loughing of corneal epithelium and wound healing complication aociated with laer in itu keratomileui in patient with epithelial baement membrane dytrophy

PURPOE: To report loughing of corneal epithelium during laer in itu keratomileui and ubequent wound healing complication in patient with epithelial baement membrane dytrophy. METHOD: In a retropective tudy, the urgical procedure, potoperative coure, and viual acuitie of 16 eye of nine patient with epithelial baement membrane dytrophy who underwent laer in itu keratomileui complicated with epithelial loughing at three center were reviewed. The mean follow-up period wa 23 week (range, 4 to 52 week). REULT: In 13 (81%) of 16 eye with epithelial baement membrane dytrophy, epithelial loughing occurred during laer in itu keratomileui. In eight of the 13 eye, epithelial growth beneath the flap wa oberved. The flap wa lifted and the interface epithelium craped in ix eye. Flap melt or keratolyi occurred in four eye. At the lat follow-up viit, 13 of 16 eye had an uncorrected viual acuity of 20/30 or better, and all eye had a bet-corrected viual acuity of 20/30 or better. CONCLUION: Patient with epithelial baement membrane dytrophy have poorly adherent corneal epithelium and are predipoed to epithelial loughing during the microkeratome pa of laer in itu keratomileui. Thi may lead to flap ditortion, interface epithelial growth, flap keratolyi, and corneal carring. It i not recommended that laer in itu keratomileui be performed in patient with claic, ymptomatic epithelial baement membrane dytrophy. In patient who preent with mild and aymptomatic epithelial baement membrane dytrophy, laer in itu keratomileui hould be performed with caution, or photorefractive keratectomy may be the preferred refractive procedure.