Surgeon’s choice: LASEK, LASIK, PRK

NICE, France — Ease of surgical performance, high patient satisfaction, minimal complications and surgeon comfort — These are the leading reasons that LASIK, photorefractive keratectomy and laser epithelial keratomileusis are all viable options for the correction of many refractive errors, according to a panel of experts here.

Assembled during the European Society for Cataract and Refractive Surgeons meeting, the panel was called a “dream team” of refractive experts by moderator Daniel Epstein, MD.

Dr. Epstein asked Michael Knorz, MD, Niels Ehlers, MD, and Daniel S. Durrie, MD, to address whether LASIK deserves the popularity it has achieved, why surgeons should still consider PRK as a refractive procedure and whether LASEK is a “flash in the pan.”

As a refractive surgeon who has undergone LASIK himself, Dr. Knorz said the procedure “is popular because you get good results. It's a pleasant surgery, with no pain during or after the surgery, instant visual rehabilitation and no postop pain.”

In his clinics, Dr. Knorz has seen the number of LASIK refractive procedures increase from around 3,500 in 1998 to more than 13,500 in 2002.

From a surgeon’s perspective, Dr. Knorz said he believes LASIK is the easiest and most reliable of the three procedures. “On day 1 [postop], I always see happy patients,” he said.

Dr. Ehlers compared corneal aberrations after LASIK and PRK using the same Asclepion-Meditec MEL-70 G-scan flying spot excimer laser. He conducted optical analysis and tonometry preoperatively, and at 1, 3, 6 and 12 months postoperatively.

“There is no real difference between the two techniques in terms of corneal aberrations,” he said. The sum of aberrations was more variable after PRK, but the difference was not statistically significant after 1 year. The PRK group had slightly higher astigmatism initially, but there was no difference between the groups at 1 year. Coma was more variable and larger after PRK, which remained true after 1 year. There was more spherical aberration in the LASIK group initially, and that held at the 1-year follow-up as well.

“Corneal and ocular aberrations after PRK and LASIK for myopia are about the same,” Dr. Ehlers said. “There's no clear winner between these two techniques. There's more pain and a longer recovery for patients who undergo PRK, but there are potential flap complications with LASIK.” He advised surgeons to use a technique they are most comfortable with performing.

Dr. Durrie equated the epithelial flap technique he uses during LASEK to making a capsulorrhexis. He said he creates an epithelial break, then extends the break around to move the epithelium superiorly.

Dr. Durrie said LASEK offers surgeons the best possible refractive procedure because, like LASIK, the patient does not experience pain, “but it's safer because there are no flap complications. You're not cutting across nerves, so you don't have a problem with dry eye.” In addition, Dr. Durrie said, LASEK creates less induced higher-order aberrations, “and it may be a better procedure for wavefront-guided ablations.”

After using non-customized, conventional excimer lasers from Bausch & Lomb and Alcon to treat more than 500 eyes, Dr. Durrie said,“I get a better uncorrected visual acuity with LASEK than I can get with LASIK.”