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Epi-LASIK yields less pain than automated brush epithelial removal in PRK
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Flap-off epi-LASIK resulted in slightly less pain than automated brush epithelial removal in PRK, according to a study.
“Flap-off eyes showed a statistically significant advantage over automated brush PRK in the pain scores. The percentage of epithelial healing time over the first 4 days between groups was not different,” the study authors said.
The prospective study included 120 eyes of 60 active-duty military patients with a mean age of 27.3 years.
All patients underwent surface ablation in both eyes. The automated brush technique was used in one eye and flap-off epi-LASIK was used in the other eye to remove the epithelium prior to PRK.
Investigators measured epithelial defect size daily until re-epithelialization was complete in each eye. Patients completed a pain questionnaire, with a score of 0 denoting no pain and a score of 6 denoting severe pain.
Study results showed that mean logMAR uncorrected distance visual acuity on the day of bandage contact lens removal was 0.29 in the flap-off group and 0.31 in the automated brush group; the between-group difference was insignificant.
The flap-off group had significantly less postoperative pain than the brush group at 1 day (P = .0003), 2 days (P = .0001), 3 days (P < .0001) and 4 days (P < .0001). The average between-group difference in pain scores was 0.33 points.
Bandage contact lenses were removed 3.83 days after surgery in the flap-off group and 4.11 days after surgery in the automated brush group.
Initial epithelial defects were 60.35 mm2 in the flap-off group and 66.34 mm2 in the brush group; the between-group difference was statistically significant (P < .0001).
Perspective
Back to TopIoannis G. Pallikaris, MD
The study is very well designed and evaluates mainly the pain scores after Epi-lasik with on- and off-flap and also after standard PRK. Is very clear that the idea of preserving the epithelial flap to cover the ablated area with living epithelial cells in order to eliminate healing response or pain does not work. This is due to the inflammatory reaction of the dead cells. On the contrary, what came out was that the epikeratome generated less mechanical damage on the remaining epithelial border and stroma, and this affected the pain score on the first postop day.
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