Corneal epithelial damage during LASIK: A review of 1873 eyes

PURPOSE: To assess the incidence, risk factors, management, and sequelae of intraoperative epithelial damage during LASIK using a linearly advancing microkeratome. METHODS: Chart review of 1873 eyes (956 patients) that underwent primary LASIK using the Automated Corneal Shaper microkeratome and the VISX Star S2 excimer laser. The main outcome measure was the incidence of intraoperative epithelial damage (patch of loosened epithelium with or without any frank epithelial defect). Univariate and multivariate logistic regression were performed to identify risk factors for intraoperative epithelial damage. RESULTS: Intraoperative epithelial damage occurred in 31 (1.66%) of 1873 eyes. The incidence of intraoperative epithelial damage increased with increasing patient age (odds ratio [OR] 1.095/decade; 95% confidence interval [CI] 1.002 to 1.197, P=.045) and increasing years of contact lens wear (OR 1.136, 95% CI 1.024 to 1.261, P=.016). No correlation was found for gender, corneal curvature, central corneal thickness, microkeratome plate depth, or preoperative or postoperative refraction. The risk of intraoperative epithelial damage was significantly higher in the second eye if damage occurred in the first eye (66.7% versus 0.67%, OR 298.7, CI 78.2 to 1141.2, P <.001). Epithelial damage was managed successfully intraoperatively in all 31 eyes; recurrent corneal erosion was noted 4 months postoperatively in 1 eye but resolved after anterior stromal puncture. CONCLUSIONS: The risk for intraoperative epithelial damage during LASIK increases with patient age, years of contact lens wear, and intraoperative epithelial damage in the first eye during simultaneous bilateral LASIK, but with proper intraoperative management, postoperative sequelae are rare.