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Incidence and clinical course of anterior basement membrane dystrophy (ABMD) in patients undergoing VisuMax femtosecond LASIK and SMILE

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First Author: G.Carp UK

Co Author(s):    D. Reinstein   T. Archer   R. Vida              

Abstract Details

Purpose:

To analyse the epidemiology and clinical course of corneas with anterior basement membrane dystrophy (ABMD) in patients undergoing femtosecond LASIK.

Setting:

London Vision Clinic, London, UK

Methods:

This was an electronic medical record based retrospective review of VisuMax femtosecond LASIK or SMILE treatments performed at the London Vision Clinic, London, UK between 2009-2019. Preoperative screening for ABMD included slit-lamp examination with and without fluorescein staining as well as epithelial thickness mapping to identify both clinically visible and sub-clinical ABMD. Patients with preoperatively identified ABMD affecting CDVA were treated by PRK. Patients with mild, non-visually significant ABMD were treated by LASIK or SMILE and were given a supplementary consent form describing the additional risks posed by the presence of ABMD.

Results:

Out of 25,206 eyes treated, ABMD was identified in 827 (3.28%) preoperatively. PRK was performed for 25 (0.10%), LASIK/SMILE in 802 (3.18%). Sub-clinical ABMD: Out of 24,379 normal eyes, ABMD was identified intraoperatively in 365 (1.50%). PTK was required for 13 (0.05%). Clinical ABMD: Out of 802 eyes with ABMD, 72 (8.98%) had an intraoperative epithelial slide, and PTK was required for 12 (1.50%). Of 25 eyes undergoing PTK, postoperative ABMD was nil for 17 (68%), trace-central for 3 (12%), trace-peripheral for 2 (8%), and moderate-peripheral for 3 (12%). A second PTK was required in 2 eyes (8%).

Conclusions:

Femtosecond LASIK or SMILE is a safe alternative to PRK for patients with mild, non-visually significant ABMD, with appropriate informed consent. No surgical therapeutic intervention for ABMD was required in 98.5% of this group, enabling them to benefit from the advantages of LASIK or SMILE over PRK. PTK or epithelial debridement was an effective method for treatment of ABMD.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented