title: Sloughing of corneal epithelium and wound healing complications associated with laser in situ keratomileusis in patients with epithelial basement membrane dystrophy.
abstract: OBJECTIVE
  To report sloughing of corneal epithelium during laser in situ keratomileusis and subsequent wound healing complications in patients with epithelial basement membrane dystrophy.
  
  
  METHODS
  In a retrospective study, the surgical procedures, postoperative course, and visual acuities of 16 eyes of nine patients with epithelial basement membrane dystrophy who underwent laser in situ keratomileusis complicated with epithelial sloughing at three centers were reviewed. The mean follow-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 eight of the 13 eyes, epithelial growth beneath the flap was observed. The flap 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 eyes 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 poorly adherent corneal epithelium and are predisposed to epithelial sloughing during the microkeratome pass of laser in situ keratomileusis. This may lead to flap distortion, interface epithelial growth, flap keratolysis, and corneal scarring. It is not recommended that laser in situ keratomileusis be performed in patients with classic, symptomatic epithelial basement membrane dystrophy. In patients who present with mild and asymptomatic epithelial basement membrane dystrophy, laser in situ keratomileusis should be performed with caution, or photorefractive keratectomy may be the preferred refractive procedure.
authors.affiliation: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. kadastgheib@aol.com
authors.forename: K A
authors.initials: KA
authors.lastname: Dastgheib
authors.forename: T E
authors.initials: TE
authors.lastname: Clinch
authors.forename: E E
authors.initials: EE
authors.lastname: Manche
authors.forename: P
authors.initials: P
authors.lastname: Hersh
authors.forename: J
authors.initials: J
authors.lastname: Ramsey
mesh_terms: D000328:Adult; D001485:Basement Membrane / Q000473:pathology / Q000601:surgery; D003317:Corneal Dystrophies, Hereditary / Q000150:complications / Q000601:surgery*; D004847:Epithelial Cells / Q000473:pathology; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology; D012189:Retrospective Studies; D013524:Surgical Flaps; D014792:Visual Acuity; D014945:Wound Healing