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First Author: M.Ang SINGAPORE
Co Author(s): J. Mehta M. Rosman C. Chan
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To compare the efficacy, predictability and safety outcomes of epipolis laser in situ keratomileusis (EpiLASIK) and laser-assisted subepithelial keratectomy (LASEK) for myopia and myopic astigmatism.
Tertiary referral eye center
Retrospective, single centre, multi-surgeon comparative study of consecutive patients with 3 month post-operative follow-up, who underwent off-flap EpiLASIK (220 eyes) performed with the Zyoptix XP Epitome (Bausch & Lomb, USA) or LASEK (146 eyes) with 20% alcohol applied for 60 seconds. All patients underwent excimer laser ablation performed with the Wavelight Allegretto Eye-Q 400Hz excimer laser system (Alcon Laboratories Inc., USA). We analyzed age and refraction adjusted comparisons of 3-month post-operative visual and refractive outcomes.
There were no significant differences in baseline demographics such as mean age (P=0.331), gender (P=0.330) and race (0.251) between groups. Overall mean age was 31ḟ7 years and majority female (59.0%). Mitomycin C 0.02% applied to the stromal bed for 60s was used in 38.3% cases of EpiLASIK and 23.3% cases of LASEK. Mean baseline spherical equivalent was -4.4ḟ1.5D and -4.5ḟ1.6D, which improved to -0.2ḟ0.4D and -0.3ḟ0.5D in EpiLASIK and LASEK groups respectively. 100% EpiLASIK eyes attained unaided VA of 20/40 or better, compared to 98.2% LASEK eyes, with comparable efficacy indices (0.95 vs. 0.95, P=0.333). 96.9% EpiLASIK eyes and 94.3% LASEK eyes were within ḟ1.0D; while 79.1% EpiLASIK eyes and 76.2% LASEK eyes were ḟ0.5D of attempted correction post-operatively (P=0.350). There was no significant difference comparing efficacy and predictability between low myopes (<-5.0D) and higher myopes (-5.0D to -10.0D). There was no significant haze in either group. There were 3 cases of stromal incursion in the EpiLASIK group, but no significant complications in the LASEK group. All of these eyes did not lose lines of vision by 3-month follow-up. We found that the safety index was marginally higher in LASEK compared to EpiLASIK (1.12 vs. 1.05, P=0.001).
We found excellent efficacy, predictability and safety profiles in both EpiLASIK and LASEK for myopia and myopic astigmatism in Asian eyes. The results are comparable in both groups.