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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


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


London Vision Clinic, London, UK


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.


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%).


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

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