LASEK, epi-LASIK to remain niche procedures despite some advantages, surgeon says

BARCELONA — Both LASEK and epi-LASIK provide safe and effective surgical options for surface treatments but will never dominate the refractive practice, according to Vikentia Katsanevaki, MD.

"Visual rehabilitation is an issue with both procedures as it is with PRK, and this is the reason why I think that surface treatments will never go beyond 10% to 15% of the total amount of laser refractive procedures," she said here at the European Society of Cataract and Refractive Surgeons Winter Refractive Surgery Meeting.

The initial enthusiasm for these procedures decreased after several studies found that neither was much effective in preventing postoperative pain.

"In some case series, they were proven to be even more painful than conventional PRK. In our study carried out at the University of Crete, we had a good 10% of patients with significant pain in the first few hours, a percentage that is comparable to that of PRK," Dr. Katsanevaki said.

Despite postoperative pain, both techniques have the advantages of minimizing corneal scarring and haze.

"This was also proved by several studies, including our own series, where at 1 year and after at least 90% of the eyes had no haze or just clinically insignificant haze," Dr. Katsanevaki said.

"This is, in my opinion, the only potential benefit of these procedures: They minimize the risk of haze without the use of mitomycin-C, which is not such an innocent drug," she said.

She strongly emphasized that the use of mitomycin-C by refractive surgeons should strictly be limited to high-risk eyes. Cases of scleral melting were found, in her personal experience, 3 to 4 years after using the drug in pterygium surgery, and the need for dilution poses further problems.

Dr. Katsanevaki said that she now prefers thin-flap LASIK, which she uses most often in her own practice.