Preoperative Versus Intraoperative Detection Of Asymptomatic Abmd In Lasik/Smile: Risk Of Recurrent Erosion Syndrome, Ptk Success And Need For Repeat Ptk
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR466 | Type: Free paper | DOI: 10.82333/00sp-zp80
Authors: Ms Ruchi Gupta* 1 , Prof. Dan Reinstein 2 , Dr Timothy Archer 1 , Mr Glenn Carp 1 , Mr Joseph Potter 1
1London Vision Clinic,London,United Kingdom, 2London Vision Clinic,London,United Kingdom;Columbia University Medical Center,New York,United States;Sorbonne Université,Paris,France;Ulster University,Biomedical Science Research Institute,Coleraine,United Kingdom
Purpose
To compare the risk of recurrent corneal erosion syndrome requiring therapeutic treatment in LASIK/SMILE eyes with preoperatively diagnosed asymptomatic anterior basement membrane dystrophy (ABMD) versus eyes in which ABMD was only detected intraoperatively.
Setting
Private Practice Academic Unit Reinstein Vision, London Vision Clinic, EuroEyes Group, UK
Methods
This retrospective analysis included 25,204 eyes undergoing femtosecond LASIK or SMILE between February 2009 and March 2019. All eyes had a complete preoperative ophthalmological examination. Eyes with mild or asymptomatic ABMD, without recurrent erosions or epithelial movement on the Epithelial Stress Test, underwent LASIK or SMILE with additional informed consent. A subset with no preoperative ABMD signs had intraoperative epithelial slide and were retrospectively confirmed to have subclinical ABMD. The incidence of recurrent erosion syndrome requiring PTK, success of first PTK, and rate of repeat PTK were compared between groups. Eyes with moderate or severe ABMD received PRK and were excluded from LASIK/SMILE analysis.
Results
ABMD was diagnosed preoperatively in 802 eyes (3.18%) who underwent LASIK/SMILE. Intraoperative epithelial slide occurred in 72 of these (8.98%). Among eyes without preoperative ABMD (n=24,377), 365 experienced intraoperative epithelial slide (1.50%) and were reclassified as intraoperatively detected ABMD. 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-only group. Repeat PTK was needed in 5 of 12 (41.7%) in the preoperative ABMD group and 2 of 19 (10.5%) in the intraoperative ABMD group.
Conclusions
With modern femtosecond laser platforms and careful preoperative assessment, femtosecond LASIK and SMILE can be performed safely in eyes with preoperatively detected ABMD. Eyes in which ABMD was identified preoperatively had a lower risk of developing recurrent erosion syndrome requiring PTK compared to eyes in which ABMD was only detected intraoperatively. Although a small proportion of eyes required therapeutic intervention, postoperative epithelial complications were infrequent and effectively managed.