Laser-assisted subepithelial keratectomy for myopia: Two-year follow-up

Purpose. To assess and compare the clinical results (efficacy, safety, stability, and postoperative pain or discomfort) of laser-assisted subepithelial keratectomy (LASEK) and conventional photorefractive keratectomy (PRK) for the correction of low to moderate myopia. Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. Methods: A prospective comparative study was performed in 184 eyes of 92 patients who had surface excimer ablation for the correction of myopia. The preoperative mean spherical equivalent (MSE) was -4.65 diopters (D) +/-3.14 (SD) (range -1.75 to -7.50 D). In each patient, LASEK was performed in 1 eye and PRK in the fellow eye by the same surgeon. The first eye treated and the surgical method used in the first eye were randomized. Both procedures were performed with the Nidek EC-5000 excimer laser using the same parameters and nomogram. The postoperative pain level, visual recovery, complications (haze), uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and refractive outcome were evaluated and compared. All eyes completed a 24-month follow-up. Results: The postoperative MSE was -0.18+/-0.53 D in the PRK eyes and -0.33+/-0.46 D in the LASEK eyes. At 1 week, the mean UCVA was 0.64+/-0.21 and 0.87+/-0.23, respectively. No LASEK eye lost a line of BSCVA. There were no statistically significant differences between PRK and LASEK eyes in the safety and efficacy indices at 2 years. The mean pain level was significantly lower on days 1 to 3 in the LASEK eyes (P<.05). The mean corneal haze level was lower in the LASEK eyes (0.21) than in the PRK eyes (0.43) (P<.05). Seventy-nine patients preferred LASEK to PRK. Conclusions: Laser-assisted subepithelial keratectomy provided significantly quicker visual recovery, eliminated post-PRK pain, and reduced the haze level in eyes with low to moderate myopia compared with conventional PRK It provided good visual and refractive outcomes. There were no serious complications.