Postoperative Pain and Epithelial Wound Healing in Epi-LASIK With and Without an Epithelial Sheet Preservation

Sang Kyoon Kim; Jong Suk Song; Hyo Myung Kim

doi:10.3341/jkos.2008.49.12.1894

Journal List > J Korean Ophthalmol Soc > v.49(12) > 1008149

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Kim, Song, and Kim: Postoperative Pain and Epithelial Wound Healing in Epi-LASIK With and Without an Epithelial Sheet Preservation

Original Article

J Korean Ophthalmol Soc 2008;49(12):1894-1900.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.12.1894

Postoperative Pain and Epithelial Wound Healing in Epi-LASIK With and Without an Epithelial Sheet Preservation

Sang Kyoon Kim, M.D., Jong Suk Song, M.D., Ph.D., Hyo Myung Kim, M.D., Ph.D.

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Hyo Myung Kim, M.D. Ph.D. Department of Ophthalmology, Korea University Anam Hospital #126-1 5-ga, Anam-dong, Seongbuk-gu, Seoul 136-705, Korea Tel: 82-2-920-5776, Fax: 82-2-924-6820, E-mail: hyomkim@hanmail.net

Received 11 September 2008 Accepted 27 March 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the influence of preservation of an epithelial sheet in Epi-LASIK on postoperative pain and epithelial wound healing time.

Methods

This prospective study included 34 eyes of 17 patients with myopia who received Epi-LASIK. An epithelial flap was created using the epikeratome (Centurion SES, Norwood Abbey EyeCare, Australia). After the stroma was ablated using the MEL 80 (Carl Zeiss Meditec. Germany) excimer laser, the epithelial sheet was replaced on the stromal bed in one randomly selected eye of each patient, and removed in the contralateral eye. The pain scores at postoperative day 0, 1, 2, 5 and the numbers of days for the complete epithelial wound healing were compared between the sheet-preserved and the sheet-removed eyes. At 1 month postoperative, uncorrected visual acuity (UCVA), refractive error and corneal haze were also compared.

Results

Pain scores on the day of operation were lower in sheet-preserved group and statistically significant ( p=0.01). On postoperative day 1, 2, and 5, pain scores did not reach statistical significance ( p=0.24, 0.08, 0.56, respectively). The mean epithelial healing time was 4.88±0.93 days for the flap-preserved eyes and 4.29±0.77 days for the flap-removed eyes, which showed statistical significance ( p=0.01). No significant difference was noted between the 2 groups for mean UCVA, corneal haze and refractive error at 1 month postoperative.

Conclusions

A preserved epithelial sheet reduced early postoperative pain but did not accelerate epithelial wound-healing rate.

Keywords: Corneal wound healing, Epi-LASIK, Epithelial flap, Pain

References

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Figure 1

. Case (A) and (B) represent the clinical appearance of the corneal epithelium 4 and 3 days after Epi-LASIK respectively. Loose epithelium or erosion-like lesion (arrow) and epithelial defect (arrowhead) were seen on slit lamp examination.

Figure 2

. Comparison of the mean epithelial healing rate between epithelial flap-preserved group and epithelial flap- removed group. * Wilcoxon signed ranks test p<0.05.

Table 1.

Preoperative characteristics of patients (Mean±SD)

	Epithelial flap-preserved group	Epithelial flap-removed group	p-value∗
Age (years)	25.9±4.75		±4.75
BCVA^†(logMAR)	-0.04±0.04	-0.04±0.04	1.00
S.E^‡(diopter)	-4.72±1.72	-4.43±1.53	0.09

^∗ Wilcoxon signed ranks test

^† BCVA=best corrected visual acuity

^‡ S.E=spherical equivalent.

Table 2.

Data of 11-point numeric pain scores after Epi-LASIK

Patient	OP day		1 day		2 day		5 day
Patient	A	B	A	B	A	B	A	B
1	4	5	3	2	2	2	0	0
2	7	7	4	5	2	4	0	1
3	4	5	1	1	1	1	0	0
4	2	2	2	2	2	2	0	0
5	4	3	3	2	2	2	0	0
6	5	6	5	3	4	4	1	1
7	2	3	1	2	1	1	0	0
78	28	38	11	22	11	12	00	00
8	8	8	1	2	1	2	0	0
910	24	25	12	13	21	12	00	00
10	4	5	2	3	1	2	0	0
1112	94	95	23	44	22	22	10	00
12	4	5	3	4	2	2	0	0
1314	24	24	24	24	11	11	00	00
14	4	4	4	4	1	1	0	0
15	5	6	5	6	3	4	0	1
16	4	8	2	2	1	1	0	0

A=Epithelial flap-preserved group; B=Epithelial flap-removed group.

Table 3.

Comparison of 11-point numeric pain scores between epithelial sheet preserved and removed group (Median pain score (range))

Time after surgery	OP day	1 day	2 day	5 day
Epithelial flap-preserved group	4 (2-9)	2 (1-5)	2 (1-4)	0 (0-1)
Epithelial flap-removed group	5 (2-9)	2 (1-6)	2 (1-4)	0 (0-1)
p-value∗	0.01	0.24	0.08	0.56

^∗ Wilcoxon signed ranks test.

Table 4.

Comparison of UCVA and S.E after Epi-LASIK (Mean±SD)

	UCVA^† (logMAR) after Epi-LASIK			S.E^‡ (Diopter)
	1 week	2 weeks	1 month	1 month
Epithelial flap-preserved group	0.11±0.10	0.03±0.04	0.02±0.04	-0.05±0.60
Epithelial flap-removed group	0.10±0.08	0.05±0.05	0.02±0.04	-0.11±0.33
p-value∗	0.78	0.30	0.73	0.97

^∗ Wilcoxon signed ranks test;

^† UCVA=uncorrected visual acuity;

^‡ S.E=spherical equivalent.

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