate of repeat PTK between groups were compared.
RESULTS: EBMD was diagnosed preoperatively in 802 eyes (3.18%) that underwent LASIK/SMILE. Intraoperative epithelial slide occurred in 72 of these eyes (8.98%). Among eyes without preoperative EBMD (n = 24,377), 365 experienced intraoperative epithelial slide (1.50%) and were classified as intraoperatively detected EBMD. PTK for recurrent erosion was required in 12 eyes (1.50%) in the preoperatively diagnosed group and in 19 eyes (5.21%) in the intraoperative group. Repeat PTK was needed in 5 of 12 eyes (41.7%) in the preoperative EBMD group and 2 of 19 eyes (10.5%) in the intraoperative EBMD group.
CONCLUSIONS: With modern femtosecond laser platforms and careful preoperative assessment, femtosecond laser-assisted LASIK and SMILE can be performed safely in eyes with preoperatively detected asymptomatic EBMD. Eyes with preoperatively identified mild asymptomatic EBMD had a lower risk of recurrent erosion syndrome requiring PTK compared with eyes in which EBMD was only detected intraoperatively. Although a small proportion of eyes required PTK, postoperative epithelial complications were infrequent and effectively managed.
PMID:42715021 | DOI:10.3928/1081597X-20260702-01