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LASEK performs better than LASIK in selected cases
LASEK may produce fewer intraoperative complications for patients with less than 6 D of myopia.
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BARCELONA, Spain – LASEK may offer an inexpensive alternative to LASIK, with a lower risk of complications, less daunting technology and an equal success rate, according to a study presented here.
“We have performed 250 LASEK cases in about a year and have compared them to 128 LASIK cases, with all patients under –6 D. There is really no statistically significant difference between the results of the two groups, but when it comes to uncorrected visual acuity at 3 months postoperatively, the LASEK patients are in fact doing better,” said Patrick Condon, MD, FRCS, here at the winter meeting of the European Society of Cataract and Refractive Surgeons.
In his series, 67% of the LASEK group achieved UCVA of 20/20 or better at 3 months, compared with 36% of the LASIK patients examined at the same follow-up period.
Low risk, high quality
LASIK procedures present a higher potential for intraoperative complications, Dr. Condon said.
“Over 1 year, I have had five microkeratome failures, two cases of microstriae causing a loss of two lines of BCVA, and three cases of interface debris. With LASEK, on the other hand, I have had only two patients with a bit of haze, which lasted for 2 months and then disappeared.”
Dr. Condon cited laser malfunction as the cause of two cases of overcorrection and one case of undercorrection and regression in the LASEK group.
“There are no other possible reasons, because there was no association with haze or healing abnormalities that I could see,” he said.
These patients underwent LASIK as a secondary enhancement procedure.
“I am also convinced that LASEK gives patients the chance of enjoying a better quality of vision. It is not immediate, because the epithelium takes some time to heal back to what it should be, but this invariably happens and the eye regains full integrity.
A cautious approach
Dr. Condon said LASEK is preferable to LASIK in patients with thin corneas or large pupils, in whom excessive tissue removal may result in ectasia.
However, he maintains a cautious approach to the technique by using it only for low to moderate myopia under –6 D, and always offering LASIK as an alternative.
“I know Dr. Massimo Camellin and some of his colleagues perform LASEK in patients up to –19 D. I don’t, because I am afraid I’d get too much haze,” he said.
Dr. Condon does not recommend the procedure for hyperopic patients.
“Up to –6 D, I let the patients make their own choice. I talk to them about both techniques, explaining the procedure, the advantages and disadvantages and the side effects of both. Then I give them time to think about it. When they tell me what they have decided, I stick to their preferences,” he said. “But when they are over –6 D, I do only LASIK.”
Astigmatism is also a determining factor for Dr. Condon.
“I will also do LASIK on patients under —6 D when they have more than 2 D of astigmatism, because I think astigmatic treatment works well under a flap,” he said.
Despite his current reservations, Dr. Condon said he will be open to new developments.
“The new customized ablation with the LaserScan LSX excimer laser (LaserSight Technologies), which creates a prolate cornea, might give better results with LASEK for higher degrees of myopia. That’s the future, I believe.”
For Your Information:
- Patrick Condon, MD, FRCS, can be reached at Waterford Eye Clinic, 3 Parnell St., Waterford, Ireland; (353) 51-87-41-35; fax: (353) 51-87-21-85; e-mail: picondon@indigo.ie. Dr. Condon has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.