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LASEK learning curve steep, despite experience, surgeons say
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Mastering laser epithelial keratomileusis is challenging, and creating the epithelial flap is more difficult than the literature suggests. So say a group of experienced refractive surgeons who described their initial cases in a recent publication.
Ronald R. Krueger, MD, and colleagues at the Cole Eye Institute in Cleveland described their experience with the first 20 patients to undergo LASEK procedures at their facility. Patients excluded from the study included those with ocular pathologies such as glaucoma, cataract, amblyopia, corneal or retinal diseases, diabetes or connective tissue disease, as well as those converted to photorefractive keratectomy during surgery.
All LASEK procedures were performed with the Alcon LadarVision laser, using the technique described by Camellin in 13 eyes and a modified technique in the remaining seven. The mean preoperative spherical equivalent manifest refraction was –6.47 D, and mean cycloplegic refraction was –6.21 D.
Three eyes were corrected for monovision. At 3 months, 100% of the eyes not corrected for monovision were 20/40 or better. At 3 months, all eyes in the monovision group read J1 without correction.
Subepithelial haze was noted at 1 month in 13 eyes. At 3 months, 15 eyes had haze of grade 0.5 or grade 1. At 6 months, 10 eyes had haze of 0.5 or grade 1. One eye, which developed regression, had grade 2 haze.
“Creating the epithelial flap is not as simple as described by others,” the authors reported in the July/August issue of the Journal of Refractive Surgery. “The surgeon tried two methods (alcohol inside the trephine and a sponge soaked with alcohol), and neither were easily executed.”
The high haze incidence may be attributed to a learning curve, the authors suggest.
They note that they prescribed fluorometholone for 1 month postop, whereas others have reported prescribing loteprednol etabonate 0.5% for 10 weeks or fluorometholone acetate 0.1% for 4 months.
The study should alert surgeons that “LASEK is not a reproducibly easy procedure at its start,” the authors said. “Moreover, additional studies should be conducted with longer follow-up to guarantee that corneal haze is not a long-term problem, especially in high corrections.”