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More physicians embracing LASEK
After gaining some experience, physicians in Germany, Ireland and the United States are reporting good surgical and visual results with the technique.
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AMSTERDAM — Since it first appeared on the scene, laser epithelial keratomileusis has continued to attract interest and new adherents in Europe and the United States.
The procedure is safe and effective so far, according to the refractive surgeons who have decided to give the microkeratome-free procedure a try. One physician with years of LASIK experience stated that LASEK has now become his preferred procedure for lower myopia.
LASEK recommended
“LASEK is a relatively risk-free technique compared to LASIK with no visual or optical differences at 3 months. We therefore recommend that LASEK should be used for myopia up to 6 D,” Patrick Condon, MD, of Ireland, told delegates at the European Society of Cataract and Refractive Surgeons meeting here.
Of appeal to him is the avoidance of potential microkeratome-related problems and potential flap complications. “Even after 8 years of LASIK surgery I still have reservations about LASIK, due to the microkeratome,” he told the audience.
In his recent comparative study in which 158 patients received LASEK and 150 patients received LASIK, he found the optical and visual results to be similar at 3 months. More patients had 20/20 uncorrected acuity in the LASEK group, he noted.
“There is nothing wrong with LASIK. In the last 188 cases of LASIK I had five microkeratome failures; four patients that lost greater than two lines of best-corrected vision due to microstriae or one thing or another; infection in flaps and diffuse lamellar keratitis in three or four,” Dr. Condon said.
Patients learn of LASEK
LASEK may appeal to refractive surgery candidates, too, one physician indicated. In the United States, patient apprehension about flap cutting with a microkeratome has kept some refractive surgery candidates from pursuing treatment and LASEK offers them an appealing alternative, said Robin Beran, MD, of Columbus, U.S.A.
“One of my indications (for surface ablation) is patient preference, and in the United States we have a lot of people who have stayed the tide and have been concerned about problems with the flap and LASEK is of interest to them,” Dr. Beran said.
He said he has no procedure of choice, though, and decisions are based on each individual patient. The longer visual recovery time with LASEK, for example, might be problematic in an anxious patient, he said.
Other indications for a surface ablation, and especially LASEK, are concerns about corneal ectasia.
“If I have a patient with a form fruste keratoconus who still wants treatment, I will consider surface ablation,” he said. Even before starting LASEK, photorefractive keratectomy comprised about 20% of Dr. Beran’s total refractive cases.
Dry eye syndrome is also avoided with LASEK.
“With LASEK I have not had a dry eye problem with patients, as opposed to the several cases of neurotrophic keratitis I’ve seen with LASIK,” he said.
Dr. Beran began LASEK in August 2000 after being impressed with the technique of Massimo Cammelin, MD.
“I had excellent results in the first 25 cases and have consequently performed over 600 procedures,” he said.
Of these 600 cases, refractive outcomes for a subtreatment group of high myopia between —9 D and —13 D are good, he indicated. At 1 week postop, 80% are 20/40 or better uncorrected, he said. At 1 month and 6 months 90% are 20/40 or better and about 60% are 20/20 uncorrected.
Postop pain is less with LASEK than PRK, he noted. Nevertheless, there were some complaints of “significant” pain as reported by the patient. But by extending use of postop nonsteroidal therapy to longer than the 1 day that has been the standard practice with his PRK patients, he was able to significantly reduce their pain.
“With LASEK there is definitely less pain than with PRK and better vision postop day 1, but still you must warn your patients that it will be 1 to 2 weeks in some people for the return of functional vision,” Dr. Beran said.
Higher myopia attempted
Another surgeon, Chris Lohmann, MD, of Germany, has evaluated LASEK in myopic patients over —6 D and found results in higher myopia comparable with LASIK. LASEK combines the advantages of PRK and LASIK, he said.
“You get a superficial treatment, not going too deep into the cornea, you don’t change the biomechanics of the cornea and you keep the epithelium on; you don’t have the pain and the wound healing response of the cornea as you have with PRK.”
Since he began performing the procedure 1 year ago, 96 patients between —2 D and —10 D have received LASEK in his center. “We had one eye where we couldn’t create the epithelial flap and another eye that lost the bandage lens due to rubbing on the first day and also lost the epithelial flap. We found in the remaining cases no corneal instability or corneal erosion during the whole postop period. There were a few cases of slight corneal haze, which peaks at 2 to 3 months after surgery, he said.
At the end of their postop care, 90% of patients with preop refractions between –6 D and –10 D were within ±1 D of target refraction and 75% were within ±0.5 D. For patients under —6 D, all were with ±0.5 D of target refraction, he said. A few cases of regression were seen in patients over –6 D, he said. There was no difficulty in performing the needed enhancements for these patients, he said.
Eight percent of patients lost one line of best corrected vision, and approximately 12% gained one line. No patient lost more than one line of visual acuity, he said.
Visual results compared well to LASIK and PRK. “I don’t think LASEK will be better than LASIK or PRK, but at least equally good,” Dr. Lohmann said. “So far we have very good refractive results. I think it is definitely an alternative to LASIK due to the reports of the biomechanical problems which comes more and more in the literature,” he added.
For Your Information:
- Patrick Condon, MD, can be reached at 3 Parnell St., Waterford, Ireland; +(35) 351-872-185; fax: +(35) 351-872-185.
- Chris Lohmann, MD, can be reached at Universitaet Augenklinik, Franz Joseph Strauss Allee, Regensburg, Germany 93042; +(49) 941-949-9201; fax: +(49) 941-949-9202; e-mail: lohmann@eye-regensburg.de.
- Robin Beran, MD, can be reached at 5965 East Broad St., Suite 480, Columbus, OH 43213-1562 U.S.A.; +(1) 614-766-2006; fax: +(1) 614-766-4637.