Patients More Comfortable after LASIK Than LASEK In Short Term

By Ana Hidalgo Simon, MD, Ph.D.

AMSTERDAM - While both LASIK and LASEK achieve good long-term results in moderately myopic patients, patients may be more comfortable in the short term following LASIK, say Dutch researchers.

Michiel Luger, MD

"We were interested in addressing specifically the short-term follow-up to be able to inform our patients about what they can expect during the short-term recovery from surgery," said Michiel Luger, MD, Vision Clinics, Rotterdam, the Netherlands, speaking at the XIX Congress of the ESCRS here.

The study enrolled consecutive cases of low to moderate myopia and/or myopia and astigmatism. The choice of treatment for each group was based on the use of exclusivity criteria for LASIK or surgeon/patient preferences. LASIK exclusion criteria included a calculated residual corneal stromal bed thickness of less than 250 microns, and a change of posterior elevation of (less than) 0.1 mm or greater. The optical zone had to be superior to 5.5 mm.

The two groups were very similar in sex and age distribution. Twenty-three eyes underwent LASIK procedures and 17 had LASEK procedures. The sphere equivalent values were similar in both groups, -4.4 in the LASIK group and -4.7 in the LASEK group. Best spectacle-corrected visual acuity was 1.1 in both groups pre-operatively.

In the LASIK group, surgeons created a corneal lamellar flap of 160-180 microns with a Hansatome microkeratome. In the LASEK group the surgeons performed epithelial lysis with 20% ethanol. LASIK, but not LASEK, was performed as a simultaneous bilateral procedure. In both procedures, excimer laser photablation was performed with a Technolas 217z Planoscan, with active infrared eye tracking. After repositioning of the epithelial flap, soft bandage contact lenses were applied for four days.

More than 80% of patients in the LASIK group were within 0.5 dioptres of emmetropia at one week. This increased to 90% one month post-operatively. More than 90% were within 1.0 dioptre at both intervals. The LASEK groups did slightly better, with almost 90% of patients within 0.5 dioptres of emmetropia at both intervals. All patients were within one dioptre of emmetropia.

"From the safety point of view, there was some deterioration of the best corrected visual acuity, as expected. After one week the LASEK group showed some substantial deterioration. Almost 60% of patients lost one to two lines. In the LASIK group only 26 % of patients lost 1 line. At the one month interval no significant differences were found between the two procedures,” Dr. Luger reported.

Post-Op LASIK Patients Happier
One case of UV induced haze occurred in the LASEK group, which had to be retreated three months after the initial procedure. Several LASEK cases showed haze shortly after the operation, varying from trace to grade 2.

"All the 17 patients operated with LASEK complained about discomfort or pain. It varied between slight discomfort for a couple of days to severe pain. We had no significant complications in the LASIK group," he noted, adding:

"Both LASIK and LASEK are safe procedures for low to moderate myopia. Efficacy, safety and predictability are similar after one month. However, for the cases in which good-vision in the short-term is important, the healing response is faster with LASIK and stabilisation of vision takes place in a shorter period of time. With LASEK we saw a deterioration of best-corrected visual acuity at one month," he concluded.
Dr Luger’s co-workers in this study were Monika Landesz and Sylvia Tabak.