Laser epithelial keratomileusis in 2010 – a review

Abstract

Photorefractive keratectomy, laser epithelial keratomileusis (LASEK) and Epi-LASIK are all variants of a similar type refractive surgery involving laser on the surface of the cornea and differ mainly in management of the epithelium. Although laser in situ keratomileusis (LASIK) is currently the most popular form of refractive surgery, LASEK is the procedure of choice in some patients. We highlight potential complications of LASEK and how these may be managed. Following laser refractive surgery, corneal thickness is reduced, which has implications for intraocular pressure measurement and glaucoma screening and management. This is particularly important following surface laser procedures where no evidence of previous surgery may be visible. In the event that cataract surgery is required at a later date, correct calculation of the appropriate intraocular lens power can be difficult and it thus important that patients are given their preoperative keratometry readings and refraction. Compared with LASIK patients, those who undergo LASEK are considered to be at lower risk of corneal ectasia. Improved understanding of wound healing post LASEK and better postoperative pain management are ongoing challenges.

Clinical Effectiveness of Topical Cyclosporine A 0.05% After Laser Epithelial Keratomileusis

“…Therefore, it can not only decrease the flap-related complications in LASIK but also reduce the delayed visual recovery, postoperative pain, and subepithelial haze in photorefractive keratectomy. [2][3][4] However, several complications related with LASEK procedures still exist, such as dry eye, corneal haze, delayed epithelial healing, ectasia, and infection. 4 Among these, dry eye is a disorder of the tear film caused by tear deficiency or excessive tear evaporation, which commonly occurs after LASEK and may negatively influence patients' satisfaction with the outcome of the procedure.…”

Effect of repositioning or discarding the epithelial flap in laser-assisted subepithelial keratectomy and epithelial laser in situ keratomileusis

“…However, exceptions were recently reported with thin-flap LASIK. 16,17 Laser-assisted subepithelial keratomileusis [18][19][20][21][22][23][24][25][26][27] is a surface ablation procedure that combines certain elements of LASIK and PRK. Manual epithelial debridement produces scratches and nicking in Bowman layer and leaves variable amounts of epithelium 28,29 ; therefore, dilute alcohol is used in LASEK to loosen the epithelial adhesion to the corneal stroma.…”

Toxic effect of using twenty percent alcohol on corneal epithelial tight junctions during LASEK

“…LASEK is more comfortable and less traumatic for patients with deep set eyes or narrow palpebral apertures, where the application of a laser keratome may be more difficult. Recent results have shown that LASEK is an effective option, a safe and successful procedure; however, the LASEK procedure involves chemically reducing the corneal epithelium adhesion to the underlying Bowman's layer using a diluted solution of alcohol, which is potentially toxic to the epithelium and corneal stroma (1). Although after treatment with alcohol, the cornea is washed using cold-balanced salt solution, the toxic effects of alcohol on the cornea cannot be neglected.…”

“…Since Jose Barraquer recognized this fact and was the first to introduce lamellar refractive surgery techniques, many techniques have been developed, such as photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK) and laser epithelial keratomileusis (LASEK), all of which involve the removal of corneal tissue (1). LASEK was performed by Azar et al in 1996, which they termed alcohol-assisted flap PRK (2).…”