Sloughing of corneal epithelium and wound healing complications associatedwith laser in situ keratomileusis in patients with epithelial basement membrane dystrophy

PURPOSE: To report sloughing of corneal epithelium during laser in situ ker atomileusis and subsequent wound healing complications in patients with epi thelial basement membrane dystrophy. METHODS: In a retrospective study, the surgical procedures, postoperative c ourse, and visual acuities of 16 eyes of nine patients with epithelial base ment membrane dystrophy who underwent laser in situ keratomileusis complica ted with epithelial sloughing at three centers were reviewed. The mean foll ow-up period was 23 weeks (range, 4 to 52 weeks). RESULTS: In 13 (81%) of 16 eyes with epithelial basement membrane dystrophy , epithelial sloughing occurred during laser in situ keratomileusis. In eig ht of the 13 eyes, epithelial growth beneath the flap was observed, The fla p was lifted and the interface epithelium scraped in six eyes, Flap melt or keratolysis occurred in four eyes, At the last follow-up visit, 13 of 16 e yes had an uncorrected visual acuity of 20/30 or better, and all eyes had a best corrected visual acuity of 20/30 or better, CONCLUSIONS: Patients with epithelial basement membrane dystrophy have poor ly adherent corneal epithelium and are predisposed to epithelial sloughing during the microkeratome pass of laser in situ keratomileusis, This may lea d to flap distortion, interface epithelial growth, flap keratolysis, and co rneal scarring. It is not recommended that laser in situ keratomileusis be performed in patients with classic, symptomatic epithelial basement membran e dystrophy, In patients who present with mild and asymptomatic epithelial basement membrane dystrophy, laser in situ keratomileusis should be perform ed with caution, or photorefractive keratectomy may be the preferred refrac tive procedure. (C) 2000 by Elsevier Science Inc. All rights reserved.