Journal List > J Korean Ophthalmol Soc > v.48(9) > 1007917

Choi, Park, Kim, and Chung: Comparison of Laser Epithelial Keratomileusis Versus Epipolis-Laser in Situ Keratomileusis for Moderate to High Myopia

Abstract

Purpose

To compare the clinical visual results and complications of laser-assisted subepithelial keratectomy (LASEK) and epipolis laser in situ keratomileusis (Epi-LASIK).

Methods

A retrospective analysis of a case series of eyes treated with LASEK or Epi-LASIK with a follow-up of six months was performed. Twenty-two eyes were treated with LASEK, and 20 eyes were treated using Epi-LASIK. The main outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and manifest refraction at one week, one month, three months, and six months after refractive surgery, and the presence of any complications.

Results

There was no significant difference of UCVA and mean postoperative spherical equivalent (SE) between the eyes treated with LASEK or Epi-LASIK at one week, three months, and six months. However at one month there was significant difference of UCVA. Additionally, in a comparison between moderate and serve myopia, there was no significant difference of UCVA and mean postoperative spherical equivalent (SE) between groups treated with LASEK or Epi-LASIK at one week, one month, three months, and six months. Seven eyes treated with LASEK and two eyes treated with Epi-LASIK showed persistent epithelial erosion less than one week. Two eyes treated with LASEK exhibited newly-developed corneal opacity, which persisted-through the last visit.

Conclusions

Epi-LASIK showed clinical visual results and complications comparable to LASEK and showed better epithelial healing.

References

1. Pallikaris IG, Papatzanak ME, Stathi EZ. Laser in situ keratomileusis. Laser Surg Med. 1990; 10:463–8.
crossref
2. Wilson SE. LASIK: management of common complications. Cornea. 1998; 17:459–67.
3. Wang Z, Chen J, Yang B. Posterior corneal surface topographic changes after laser insitu keratomileusis are related to residual corneal bed thickness. Ophthalmology. 1999; 106:406–9.
4. Camelin M. Laser epithelial keratomileusis for myopia. J Refract Surg. 2003; 19:666–70.
crossref
5. Seiler T, Quurke AW. Iatrogenic keratectasia after laser in situ keratomileusis. J Cataract Refract Surg. 1998; 24:1007–9.
crossref
6. Haw WW, Manche EE. Iatrogenic keratectasia after a deep primary keratotomy during laser in situ keratomileusis. Am J Ophthalmol. 2001; 132:920–1.
crossref
7. Lee JB, Choe CM, Kim HS, et al. Comparison of TGF-1 in tears following laser subepithelial cells: electron microscopic study. Cornea. 2002; 21:388–92.
8. Gabler B, Winkler MC, Deiss AK, et al. Vitality of epithelial cells after alcohol exposure during laser-assisted subepithelial keratectomy flap preparation. J Cataract Refract Surg. 2002; 28:1841–6.
crossref
9. Pallikaris JG, Naoumidi II, Kalyvianaki MI, et al. Epi-LASIK: Comparative histological evaluation of mechanical and alcohol-assisted epithelial separation. J Cataract Refract Surg. 2003; 29:1496–501.
crossref
10. Kornilovsky IM. Clinical results after subepithelial photorefractive keratectomy (LASEK). J Refract Surg. 2001; 17:S222–3.
crossref
11. Lee JB, Seong GJ, Lee JH, et al. Comparison of laser epithelial keratomileusis and photorefractive keratectomy for low to moderate myopia. J Cataract Refract Surg. 2001; 27:565–70.
crossref
12. Kamm O. The relation between structure and physiological action of the alcohols. J Am Pharm Assoc. 1921; 10:87–92.
13. Pallikaris IG, Katasanevaki VJ, Kalyvianaki MI. Advances in subepithelial excimer refractive surgery techniques : Epi-LASIK. Curr Opin Ophthalmol. 2003; 14:207–12.
14. Kwon HL, Kim KI, Koo BS, Park HR. Short term clinical results of laser epithelial keratomleusis and Epi-laser in situ keratomileusis for moderate and high myopia. J Korean Ophthalmol Soc. 2005; 46:1711–7.
15. Pallikaris IG, Kalyvianaki MI, Katasanevaki VJ, Ginis HS. Epi-LASIK : Preliminary clinical results of an alternative surface ablation procedure. J Cataract Refract Surg. 2005; 31:879–85.
16. Katsanevake VJ, Naoumidi II, Kalyvianaki MI, Pallikaris IG. Epi-LASIK : Histological findings of separated epithelial sheets 24 hours after treatment. J Refract Surg. 2006; 22:151–4.
17. Azar DT, Ang RT, Lee JB, et al. Laser subepithelial keratomileusis: electron microscopy and visual outcomes of flap photorefractive keratectomy. Curr Opin Ophthalmol. 2001; 12:323–8.
crossref
18. Camellin M. Laser epithelial keratomileusis for myopia. J Refract Surg. 2003; 19:666–70.
crossref
19. Pallikaris IG, Katasanevaki VJ, Kalyvianaki MI, Naoumidi II. Advances in subepithelial excimer refractive surgery techniques : Epi-LASIK. Curr Opin Ophthalmol. 2003; 4:207–12.
20. Anderson NJ, Beran RF, Schneider TL. Epi-LASIK for the correction of myopia and myopic astigmatism. J Cataract Refract Surg. 2002; 28:1343–7.

Table 1.
Demographies of LASEK and Epi-LASIK
LASEK Epi-LASIK
Age (years) 27.0±4.26 27.2±6.20
Sex M:F=1:11 M:F=1:10
Moderate myopia 15 eyes 15 eyes
High myopia 7 eyes 5 eyes
Total 22 eyes 20 eyes
Manifest refractive error (SE) (D) −5.48±1.18 −4.96±1.17
Cycloplegic refractive error (SE) (D) −5.02±1.18 −4.70±1.16

LASEK:Laser epithelial keratomileusis.

Epi-LASIK:Epipolis laser in situ keratomileusis.

SE:Spherical equivalent.

Table 2.
Comparison of uncorrected visual acuity after LASEK and Epi-LASIK
Postoperative period
1 week
1 month
3 months
6 months
LASEK Epi-LASIK LASEK Epi-LASIK LASEK Epi-LASIK LASEK Epi-LASIK
Moderate myopia 0.20±0.24 0.26±0.16 0.02±0.04 0.07±0.08 0.02±0.04 0.05±0.06 0.00±0.00 0.04±0.11
P =0.285 P=0.250 P=0.202 P=0.539
High myopia 0.31±0.16 0.52±0.18 0.17±0.17 0.42±0.71 0.06±0.09 0.10±0.07 0.08±0.14 0.02±0.05
P=0.05 P=0.981 P=0.343 P=0.755
Total 0.23±0.22 0.33±0.20 0.06±0.11 0.15±0.37 0.02±0.06 0.06±0.07 0.02±0.08 0.03±0.10
P=0.125 P=0.385 P=0.057 P=0.591

P: Mann-Whitney test.

Table 3.
Comparison of post-operative residual spherical equvalent after LASEK and Epi-LASIK
Postoperative period
1 week
1 month
3 months
6 months
LASEK Epi-LASIK LASEK Epi-LASIK LASEK Epi-LASIK LASEK Epi-LASIK
Moderate myopia 0.38±1.23 −0.3±0.67 −0.73±0.17 −0.12±0.68 −1.00±1.13 −0.34±0.48 −0.57±0.51 −0.470.40
P =0.412 P=0.267 P=0.595 P=0.567
High myopia −0.5±0.80 −0.40±0.65 −0.33±0.48 −0.20±0.78 −0.41±0.46 −0.12±0.68 −0.38±0.40 −0.47±0.54
P=0.268 P=0.755 P=0.268 P=0.876
Total −0.20±0.99 −0.30±0.65 −0.45±0.66 −0.13±0.68 −0.57±0.74 −0.28±0.52 −0.43±0.43 −0.47±0.42
P=0.980 P=0.235 P=0.282 P=0.611

P: Mann-Whitney test.

Table 4.
Comparison of uncorrected visual acuity and manifest spherical equivalent between moderate myopia and high myopia in each groups after LASEK
Postoperative period
1 week
1 month
3 months
6 months
visual acuity (logMAR) SE visual acuity (logMAR) SE visual acuity (logMAR) SE visual acuity (logMAR) SE
Moderate myopia 0.20±0.20 0.38±1.23 0.02±0.04 0.73±0.17 0.02±0.04 −1.00± 1.13 0.00±0.00 −0.57±0.31
High myopia 0.31±0.20 0.50±0.80 0.17±0.17 0.33±0.48 0.05±0.09 −0.41±0.46 0.08±0.14 −0.38±0.40
P§=0.142 P=0.123 P=0.026 P=0.680 P=0.630 P=0.680 P=0.298 P=0.731

SE: Spherical equvalent,

MAR: Minimal angle of resolution,

P§: Mann-Whitney test.

Table 5.
Comparison of uncorrected visual acuity and manifest spherical equivalent between moderate myopia and high myopia in each groups after Epi-LASIK
Postoperative period
1 week
1 month
3 months
6 months
visual acuity (logMAR) SE visual acuity (logMAR) SE visual acuity (logMAR) SE visual acuity (logMAR) SE
Moderate myopia 0.26±0.20 0.30±0.67 0.07±0.08 −0.12±0.68 0.05±0.06 0.34±0.48 0.04±0.11 −0.47±0.40
High myopia 0.52±0.20 −0.40±0.65 0.42±0.71 −0.20±0.78 0.10±0.07 −0.12±0.68 0.02±0.05 −0.47±0.54
P§=0.025 P=0.800 P=0.197 P=0.672 P=0.230 P=0.395 P=0.933 P=0.933

MAR: Minimal angle of resolution,

SE: Spherical equvalent,

P§: Mann-Whitney test.

TOOLS
Similar articles