Laser-assisted subepithelial keratectomy versus photorefractive keratectomy for the correction of myopia - A prospective comparative study

CODET Aris Vision Institute, Padre Kino 10159, Tijuana, BC 22320, Mexico.
Journal of Cataract and Refractive Surgery (Impact Factor: 2.55). 09/2002; 28(8):1330-3. DOI: 10.1016/S0886-3350(02)01376-7
Source: PubMed

ABSTRACT To compare the early postoperative visual rehabilitation after laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) for the correction of myopia.
CODET Aris Vision Institute, Tijuana, Mexico.
This prospective study included 50 eyes of 25 patients with myopia who received LASEK in 1 eye and PRK in the contralateral eye. Excimer laser corneal ablation was done using the Nidek EC-5000 excimer laser. Patients were seen at 1 and 3 days, 1 week, and 1 month. Discomfort, subjective uncorrected visual acuity (UCVA), objective UCVA, best corrected visual acuity (BCVA), corneal clarity (haze), and time for corneal reepithelialization were analyzed.
Seventy-two percent and 80% of the LASEK eyes had more discomfort at 1 day and 3 days, respectively. Eighty percent and 96% of the PRK eyes had better subjective UCVA at 1 day and 3 days, respectively. Corneas were fully reepithelialized at a mean of 3.3 days +/- 0.5 (SD) and 3.6 +/- 0.5 days in the PRK and LASEK groups, respectively. At 1 month, the UCVA was similar in both groups; no eye had lost lines of BCVA or developed haze.
Both LASEK and PRK were effective and safe procedures in the surgical correction of myopia at the 1-month postoperative visit. Patients reported less discomfort and better visual acuity in their PRK eye during the early postoperative period. Patients should be informed that LASEK, whose acronym is similar to that of laser in situ keratomileusis, has a recovery speed that is similar to that of surface laser refractive procedures such as PRK.

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    ABSTRACT: Purpose To compare the efficacy, safety and postoperative pain of mechanical versus transepithelial photorefractive keratectomy (PRK) techniques. Setting Cornea and refractive surgery subspecialty. Design Prospective clinical trial. Methods This prospective comparative study included 84 eyes of 42 patients with myopia who received mechanical PRK (m-PRK) in 1 eye and transepithelial PRK (t-PRK) in the contralateral eye. The mean patient age was 28.5 ± 6.3 years (range 20–46 years). Postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractions, postoperative epithelial healing time, surgical time, postoperative pain rating and corneal haze were recorded. Results At week 1, statistically the UDVA was significantly better in the t-PRK eyes; however, at 3 months, similar refractive stability was achieved in both groups. The mean spherical equivalent (SE) decreased from −2.44 ± 1.00 D (m-PRK eyes) and −2.88 ± 1.24 D (t-PRK eyes) at baseline to −0.19 ± 0.38 D and −0.30 ± 0.40 D, respectively, after 1 year. Surgical time was 98.6 ± 9.8 s in m-PRK eyes and 58.0 ± 6.4 s in t-PRK eyes. On postoperative days 1 and 3, using the global assessment rating, 81% of mPRK eyes that had pain, reported more pain than that reported for the tPRK eyes. In addition, m-PRK treated eyes demonstrated higher mean pain scores based on the 11-point numerical rating scale and Visual Analogue Scale (VAS). The mean time to complete epithelial healing was 2.19 ± 0.39 days (t-PRK) and 3.76 ± 0.43 days (m-PRK). Conclusion t-PRK for mild-to-moderate myopia was more comfortable than conventional m-PRK; patients had less pain, and faster healing time.
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    ABSTRACT: Die Laser-epitheliale Keratomileusis (LASEK) ist ein relativ neues keratorefraktives Verfahren zur Behandlung von Myopie und myopem Astigmatismus. Es werden die Ergebnisse von 108 konsekutiv LASEK-behandelten Augen mit einer Nachbeobachtungszeit von 12 Monaten vorgestellt.Bei 108 Augen wurde eine LASEK mit dem Keracor-117-Excimer-Laser durchgeführt. Die mittlere präoperative Myopie betrug −4,12±1,30 dpt sphärisches Äquivalent (SÄ), der Astigmatismus maximal 3,25 dpt. Die 12-Monatsergebnisse liegen für 101 Augen (93,5%) vor.Es traten keine schwerwiegenden Komplikationen auf. Nach 12 Monaten lagen 96% der Augen innerhalb von ±1,0 dpt und 86% innerhalb von ±0,5 dpt SÄ um Emmetropie. Ein Verlust an korrigiertem Visus von mehr als 1 Zeile oder ein kornealer Haze von mehr als Grad 1 wurde bei keinem Auge festgestellt. Ein unkorrigierter Visus (UCVA) von ≥1,0 wurde von 80%, von ≥0,5 von 98% der Augen erzielt.Mit der LASEK scheinen Myopien und myope Astigmatismen bis −6 dpt sicher und effektiv korrigiert werden zu können. Die Ergebnisse nach LASEK sind nach den bisherigen Erfahrungen mit denen nach PRK und LASIK vergleichbar. Die Ausbildung von Haze nach LASEK scheint gering. Die Abdeckung der stromalen Wunde mit einem vitalen Epithelläppchen könnte die postoperativen Wundheilungsreaktionen günstig beeinflussen.
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    ABSTRACT: Purpose. To compare the clinical and confocal microscopic results of transepithelial PRK versus LASEK for correction of myopia. Materials and Methods. Twelve patients with myopia received transepithelial PRK in one eye and LASEK in the other. In transepithelial PRK-treated eyes, the corneal epithelium was removed with 40 microns of excimer laser ablation and in LASEK-treated eyes with 25-second application of 18% ethanol. Time to epithelial healing, ocular discomfort, uncorrected and best corrected visual acuities, manifest refraction, haze, greyscale value, and keratocyte apoptosis in confocal microscopy were recorded. Results. The mean time to epithelial healing was significantly longer after LASEK (4.00 ± 0.43 versus 3.17 ± 0.6 days). On day 1, ocular discomfort was significantly higher after transepithelial PRK. The grade of haze, keratocyte apoptosis, and greyscale value in confocal microscopy were significantly higher in transepithelial PRK-treated eyes at 1 month. All transepithelial PRK- and LASEK-treated eyes achieved 20/25 or better UCVA and were within ±1.00 D of emmetropia at final visits. Conclusions. Both transepithelial PRK and LASEK offer effective correction of myopia at 1 year. However, LASEK appeared to induce less discomfort and less intense wound healing in the early postoperative period.
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