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Maria Regina Chalita, MD; Navin H. Tekwani, MD; Ronald R. Krueger, MD, MSE; Division of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation
Purpose: To evaluate the refractive outcome and objective clinical data to determine the efficacy, predictability and safety of LASEK for treatment of myopia.
Methods: A retrospective study was performed on the first 19 LASEK-treated eyes at our institution. Myopia (with and without astigmatism) ranged from -3.50 to -10.50 D (mean -7.04D). Surgical technique in 12 cases used an 8.0-mm circular trephine filled with 20% ethanol solution applied on the cornea for 40 seconds, while the other 7 cases used a 8.0-mm sponge soaked with 20% ethanol solution applied for the same time. Refractive surgery was performed using the Alcon LADARVision 4000. After surgery, patients received fluorometholone 0.1% for 1 month. Corneal haze, BCVA, UCVA and manifest refraction were evaluated.
Results: Of 19 eyes studied, 3 were corrected for monovision (targeted to achieve -1.00 D). In the non-monovision group, at 1 month, 100% of eyes had UCVA 20/40 or better and 40% achieved 20/25 or better. At 3 months, 94.7% of eyes had UCVA 20/40 or better and 43.7% achieved 20/25 or better. One of 19 eyes had trace corneal haze at 1 month, 8 eyes had 1+ haze and 1 eye had 2+ haze. At 3 months, 1 eye had trace corneal haze, 9 eyes had 1+ haze and 2 eyes had 2+ haze. One patient developed significant haze with regression 6 months after surgery with UCVA 20/100. After treatment with prednisolone 1% drops, the haze regressed and UCVA improved to 20/25. No eyes lost >1 Snellen line of BCVA. Three-month and 6-month data will be reported. With both techniques, the surgeon experienced limitations in creating the epithelial flap.
Conclusion: Despite being an effective method to correct myopia, LASEK is a challenging surgical procedure. Even for an experienced surgeon, creating the epithelial flap is not simple as described by others. This can be one of the causes of the high incidence of haze in our study. In addition, fluorometholone acetate was used for just one month. Other papers showing low haze incidence used either fluorometholone or prednisolone acetate until 3 months after surgery. Additionally, topical mitomycin may be a helpful adjunct in eyes undergoing high correction.
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