ESCRS - POREF233 - Bandage Contact Lens–Shielded Edge Transepithelial Ptk (Belt-Ptk) To Maintain Eye Tracking And Produce Focal Tissue Exposure Despite Wide-Area Ptk Ablation For Smoothing Lasik Flap Margin Irregularities

Bandage Contact Lens–Shielded Edge Transepithelial Ptk (Belt-Ptk) To Maintain Eye Tracking And Produce Focal Tissue Exposure Despite Wide-Area Ptk Ablation For Smoothing Lasik Flap Margin Irregularities

Published 2026 - 44th Congress of the ESCRS

Reference: POREF233 | Type: Free paper | DOI: 10.82333/msbq-yy68

Authors: Dr Michael Rossiter-Thornton* 1 , Prof. Dan Reinstein 2 , Dr Timothy Archer 3 , Joseph Potter 3 , Ruchi Gupta 3 , Prof. Tara Moore 4

1Reinstein Vision,London,United Kingdom;Ulster University,Biomedical Science Research Institute,Coleraine,United Kingdom;School of Medicine,University of Sydney,Sydney,Australia;London Vision Clinic,London,United Kingdom, 2Reinstein Vision,London,United Kingdom;London Vision Clinic,London,United Kingdom;Ulster University,Biomedical Science Research Institute,Coleraine,United Kingdom;Columbia University Medical Center,New York,United States;Sorbonne Université,Paris,France, 3Reinstein Vision,London,United Kingdom;London Vision Clinic,London,United Kingdom, 4Ulster University,Biomedical Science Research Institute,Coleraine,United Kingdom

Purpose

To describe BELT-PTK, a bandage contact lens–shielded edge transepithelial PTK technique for smoothing focal LASIK flap-margin irregularities while maintaining pupil tracking. Raised flap edges may follow epithelial ingrowth and may be worsened by Nd:YAG treatment, causing astigmatic/hyperopic shift or focal lid–cornea friction with SPK and blink discomfort. Standard TransPTK delivers a minimum wide ablation (typically ≥5 mm overall due to transition zones), and small 2–3 mm treatments are circular and may not match a linear flap-edge defect; BCL shielding creates focal exposure despite wide-area programming.

Setting

Private Practice academic unit (Reinstein Vision), London Vision Clinic, EuroEyes Group, UK.

Methods

Retrospective consecutive case series: EMR search identified all eyes undergoing selective flap-edge PTK after LASIK and retreatments. Prior procedures and epithelial ingrowth history were extracted and surgical videos reviewed. Visual acuity, refraction and symptoms were recorded. Transepithelial PTK was delivered in 20–40 µm increments, programmed as an 8 mm zone. A bandage contact lens was placed and shifted with a cellulose sponge spear to expose only the peripheral flap edge while maintaining pupil-edge tracking. After each pass, residual elevation was assessed and further passes performed until smoothness was achieved without breaking the surface tension of applied BSS. Follow-up was 3 months–3 years.

Results

Seven eyes (six patients) underwent flap-edge PTK for symptomatic LASIK flap-margin irregularity with lid–cornea mechanical friction; one eye had an associated hyperopic shift (+0.50/−0.25×123). Five eyes had one prior LASIK retreatment and one had two flap-lift retreatments; two had prior Nd:YAG treatment for epithelial ingrowth. Smoothing required 1–7 passes per eye; two eyes also underwent wet PTK to refine residual micro-irregularities. All epithelial defects healed within 3 days and symptoms improved or resolved. DCVA: one eye lost one line (20/12.5→20/16) and one gained one line (20/25→20/20); all eyes were ≥20/20. Mean spherical equivalent change was +0.05±0.25 D (−0.25 to +0.50). One eye underwent PRK enhancement at 9 months.

Conclusions

BELT-PTK provided effective symptomatic relief with rapid re-epithelialisation, minimal refractive change and preserved acuity in this series. Bandage contact lens shielding permits focal flap-edge smoothing despite wide-area TransPTK programming and allows uninterrupted pupil-edge tracking, avoiding unnecessary full-diameter PTK of the visual axis and the geometric mismatch of small circular ablations.