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Two Years Clinical Results of LASEK Compared to Conventional PRK

Autrata R., Rehurek J.,
Department of Ophthalmology, University Hospital Brno (Brno)

Purpose: To assess and compare clinical results- the effectiveness, safety, and stability of laser epithelial keratomileusis (LASEK) with those of conventional photorefractive keratectomy (PRK) for correction of low to moderate myopia.
Methods: A prospective, comparative study was performed in 184 eyes of 92 patients whounderwent PRK for correction of myopia and myopic astigmatism. The preoperative mean spherical equivalent (MSE) was -4,65 D  ± 3,14 D ( range -1,75 D to -7,5 D). All the eyes were divided into two groups. At group A was the first eye treated by conventional PRK with epithelial removal, at group B the second eye of each patient was operated by LASEK ( laser epithelial keratomileusis). An epithelial flap with superior hinge was prepared and rolled up. Then PRK was performed and the flap rolled back over the stromal ablation. Laser system (Nidek EC 5000) parameters and nomograms were the same in both groups. Postoperative pain level, visual recovery, complications (haze), visual acuity (UCVA, BCVA) and refractive outcome were evaluated and compared in both groups. All the eyes completed 24 months (range from 24 to 30 months) follow up.
Results: The preoperative MSE was -4,65 D  ± 3,14 D with no significant difference between both groups. The postoperative MSE was -0,18 D  ± 0,53 D in A group and -0,33 D  ± 0,46 D in B group.There was no statistically significant difference bettwen A and B group in postoperative refractionat last examination (24 to 30 months after procedure). The mean uncorrected visual acuity (UCVA) at one week postoperatively was 0,66  ± 0,17 in the A (PRK) group and 0,87 ± 0,18 in the B (LASEK) group.There was no line lost of BCVA at all eyes. The mean pain level was significantly lower during the first to the third postoperative days in B group (p<0.05). It was evaluated by subjective questionnare (grade 0 to 4 of pain). The corneal haze level was lower in LASEKgroup B at 0,21 compared to 0,43 in the eyes with conventional PRK. This difference was also statistically significant ( p<0.05). Seventy nine patients preferred LASEK procedure over PRK.
Conclusions: LASEK for correction of low to moderate myopia, provides significantly quicker visual recovery and refractive stability, eliminates post PRK pain and reduces the haze level, as compared to conventional PRK.