Original articleComparison of Visual Results Between Laser-Assisted Subepithelial Keratectomy and Epipolis Laser In Situ Keratomileusis to Correct Myopia and Myopic Astigmatism
Section snippets
Patients and Methods
We performed a retrospective study of consecutive patients (94 eyes) who underwent laser surface ablation, 47 eyes with epi-LASIK and 47 eyes with LASEK, to correct myopia of −9.00 diopters (D) or less of spherical refractive error and cylinder of −3.75 D or less. We included all patients who underwent epi-LASIK in our hospital and fulfilled the inclusion criteria during the period from January 1 to March 31, 2007. We also identified consecutive patients who underwent LASEK during the same
Results
Ninety-four consecutive eyes were included in the study: 47 eyes in the epi-LASIK group and 47 eyes in the LASEK group. The eyes were matched for age and preoperative refraction.
The mean patient age was 31.6 ± 3.5 years in the epi-LASIK group and 31.4 ± 6.1 years in the LASEK group (P = .7). The mean preoperative spherical refraction values were −3.95 ± 2.4 D in the epi-LASIK group (range, −0.50 to −9.00 D) and −3.98 ± 2.4 D in the LASEK group (range, −0.50 to −9.00 D) (P = .9). The mean
Discussion
In the current study, LASEK-treated eyes had better UCVA during the first postoperative month compared to epi-LASIK-treated eyes, differences that were significant one day and one month after surgery. It is noteworthy that the difference one day after surgery was not only significant but also clinically relevant (two lines of UCVA on the Snellen chart).
The mean UCVA did not differ significantly three months postoperatively, but the percentages of eyes with an UCVA equal to or better than 0.5
Miguel A. Teus, MD, PhD, is a summa cum laude graduate of Valladolid University School of Medicine, Spain. He did his Ophthalmology residency at the Ramón y Cajal University Hospital, Madrid, Spain. Dr Teus obtained his PhD in glaucoma with cum laude at the Universidad de Alcalá, Madrid. Dr Teus is a full Professor at the University of Alcalá, Madrid, Head of the Ophthalmology Department of the University Hospital of Alcalá, Madrid, and Medical Director of Vissum Madrid.
References (41)
- et al.
Safety, efficacy and stability indices of LASEK correction in moderate myopia and astigmatism
J Cataract Refract Surg
(2004) - et al.
A control-matched comparison of laser epithelial keratomileusis and laser in situ keratomileusis for low to moderate myopia
Am J Ophthalmol
(2006) - et al.
Evolution, techniques, clinical outcomes and pathophysiology of LASEK: review of the literature
Surv Ophthalmol
(2004) - et al.
Comparison of laser epithelial keratomileusis and photorefractive keratectomy for low to moderate myopia
J Cataract Refract Surg
(2001) - et al.
Laser-assisted subepithelial keratectomy for myopia: two-year follow-up
J Cataract Refract Surg
(2003) - et al.
Laser-assisted subepithelial keratectomy versus photorefractive keratectomy for the correction of myopiaA prospective comparative study
J Cataract Refract Surg
(2002) - et al.
Epithelial healing and clinical outcomes in excimer laser photorefractive surgery following three epithelial removal techniques: mechanical, alcohol, and excimer laser
Am J Ophthalmol
(2005) - et al.
Cleavage of corneal basement membrane components by ethanol exposure in laser-assisted subepithelial keratectomy
J Cataract Refract Surg
(2003) - et al.
Vitality of epithelial cells after alcohol exposure during laser-assisted subepithelial keratectomy flap preparation
J Cataract Refract Surg
(2002) - et al.
Epi-LASIK: comparative histological evaluation of mechanical and alcohol-assisted epithelial separation
J Cataract Refract Surg
(2003)
Epi-LASIK: preliminary clinical results of an alternative surface ablation procedure
J Cataract Refract Surg
One-year clinical results after epi-LASIK for myopia
Ophthalmology
Learning curve of laser-assisted subepithelial keratectomyInfluence on visual and refractive results
J Cataract Refract Surg
Assessment of epithelial integrity and cell viability in epithelial flaps prepared with the epi-LASIK procedure
J Cataract Refract Surg
Pain reduction after epi-LASIK with a simple surgical procedure
J Cataract Refract Surg
Inadvertent stromal dissection during mechanical separation of the corneal epithelium using an epikeratome
J Cataract Refract Surg
Histopathology of epi-LASIK in eyes with virgin corneas and eyes with previously altered corneas
J Cataract Refract Surg
Laser in situ keratomileusis versus laser epithelial keratomileusis (LASIK vs. LASEK)
J Refract Surg
Prospective, paired comparison of laser in situ keratomileusis and laser epithelial keratomileusis for myopia less than −6.00 diopters
J Refract Surg
Comparison between LASEK and LASIK for the correction of low myopia
J Refract Surg
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Long term results of Epi-LASIK and LASEK for myopia
2014, Contact Lens and Anterior EyeCitation Excerpt :In this study we showed that the results of Epi-LASIK and LASEK were similar in terms of UCVA, safety and efficacy indexes at last visits. Teus et al. compared the visual results of LASEK and Epi-LASIK after 3 months from surgery [21]. They suggested that LASEK provides a faster visual rehabilitation and better safety and efficacy indexes after LASEK.
Epi-LASIK versus LASEK and PRK
2012, Journal of Cataract and Refractive SurgeryInfectious keratitis in 18651 laser surface ablation procedures
2011, Journal of Cataract and Refractive SurgeryEffects of advanced surface ablations and intralase femtosecond LASIK on higher order aberrations and visual acuity outcome
2011, Saudi Journal of OphthalmologyCitation Excerpt :However, a difference was observed when any single procedure in the flap-off to flap-on group was compared (AlMahmoud et al., 2011). Also studies have cited comparable results for visual or refractive outcome at 3 months between Epi-LASIK and LASEK (Hondur et al., 2008; Teus et al., 2008) and thus we found that it would be reasonable to group the ASA procedures into flap-on and off. We are not aware of the previously published reports comparing epithelial flap-on and epithelial flap-off advanced surface ablations (ASA) techniques to intralase femtosecond LASIK (iLASIK) with detailed analysis of both ocular and corneal HOAs.
Wavefront-guided epithelial laser in situ keratomileusis with mitomycin-C for myopia and myopic astigmatism: Flap-on versus flap-off technique
2011, Journal of Cataract and Refractive SurgeryCitation Excerpt :This allows surgeons to efficiently dissect the epithelial sheet, separating it from Bowman layer, using standard LASIK surgical techniques without a significant learning curve.6,7 Using the epikeratome spares the cornea and conjunctiva from the possible toxic effects of alcohol exposure.4–12,14,15,A The thorough dissection of the epithelial sheet between the lamina lucida and lamina densa maintains an intact basement membrane and normal basal cell integrity, which are important predictors of postoperative pain and epithelial wound healing.4,5,10,12
Surface ablation techniques
2011, Journal of Cataract and Refractive SurgeryCitation Excerpt :Hondur et al.76 also report similar UDVA results at all time points. In a study by Teus et al.,98 the efficacy index was significantly better in the LASEK group than in the epi-LASIK group—0.97 and 0.89, respectively. The UDVA was better in the LASEK group on days 1 and 30, but there was no statistically significant difference by month 3.
Miguel A. Teus, MD, PhD, is a summa cum laude graduate of Valladolid University School of Medicine, Spain. He did his Ophthalmology residency at the Ramón y Cajal University Hospital, Madrid, Spain. Dr Teus obtained his PhD in glaucoma with cum laude at the Universidad de Alcalá, Madrid. Dr Teus is a full Professor at the University of Alcalá, Madrid, Head of the Ophthalmology Department of the University Hospital of Alcalá, Madrid, and Medical Director of Vissum Madrid.
Laura de Benito-Llopis, MD, PhD, graduated in 2000 with summa cum laude at Valencia University School of Medicine, Spain. She did her Ophthalmology residency at the Gregorio Marañón University Hospital in Madrid, Spain. Dr De Benito-Llopis obtained her PhD in laser surface ablation surgery with cum laude at the Universidad Complutense, Madrid. She works as a consultant at the Cornea and Refractive Surgery, Department at Vissum Madrid, Spain.