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Refractive surgery entered a new era with the
introduction of the excimer laser. While PRK - the first excimer procedure
- gave generally excellent results, postoperative pain and occasional
corneal haze limited the usefulness and acceptance of this procedure. The
subsequent widespread success of LASIK is well known. However, patients
should understand that there are about 0.5% surgical flap complications in
published LASIK series.
Another 2-5% of patients have postoperative complications, and essentially
all of these problems are related to the stromal flap. In addition, the
stromal interface never heals completely and, therefore, problems such as
a corneal abrasion leading to diffuse lamellar keratitis, or traumatic
flap dislocation, can be seen years after the LASIK operation. Finally,
the stromal flap permanently weakens the cornea, and cases of ectasia
requiring corneal transplant have been reported.
About two years ago, Dr. Massimo Camellin in Italy described LASEK (Laser
Assisted Sub-Epithelial Keratectomy). In this new procedure, also known as
E-LASIK or thin-flap LASIK, excimer laser ablation is performed under a
hinged flap of corneal epithelium. No microkeratome is used, and no
stromal lamellar cut is made. The advantage of LASEK is safety. All of the
complications associated with stromal flaps are eliminated. There is
growing interest in this procedure. At the October, 2000 AAO meeting in
Dallas, Dr. Paolo Vinciguerra presented a series of about 500 eyes treated
with LASEK, which is now his procedure of choice. At the same meeting, Dr.
Dan Durrie predicted that LASEK will replace LASIK.
What are the disadvantages of LASEK? Postoperatively, patients are not
quite as comfortable as LASIK patients. Also, vision is somewhat blurry
for the first 4-7 days. So, in the first postoperative week, traditional
LASIK has more ‘wow’ appeal. However, after 1-2 weeks, vision with
LASEK is as good as, or slightly better than, with LASIK. I have seen no
significant corneal haze, even when treating up to -12 diopters of myopia.
Question & Answer about LASEK
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