LASEK an alternative to PRK and LASIK

Another surgeon reports good refractive results, fast visual recovery, no haze and no pain.

ByMichela Cimberle

REGENSBURG, Germany – Laser epithelial keratomileusis is a safe and promising technique for the treatment of myopia, combining the advantages of both PRK and LASIK without their disadvantages, according to a surgeon here.

“We have been performing LASEK for more than 1 year. The technique produces very good refractive results, fast postoperative visual recovery, no pain and no or very mild corneal haze. If results in the future are as good as they seem now, LASEK should become more than an alternative for the surgical correction of myopia,” said Chris Lohmann, MD.

Laser epithelial keratomileusis (LASEK) was described by Massimo Camellin, MD, in 1999. In this procedure the epithelium of the cornea is detached from the underlying basal membrane using a 20% alcohol solution and rolled back as a flap. After laser ablation has been performed, the epithelium is placed back to cover the wound bed. Re-epithelialization occurs in a few days, while the epithelial flap protects the surface, preventing pain and infection and accelerating visual recovery.

The procedure

The procedure is performed under topical anesthesia. Using a special micro-trephine and a calibrated blade, an epithelial flap of 8.5 mm diameter and 70 µm depth is performed using a special microtrephine and a calibrated blade (Geuder). The trephine is designed to leave a hinge of 80° at 12 o’ clock.

“Then I place on the eye a special cone (Geuder) of the same diameter of the flap and pour inside it 0.1 cc of a 20% alcohol solution, leaving it there for 20 seconds. Thereafter, the corneal surface is thoroughly washed with balanced salt solution (BSS) to remove the alcohol. The epithelium is lifted and folded back at the 12 o’clock position with a modified microhoe (Geuder),” Dr. Lohmann said.

At this point, the treatment proceeds as for traditional PRK. Dr. Lohmann uses a Bausch & Lomb Technolas 217 excimer laser. After the ablation, he cleans the surface with BSS and repositions the epithelium, again using the modified microhoe. A soft contact lens is kept on the eye for 48 hours to hold the epithelial flap in place. Postoperatively, topical antibiotic drops are instilled for 2 days, topical corticosteroids (dexamethasone 0.1%) and artificial tears (Liposic) are administered for 4 weeks.

“It’s an easy technique, and only in one eye we were not able to create an epithelial flap. If this happens, however, conventional PRK can be performed,” Dr. Lohmann said.

Results

He treated a total of 102 myopic eyes with LASEK, ranging from –2 D to –14.75 D. The follow-up was more than 3 months for 50 eyes and more than 6 months for 21 eyes.

“Except for one eye, where the contact lens and consequently the epithelial flap was lost during the first 24 hours, we have not seen any epithelial instability during the entire postoperative period. Corneal haze, which is so common after PRK, was not a problem after LASEK. Most of the eyes had a transparent cornea and only a few had very minor postoperative haze,” Dr. Lohmann said.

None of the patients, he pointed out, suffered the severe pain that is typical of PRK. There was only some itching due to the contact lens in the first 48 hours, which disappeared when the lens was removed.

“Postoperative visual recovery is comparable to LASIK,” he said. “After 1 week all treated eyes had uncorrected visual acuity of 20/30 or better. Initially, all eyes showed a hyperopic shift, but after 3 months 43 of the 50 treated eyes were within ±0.5 D and 49 of the 50 eyes were within ±0.75 D of emmetropia. One eye showed a myopic regression to –1.25 D. In this case we successfully have performed a second LASEK procedure.”

Conclusions

LASIK has become popular for the benefits of minimal postop pain and rapid visual recovery.

“Both these goals can also be achieved by LASEK,” Dr. Lohmann pointed out.

On the other hand, LASIK is known to have some potential drawbacks. Flap complications and changes of the biomechanics and stability of the cornea can hinder the long-term results of the technique.

“In eye clinics where both PRK and LASIK are performed, many patients do not wish to have LASIK after they have been informed of the possible complications,” Dr. Lohmann said.

“With LASEK, we can now offer a third option, which is extremely reassuring from all points of view.”

For Your Information:

Chris Lohmann, MD, can be reached at the University Eye Hospital, Franz–Joseph Strauss Allee, D 93042 Regensburg, Germany; +(49) 941-944-9201; fax: +(49) 941-944-9202; e-mail: lohmann@eye-regensburg.de. Dr. Lohmann has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Geuder AG can be reached at Hertzstrasse 4, D-69126 Heidelberg, Germany; +(49) 6221-3066; fax: +(49) 6221-303-122; e-mail: info@Geuder.de; Web site: www.geuder.de.