OJOph  Vol.4 No.3 , August 2014
Re-Evaluation of the Safety of Laser-Assisted Subepithelial Keratectomy
ABSTRACT

Purpose: Additional analyses of outcomes of laser-assisted subepithelial keratectomy (LASEK) are still necessary to improve the safety of LASEK. Therefore, in our study, outcomes were assessed retrospectively in 561 eyes that underwent LASEK treatment. Methods: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA) and residual spherical equivalent were analyzed at 3 and 6 months postoperatively. We assessed four subgroups based on the degree of preoperative myopia considering mean BSCVA and loss of two or more lines. Results: Mean UCVAs and BSCVAs were obtained at 3 and 6 months postoperatively (1.23/1.35 and 1.23/1.37, respectively). The mean predictability was within ±0.125 diopters. Conversely, the safety indexes were 0.94 and 0.96 respectively, and the efficacy indexes were 0.86 and 0.86 at 3 and 6 months postoperatively, respectively. 8.4% eyes and 5.2% eyes lost two or more lines of BSCVA at 3 and 6 months postoperatively, respectively. The mean BSCVAs of the high or ultra-high groups were significantly lower than those of the low or mild groups both 3 months and 6 months postoperatively. The incidence rates of losing two or more lines of BSCVA in the high or ultra-high myopia groups were significantly greater than in the low or mild groups at 3 months and 6 months postoperatively. Conclusion: LASEK predictably corrected myopia achieving >1.2 in UCVA and BSCVA. However, the safety and efficacy indexes were <1.0, which were related to the loss of two or more lines of BSCVA. Since the incidence rates of losing two or more lines of BSCVA were greater in the high or ultra-high myopia groups, we consider LASEK as more safely performed in patients with low to mild preoperative myopia.


Cite this paper
Kumano, Y. , Soejima, Y. , Numa, S. , Matsui, H. , Zushi, I. , Shigematsu, M. , Matsui, T. and Nishida, T. (2014) Re-Evaluation of the Safety of Laser-Assisted Subepithelial Keratectomy. Open Journal of Ophthalmology, 4, 79-85. doi: 10.4236/ojoph.2014.43013.
References
[1]   Azar, D.T., Ang, R.T., Lee, J.B., Kato, T., Chen, C.C., Jain, S., Gabison, E. and Abad, J.C. (2001) Laser Subepithelialkeratomileusis: Electron Microscopy and Visual Outcomes of Flap Photorefractive Keratectomy. Current Opinion in Ophthalmology, 12, 323-328.
http://dx.doi.org/10.1097/00055735-200108000-00014

[2]   Taneri, S., Feit, R. and Azar, D.T. (2004) Safety, Efficacy, and Stability Indices of LASEK Correction in Moderate Myopia and Astigmatism. Journal of Cataract Refractive Surgery, 30, 2130-2137.
http://dx.doi.org/10.1016/j.jcrs.2004.02.070

[3]   Claringbold 2nd, T.V. (2002) Laser-Assisted Subepithelial Keratectomy for the Correction of Myopia. Journal of Cataract Refractive Surgery, 28, 18-22.
http://dx.doi.org/10.1016/S0886-3350(01)01234-2

[4]   Rouweyha, R.M., Chuang, A.Z., Mitra, S., Phillips, C.B. and Yee, R.W. (2002) Laser Epithelial Keratomileusis for Myopia with the Autonomous Laser. Journal of Refractive Surgery, 18, 217-224.

[5]   Autrata, R. and Rehurek, J. (2004) Laser-Assisted Subepithelial Keratectomy and Photorefractive Keratectomy versus Conventional Treatment of Myopic Anisometropic Amblyopia in Children. Journal of Cataract Refractive Surgery, 30, 74-84.

[6]   http://dx.doi.org/10.1016/S0886-3350(03)00417-6

[7]   Kim, J.K., Kim, S.S., Lee, H.K., Lee, I.S., Seong, G.J., Kim, E.K. and Han, S.H. (2004) Laser in Situ Keratomileusis versus Laser-Assisted Subepithelial Keratectomy for the Correction of High Myopia. Journal of Cataract Refractive Surgery, 30, 1405-1411.
http://dx.doi.org/10.1016/j.jcrs.2003.12.053

[8]   Taneri, S., Zieske, J.D. and Azar, D.T. (2004) Evolution, Techniques, Clinical Outcomes, and Pathophysiology of LASEK: Review of the Literature. Survey of Ophthalmology, 49, 576-602.
http://dx.doi.org/10.1016/j.survophthal.2004.08.003

[9]   Taneri, S., Weisberg, M. and Azar, D. (2011) Surface Ablation Techniques. Journal of Cataract Refractive Surgery, 37, 392-408.
http://dx.doi.org/10.1016/j.jcrs.2010.11.013

[10]   Feit, R., Taneri, S., Azar, D.T., Chen, C.C. and Ang, R.T. (2003) LASEK Results. Ophthalmology Clinics of North America, 16, 127-135.
http://dx.doi.org/10.1016/S0896-1549(02)00063-9

[11]   Vinciguerra, P. and Camesasca, F. (2002) Butterfly Laser Epithelial Keratomileusis for Myopia. Journal of Refractive Surgery, 18 [Suppl], 371-373.

[12]   Teus, M.A., de Benito-Llopis, L. and Alió, J.L. (2009) Mitomycin C in Corneal Refractive Surgery. Survey of Ophthalmology, 54, 487-502.
http://dx.doi.org/10.1016/j.survophthal.2009.04.002

[13]   Chen, S.H., Feng, Y.F., Stojanovic, A. and Wang, Q.M. (2011) Meta-Analysis of Clinical Outcomes Comparing Surface Ablation for Correction of Myopia with and without 0.02% Mitomycin C. Journal of Refractive Surgery, 27, 530-541.
http://dx.doi.org/10.3928/1081597X-20110112-02

[14]   Ghirlando, A., Gambato, C. and Midena, E. (2007) LASEK and Photorefractive Keratectomy for Myopia: Clinical and Confocal Microscopy Comparison. Journal of Refractive Surgery, 23, 694-702.

[15]   Pirouzian, A., Thornton, J.A. and Ngo, S. (2004) A Randomized Prospective Clinical Trial Comparing Laser Subepithelial Keratomileusis and Photorefractive Keratectomy. Archives of Ophthalmology, 122, 11-16.
http://dx.doi.org/10.1001/archopht.122.1.11

[16]   Zhao, L.Q., Wei, R.L., Cheng, J.W., Li, Y., Cai, J.P. and Ma, X.Y. (2010) Meta-Analysis: Clinical Outcomes of Laser-Assisted Subepithelial Keratectomy and Photorefractive Keratectomy in Myopia. Ophthalmology, 117, 1912-1922.
http://dx.doi.org/10.1016/j.ophtha.2010.02.004

[17]   de Benito-Llopis, L., Teus, M.A., Gil-Cazorla, R. and Drake, P. (2009) Comparison between Femtosecond Laser-Assisted Sub-Bowman Keratomileusis vs Laser Subepithelial Keratectomy to Correct Myopia. American Journal of Ophthalmology, 148, 830-836.
http://dx.doi.org/10.1016/j.ajo.2009.07.008

[18]   Moller-Pedersen, T., Cavanagh, H.D., Petroll, W.M. and Jester, J.V. (2000) Stromal Wound Healing Explains Refractive Instability and Haze Development after Photorefractive Keratectomy: A 1-Year Confocal Microscopic Study. Ophthalmology, 107, 1235-1245.

[19]   http://dx.doi.org/10.1016/S0161-6420(00)00142-1

[20]   Kymionis, G.D., Tsiklis, N.S., Ginis, H., Diakonis, V.F. and Pallikaris, I. (2006) Dry Eye after Photorefractive Keratectomy with Adjuvant Mitomycin C. Journal of Refractive Surgery, 22, 511-513.

[21]   Lee, D.H., Chung, H.S., Jeon, Y., Boo, S.D., Yoon, Y.D. and Kim, J.G. (2005) Photorefractive Keratectomy with Intraoperative Mitomycin-C Application. Journal of Cataract & Refractive Surgery, 31, 2293-2298.
http://dx.doi.org/10.1016/j.jcrs.2005.05.027

[22]   Netto, M.V., Mohan, R.R., Sinha, S., Sharma, A., Gupta, P.C. and Wilson, S.E. (2006) Effect of Prophylactic and Therapeutic Mitomycin C on Corneal Apoptosis, Cellular Proliferation, Haze, and Long-Term Keratocyte Density in Rabbits. Journal of Refractive Surgery, 22, 562-574.

[23]   Rajan, M.S., O’Brart, D.P.S., Patmore, A. and Marshall, J. (2006) Cellular Effects of Mitomycin-C on Human Corneas after Photorefractive Keratectomy. Journal of Cataract & Refractive Surgery, 32, 1741-1747.
http://dx.doi.org/10.1016/j.jcrs.2006.05.014

[24]   Morales, A.J., Zadok, D., Mora-Retana, R., Martínez-Gama, E., Robledo, N.E. and Chayet, A.S. (2006) Intraoperative Mitomycin and Corneal Endothelium after Photorefractive Keratectomy. American Journal of Ophthalmology, 142, 400-404.
http://dx.doi.org/10.1016/j.ajo.2006.04.029

[25]   Nassiri, N., Farahangiz, S., Rahnavardi, M., Rahmani, L. and Nassiri, N. (2008) Corneal Endothelial Cell Injury Induced by Mitomycin-C in Photorefractive Keratectomy: Nonrandomized Controlled Trial. Journal of Cataract & Refractive Surgery, 34, 902-908.
http://dx.doi.org/10.1016/j.jcrs.2008.03.007

[26]   Matsui, H., Kumano, Y., Zushi, I., Yamada, T., Matsui, T. and Nishida, T. (2001) Corneal Sensation after Correction of Myopia by Photorefractive Keratectomy and Laser in Situ Keratomileusis. Journal of Cataract & Refractive Surgery, 27, 370-373.
http://dx.doi.org/10.1016/S0886-3350(00)00756-2

[27]   Kumano, Y., Matsui, H., Zushi, I., Mawatari, A., Matsui, T., Nishida, T. and Miyazaki, M. (2003) Recovery of Corneal Sensation after Myopic Correction by Laser in Situ Keratomileusis with a Nasal or Superior Hinge. Journal of Cataract & Refractive Surgery, 29, 757-761.
http://dx.doi.org/10.1016/S0886-3350(02)01840-0

[28]   Lee, S.J., Kim, J.K., Seo, K.Y., Kim, E.K. and Lee, H.K. (2006) Comparison of Corneal Nerve Regeneration and Sensitivity between LASIK and Laser Epithelial Keratomileusis (LASEK). American Journal of Ophthalmology, 141, 1009-1015.
http://dx.doi.org/10.1016/j.ajo.2006.01.048

 
 
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