LASEK, PRK, LASIK Forum - Operation Auge NPO

[Marianne]

Hi all,

I am hesitating between Lasik and EpiLasik techniques. The doctor told me I could choose between both techniques, but that they would have to be combined with Zyoptix laser, as my pupils are too wide for standard laser treatment and I have astigmatism (cylinders). Price for both techniques would be the same (1850 euro per eye). I know EpiLasik will cause more discomfort in the first post-op period, but if that is compensated with a better (long term) result and less risks, I would't mind too much bearing that discomfort. I have a slight preference for EpiLasik, as it seems less invading, but is that a correct thought? I am still worried because I read about scarring, Bowman's layer and haze... Can anyone help me to choose wisely?

Thanks,

Marianne

[stareyes]

Both methods have risks. So when the doctor gives you the option, it will be really your choice. Since EpiLasik is relatively new, there is no long-term outcome results.

HOw much is your refraction exactly? The shape of your cornea, flat or concave? You may go to the left bar and click on"risks" or "complications". This left side bar presents studies which may answer the questions you have. You may have a look at your individual risk factors on the topic"risks"

HOpe this helps
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I know nothing but would like to know everything

[stareyes]

http://refraktiv.com/aktu....n_Interview.pdf

This is an interview with Prof. Kohnen, an internationally respected surgeon. He stated his opinion about epilasik. It is in German.

I would tend to recommend Lasik unless your surgeon state that your pupil size will cause disturbances like night vision complaints, decreased contrast sensitivity, halos, ghostings, starburst etc. Ask the surgeon more detailed questions on this topic
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I know nothing but would like to know everything

[Ron]

Hi Marianne,

for individual advice I need some parameteres:
- refraction (sphere & astigamatism in dpt)
- what is the size of your dark-adapted pupils
- how old are you

Epi-LASIK is not really a new procedure, its a modification of PRK to reduce postoperative pain and speed up healing. So PRK ist known for 20 years. Your right, Epi-LASIK will cause more discomfort in the first post-op period but has a faster rehabilitation of corneal sensitivity and tear function than LASIK-treated eyes.

Source:
1: Am. J. Ophthalmol. 2006 Oct;142(4):669-71.

Comparison of corneal sensitivity and tear function following Epi-LASIK or laser
in situ keratomileusis for myopia.

Kalyvianaki MI, Katsanevaki VJ, Kavroulaki DS, Kounis GA, Detorakis ET,
Pallikaris IG.

Department of Ophthalmology, University Hospital of Heraklion, Crete, Greece.
mariakalyvianaki@hotmail.com

PURPOSE: To compare the effect of Epi-LASIK or Laser In Situ Keratomileusis (LASIK) on corneal sensitivity and tear function. DESIGN: Prospective, non-randomized comparative clinical trial. METHODS: Seventy-nine eyes (Group A) underwent Epi-LASIK and 61 eyes underwent LASIK (Group B) for the treatment of myopia. Matching parameters between the groups were age and attempted correction. Corneal sensitivity, tear break-up time (BUT), and Schirmer test II were evaluated before and at one, three, and six months after the procedure.
RESULTS: Corneal sensitivity and BUT were decreased at one month in Group A (P < .001) to be restored by the third month (P = .71 and P = .58, respectively). In Group B, corneal sensitivity and BUT were reduced postoperatively (P < .001). There was a
significant difference in corneal sensitivity between the two groups at all postoperative intervals. Schirmer test II was not significantly decreased postoperatively in Group A. In Group B, it was decreased at one and three months and restored by the sixth month. CONCLUSION: Epi-LASIK-treated eyes had faster
rehabilitation of corneal sensitivity and tear function than LASIK-treated eyes.

Publication Types:
Clinical Trial
Comparative Study
Research Support, Non-U.S. Gov't

PMID: 17011861 [Pubmed - indexed for MEDLINE]


To reduce the risk of haze in high myopia surface procedures like PRK, LASEK and Epi-LASIK Mitomycin C is used. The substance is known from glaucoma surgery since over 40 years and seems to be safe for treatment of corneas.


1: Am J Ophthalmol. 2007 May 15; [Epub ahead of print]

Alterations in Endothelial Cell Density After Photorefractive Keratectomy With Adjuvant Mitomycin.

Diakonis VF, Pallikaris A, Kymionis GD, Markomanolakis MM.

Institute of Vision and Optics, University of Crete (V.F.D., A.P., G.D.K.,
M.M.K.), Heraklion, Greece.

PURPOSE: To elucidate the distinct role of the intraoperative use of mitomycin C (MMC) on endothelial cell density after photorefractive keratectomy (PRK) in human eyes. DESIGN: Prospective, double-masked, randomized clinical trial. METHODS: One eye of 15 patients was treated with PRK with intraoperative use of
topical 0.02% MMC (15 seconds), whereas the fellow eye was treated with Epipolis laser in situ keratomileusis (Epi-LASIK) in random order. Corneal confocal microscopy was performed in all eyes preoperatively and at one, three, six, and 12 months after the surgery. Moreover, three endothelial images were acquired in
each of 15 preoperative-normal eyes to evaluate the repeatability of measuring endothelial cell density. Repeated measures analysis of variance was used to compare the temporal variations of endothelial cell density between the two techniques and the changes of endothelial cell density over time. RESULTS: The
coefficient of repeatability of endothelial cell count was 148 cells/mm(2). Preoperative endothelial cell density was not significantly different between the two groups (P = .82). Moreover, the effect of the treatment on the temporal
variation of endothelial cell density was insignificant (P = .83), whereas the differences between the preoperative and the postoperative endothelial cell densities reached statistical significance (P </= .05). Nonetheless, inclusion of
the repeatability of the instrument on the analysis diminished these significant differences (P > .05). CONCLUSIONS: The prophylactic intraoperative application of MMC (up to 15 seconds) after PRK does not seem to affect the endothelial cell density.

PMID: 17509511 [Pubmed - as supplied by publisher]

Regards, Ron
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LASIK benefits, risks and complications
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[stareyes]

@Ron

I have read the study with interest. However, is it right that the EPI-Lasik group had 79 eyes(Group A) and the Lasik group had only 61(Group B). Can you shed a light on this? Apart from this, I do have the impression after all I hear and read that EpiLasik is less invading. I do know Epilasik is a modification of PRK, is it right that the instrument they use is blunt(for lack of a better term)? Therefore I said it was "new".

@Marianne

I can't recommend anything but just stating my opinion. I am a general physician with cardiology subspecialty and not a refractive surgeon and not even an ophthalmologist.

You may try to go to the left bar and click risk. Under "individual risk factors" you will find a chart which will possibly(!) predict your outcome. It does not mean that your outcome will be poor. but a higher risk factor is associated with a higher probability in terms of statistics. For age you get quite a high score like 3 for >50, dark-adapted dilated pupil size > 6 score of 1, high refraction up to 3 points, astigmatismus > 1 you get 1 point(need to check the chart again)

With a score between 6-9 you will have a moderate level of risk

Good luck anyway
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I know nothing but would like to know everything