LASEK a Good Alternative to LASIK for Low Myopia

By Ana Hidalgo Simon, MD, Ph.D.

AMSTERDAM-.An Irish study presented at the XIX Congress of the ESCRS in Amsterdam showed good results using Laser Epithelial Keratomileusis (LASEK) in patients with low myopia of up to -6.0 dioptres.

Patrick Condon, MD

"The main difference between these two techniques is that with LASEK you make a flap only with the epithelium, while in LASIK the flap contains both epithelium and stroma", explained Patrick Condon, MD, Waterford Eye Clinic and Aut Even Hospital in Kilkenny, Ireland.

Over a period of a year, Dr Condon recruited 273 patients into the study. One hundred and fifty-eight patients underwent LASEK and 115 had LASIK performed. They were mostly female and had an average age of 31 years.


"We removed the epithelium with 20% alcohol solution in the LASEK group and used the SKBM microkeratome for the LASIK flaps. The software used in both was Technolas Planoscan 2000," he reported.

The results of the study after 3 months showed very little difference between the achieved and the attempted values. A full 96% of the LASEK procedures were within one dioptre of correction, as were 85% of the LASIK procedures. There were no statistically significant differences between groups in predictability of either procedure.

The stability of the refraction was also very similar. The postoperative result was very good: -0.19 dioptres in LASEK patients and -0.28 dioptres in LASIK patients at three months. The only noticeable difference between the two groups was that 67% of LASEK patients had 6/6 unaided vision over 3 months compared with only 43% of the LASIK patients in this series.

"From the safety point of view we found no difference in lines lost over 3 months. Both groups were between seven and ten percent of between one and two lines lost. They showed a similar gain in best corrected visual acuity at the same time period," Dr Condon reported.

Complications of the LASEK procedure included haze, which was marked in two cases. There were no infections or other major problems in this group.

<"When compared with PRK, both of these procedures induce less pain. LASEK is less painful than PRK and slightly more painful than LASIK.> There is a tendency to create haze, but we only had three patients with haze out of 158. Visual recovery is much faster after LASEK compared with PRK. It is quite common to have patients seeing 20/20 within a week of a LASEK procedure, after removal of the disposable Purevision contact lens”.

"I have been doing LASIK for 8 years now and I still have reservations about it. In the last 188 LASIK operations I have had five microkeratome failures, four patients who lost more than two lines for various causes, four flap infections and four sands of the Sahara syndromes. Most of these problems are connected with the microkeratome," he said.
From the point of view of cost, Dr Condon explained that LASEK is an inexpensive procedure compared to LASIK, mainly because you don’t need a microkeratome. On the down side, LASEK is more time-consuming than LASIK and more post-operative management is needed, he noted.

<"We recommend that LASEK should be used for myopia up to - 6.0 D as well as in specialized cases, such as thin corneas, where LASIK is contraindicated.> It offers a relatively risk-free technique compared to LASIK and does not require microkeratome use. Whereas visual results are better initially with LASIK at one week, they compare very favourably to LASEK at one month and at three months, when there are no significant differences in visual or optical results between the two techniques," Dr Condon said.