Comparison of Visual Results Between Laser-Assisted Subepithelial Keratectomy and Epipolis Laser In Situ Keratomileusis to Correct Myopia and Myopic Astigmatism

• Published in: American journal of ophthalmology 2008-09, Vol.146 (3), p.357-362.e2
• Main Authors: Teus, Miguel A, de Benito-Llopis, Laura, García-González, Montserrat
• Format: Article
• Language: English
• Subjects: Adult; Advantages; Antibiotics; Astigmatism - physiopathology; Astigmatism - surgery; Biological and medical sciences; Cellulose; Contact lenses; Dissection; Ethanol; Humans; Keratectomy, Subepithelial, Laser-Assisted - methods; Keratomileusis, Laser In Situ - methods; Lasers; Lasers, Excimer - therapeutic use; Medical sciences; Miscellaneous; Myopia - physiopathology; Myopia - surgery; Ophthalmology; Refraction, Ocular - physiology; Rehabilitation; Retrospective Studies; Surgery; Surgical Flaps; Treatment Outcome; Vision disorders; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2008.05.022

Purpose To compare the visual results after laser-assisted subepithelial keratectomy (LASEK) and epipolis laser in situ keratomileusis (epi-LASIK) to correct myopia. Design Retrospective, interventional, nonrandomized comparative study. Methods Patients treated with LASEK to correct myopia ≤−9.00 diopters (D) were compared to age- and refraction-matched patients treated with epi-LASIK using the same excimer laser (Esiris; Schwind Eye Tech Solutions, Kleinostheim, Germany). The epithelial flap was replaced after the ablation in every case. The visual results after both procedures were compared at each postoperative visit (one day, one week, one and three months). Results Ninety-four consecutive eyes were included in the study (47 in each group), matched for age and refraction. The preoperative spherical manifest refraction was −3.98 ± 2.40 D in the LASEK group and −3.95 ± 2.40 D in the epi-LASIK group ( P = .9) (range −0.50 to −9.00 D). The uncorrected visual acuity (UCVA) one day postoperatively was 0.7 ± 0.2 and 0.5 ± 0.2 ( P < .001), and one week after surgery it was 0.8 ± 0.2 and 0.7 ± 0.2, respectively ( P = .1). The difference was again statistically significant one month after surgery (0.94 ± 0.1 after LASEK, 0.82 ± 0.1 after epi-LASIK, P < .001), but not three months postoperatively (1.06 ± 0.21 and 1.03 ± 0.18, respectively, P = .1). UCVA was ≥1.0 in 78.7% of LASEK eyes and 65.9% of epi-LASIK eyes three months after surgery. At that moment, the safety indices were 0.99 ± 0.1 after LASEK and 0.93 ± 0.1 after epi-LASIK ( P = .04). The efficacy indices were 0.97 ± 0.1 and 0.89 ± 0.1, respectively ( P = .01). Conclusions Our results suggest a faster visual rehabilitation and better safety and efficacy outcomes after LASEK compared to epi-LASIK with repositioning of the epithelial flap when correcting low to moderate myopia.