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PRK offers alternative to flap lift to enhance LASIK

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Vance M. Thompson

WAILEA, Hawaii — PRK limits the risk of epithelial ingrowth and should be considered as an option to treat regression after LASIK, a speaker said here.

"Regression after LASIK is traditionally treated with a lift-flap enhancement," Vance M. Thompson, MD, FACS, said at Hawaiian Eye 2012. "However, there is the risk of epithelial ingrowth, and in a certain population, PRK can be a safer option."

Studies have demonstrated the efficacy of flap lift, he noted, with more than 90% of patients maintaining 20/50 or better uncorrected visual acuity for at least 1 year postop. But epithelial ingrowth is an issue in a percentage of these patients, with a 2005 study showing ingrowth in a clinically significant 34.2% of patients.

A retrospective review analyzed 68 patients who underwent custom PRK enhancement after LASIK to treat regression, Dr. Thompson said.

After PRK, 100% of patients reached 20/40 or better UCVA, he said. Median time was 6 days, with a range of 1 day to 210 days.

"PRK enhancement is a viable option for regression after LASIK," Dr. Thompson said. "You do avoid the risk of epithelial ingrowth, which can be a significant problem for lift-flap enhancements."

However, cataract formation was higher than expected, he noted, which might mean it had been underrecognized before surgery or might have been accelerated by the postop steroid regimen.

• Disclosure: Dr. Thompson is a patent holder with Avedro, a consultant with AcuFocus, and a stockholder with AcuFocus, Avedro and Forsight. He performs contracted research for Abbott Medical Optics, AcuFocus, Alcon and Forsight
• Note: Elizabeth A. Davis, MD, initially was scheduled to give this presentation. Dr. Davis is a consultant with Abbott Medical Optics, Ista Pharmaceuticals and Merck, a stockholder with Refractec, and a member of Allergan's speakers bureau.

Hawaiian Eye and Retina 2013 will be held January 20-25, 2013, at the Hilton Waikoloa Village on Hawaii's Big Island. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.