Lasek

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"LASEK" is defined as Laser Epithelial Keratomileusis Excimer Laser Eye surgery to correct vision is the most popular elective ophthalmological procedure in North America. Of these procedures LASIK and PRK were the most commonly performed. Both have been deemed safe and effective by the FDA. PRK is a surface ablation procedure. LASIK is a cutting procedure creating a flap. PRK is a safer procedure with slower vision recovery.

LASIK has faster vision recovery but much riskier with flap- related complications, interface complications, ectasia complications and rick for corneal neuralgia.

LASEK was developed with an eye to avoid the LASIK disadvantages but to aim to achieve the advantages of both PRK and LASIK. LASEK is Advanced Surface Ablation like PRK and does not require additional FDA approval.


History[edit]

The first LASEK procedure was performed in 1996 at the Massachusetts Eye and Ear Hospital by Dr D T Azar. There are different techniques of the LASEK procedure. Common to all is using a diluted alcohol solution to elegantly, gently detach the corneal epithelium as a sheet of cells. Excimer Laser ablation is then applied to the cornea. The epithelial sheet may or may not be replaced. Topical antibiotic and steroid drops are applied and a soft contact lens is placed, to be removed 4 days later.


Advantages of LASEK[edit]
  • No risk of free cap
  • No risk of LASIK incomplete flap
  • No risk of LASIK button hole flap
  • No risk of LASIK flap striae (wrinkles)
  • No LASIK flap infection
  • No LASIK flap dislocation
  • No epithelial ingrowth
  • No diffuse lamellar keratitis
  • Lower risk of ectasia
  • No corneal neuralgia


Disadvantages of LASEK[edit]
  • May have post op discomfort
  • Slower visual recovery
  • Risk of corneal haze
  • Risk of persistent corneal defects
  • Risks of microbial keratitis


Results[edit]

LASEK vs PRK Clinical studies showed in a prospective paired randomized comparison showed similar safety, patient satisfaction, and predictability of LASEK and PRK for low to moderate myopia. LASEK had lower postoperative pain scores and less corneal haze. Majority of patients preferred LASEK to PRK. A meta analysis of PRK and LASEK up to -9.0 Diopters (High Myopia) found similar results. More studies are needed to know if there are significant advantages between these 2 techniques. Because LASEK is more gentle than PRK in epithelial removal, it is intuitively preferable to do LASEK for patients who have previous trauma or surgery to their eyes.

LASEK vs LASIK Studies have shown some differences in visual refractive outcomes favouring LASEK, they were not clinically significant. Both are safe and effective.

References[edit]
Azar DT, Gatinel D, Hoang-Xuan T, (2007) – “Refractive Surgery. Mosby Incorporated”    
Azar DT, Ang RT. (2002) – “Laser subepithelial keratomileusis: evolution of alcohol assisted flap surface ablation.” Int Ophthalmol Clin. Fall; 42(4):89-97.    

Azar DT, Ang RT, Lee JB,. (2001)- “Laser subepithelial keratomileusis: electron microscopy and visual outcomes of flap photorefractive keratectomy.” Curr Opin Ophthalmol 12:323– 8. Azar DT, Farah SG. (1998) – “Laser in situ keratomileusis versus photo- refractive keratectomy: an update on indications and safety.” Ophthalmology 105:1357–8 Ambrósio RJ, Wilson S, (2003). – “LASIK vs LASEK vs PRK: Advantages and indications.” Seminars in Ophthalmology, 18(1), 2–10. Camellin M. (2003). – “Laser Epithelial Keratomileusis for Myopia.” J Refract Surg. 19:666–670. Cimberle M, Camellin M. (2000). - “LASEK technique promising after 1 year of experience.” Ocul Surg News 14:14–7. - Cimberle M, Condon M. (2002). - “LASEK performs better than LASIK in selected cases.” Ocul Surg News. - Condon P, Camellin M. (1999). – “LASEK may offer the advantages of both LASIK and PRK”. Ocular Surgery News International Edition. Cui M, Chen XM, Lü P, (2008). - “Comparison of laser epithelial keratomileusis and photorefractive keratectomy for the correction of myopia: a meta-analysis.” Chinese Medical Journal. 121(22), 2331–2335. Ghadhfan F, Al-Rajhi A, Wagoner MD (2007). – “Laser in situ keratomileusis versus surface ablation: Visual outcomes and complications”. Journal of Cataract & Refractive Surgery, 33(12), 2041–2048. Ghanem VC, Souza GC, Souza DC, Viese JM, Weber SL, Kara-José NJ, (2008). – “PRK and butterfly LASEK: prospective, randomized, contralateral eye comparison of epithelial healing and ocular discomfort.” J Cataract Refract Surg. 24(6):591-9. - Hashemi H, Fotouhi A, Foudazi H, Sadeghi N, Payvar S., (2004) - “Prospective, randomized, paired comparison of laser epithelial keratomileusis and photorefractive keratectomy for myopia less than -6.50 diopters.” J Refract Surg. 20(3):217-22. Iskander NG, Peters NT, Penno EA, Gimbel HV, (2000) - “Postoperative complications in laser in situ keratomileusis.” Current Opinion in Ophthalmology. v11(4):273-9 Jain V, Mhatre K, Shome D. (2010). - “Flap Buttonhole in Thin-Flap Laser In Situ Keratomileusis: Case Series and Review.” Cornea. 29(6):655-8 Kaya V, Oncel B, Sivrikaya H, Yilmaz OF, (2004). – “Prospective, paired comparison of laser in situ keratomileusis and laser epithelial keratomileusis for myopia less than -6.00 diopters. “
J Refract Surg .20:223–228. Kim JK, Kim SS, Lee HK, et al. (2004) - “Laser in situ keratomileusis 
versus laser-assisted subepithelial keratectomy for the correction 
of high myopia”. J Cataract Refract Surg. 30:1405–1411 Knorz MC, (2002) - “Flap and interface complications in LASIK.” Curr Opin Ophthalmol. 13(4):242-5. Lee JB., Seong GJ, Lee JH, Seo KY, Lee YG, Kim EK, (2001) - “Comparison of laser epithelial keratomileusis and photorefractive keratectomy for low to moderate myopia.” Journal of Cataract & Refractive Surgery. 27(4), 565–570. Litwak S, Zadok D, García-de Quevedo V, Chayet AS, (2002). - "Lasser-assited subepithelial keratectomy versus photorefractive keratectomy for the correction of myopia. A prospective comparative study." J Cataract Refract Surg. 28(8):1330-3. McDonald MB: Binkhorst Lecture: Refractive Surgery: The Next Generation. American Academy of Ophthalmology 2001 Annual Meeting. American Academy of Ophthalmology: New Orleans Piechocki M, McDonald M. (2002) - “Alcohol-free LASEK procedure proves too effective in pilot study.” Ocular Surg News. Randleman JB, Shah RD, (2012) – “LASIK interface complications: etiology, management, and outcomes.” J Refract Surg. 28(8):575-86. Randleman JB, Stulting RD, (2007). - “Ectasia after photorefractive keratectomy.” Ophthalmology. 114(2):396. Taneri S, Weisberg M, Azar DT. (2011) -“Surface ablation techniques.” Cataract Refract Surg 37(2):392-408 Taneri S, Zieske JD, Azar DT. (2004).- “Evolution, techniques, clinical outcomes, and pathophysiology of LASEK: review of the literature.” Surv Ophthalmol. 49(6):576-602. Tobaigy FM, Ghanem RC, Sayegh RR, Hallak JA, Azar DT, (2006) –“ A Control-Matched Comparison of Laser Epithelial Keratomileusis and Laser In Situ Keratomileusis for Low to Moderate Myopia. American Journal of Ophthalmology”, 142(6), 901–908. Vinciguerra P, Camesasca FI, Randazzo A. (2003). - “One-year results of butterfly laser epithelial keratomileusis.” J Refract Surg. 19:S223–S226 n Vinciguerra P, Camesasca FI. (2002) -“Butterfly laser epithelial keratomileusis for myopia”. J Refract Surg 18:S371–3 Yee RW, Yee SB. (2004). – “Update on laser subepithelial keratectomy (LASEK)”. Curr Opin Ophthalmol. 15(4):333-41. Zhao, LQ, Wei, RL, Cheng, JW, Li Y, Cai JP, Ma XY, et al. (2010) - "Meta-analysis: clinical outcomes of laser-assisted subepithelial keratectomy and photorefractive keratectomy in myopia." Ophthalmology 117(10): 1912-1922. Zhao LQ, Zhu H, Li LM, (2014). -“Laser-Assisted Subepithelial Keratectomy versus Laser In Situ Keratomileusis in Myopia: A Systematic Review and Meta-Analysis.” ISRN Ophthalmol. 12;2014:672146



See also[edit]