dr. nitin balakrishnan, crystal vision laser centre, mumbai, india. dr. shilpa kodkany, dr....
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Dr. Nitin Balakrishnan, Crystal Vision Laser Centre, Mumbai, India.
Dr. Shilpa Kodkany,Dr. Kodkany’s Eye Care Centre, Belgaum, India. .
No author has any financial or proprietary interest in any materials or methods mentioned
PURPOSE
To compare the results of Laser in situ keratomileusis (LASIK) & Mitomycin C assisted, Laser subepithelial keratomileusis (LASEK), to correct residual refractive errors following cataract surgery.
DESIGN Dual centre, comparative, retrospective
study.
METHODS Nineteen Patients (20 eyes) - 10 males & 9 females
had LASIK. Nineteen Patients (19 eyes) - 8 males & 11 females
had LASEK. Patient’s Age varied from 51 to 66 years. Interval between Cataract Surgery and Refractive
procedure – 3 to 36 months(mean 14 months). All Patients had Phakoemulsification with In the Bag
IOL implants. Pre-op Spherical Equivalent Refraction (SEQ) - + 4
to – 5 Diopters..
METHODS LASEK performed with 20% alcohol, for Mechanical Epithelial Debridement.
Ablated bed treated with 0.02% Mitomycin C for 90 seconds
LASIK flap made with Moria MII microkeratome, with a thickness of 130 or 90 microns.
Wavelight Allegreto eximer laser was used for all patients.With repetition rate of 200 Hz & optical zone of 6 or 6.5mm.Eyes with tracking difficulties were excluded.
Uncorrected Visual Acuity (UCVA),Best Spectacle-corrected Visual Acuity(BSCVA), percentage of eyes within Half diopter (D) of targeted refraction, targeted v/s achieved spherical equivalent correction and gain/ loss in Snellen’s lines were compared between the two groups.
Length of follow up - 6 months
RESULTS - UCVA
Postoperative period (months)
Per
cen
tag
e o
f ey
es with
UC
VA
≥ 2
0/20
Mean UCVA better in the LASIK group from 1 – 4 months
No significant difference in mean UCVA at 6 months
RESULTS - BSCVA
Postoperative period (months)
Per
cen
tag
e o
f ey
es with
BS
CV
A ≥
20/
20
Mean BSCVA better in the LASIK group from 1 to 3 months
No significant difference in mean BSCVA from 4 to 6 months
RESULTS - Post op Spherical Equivalent Refraction - 6 months
Post op Spherical Equivalent Refraction in D
Per
cent
age
of e
yes
RESULTS - Percentage of eyes within ± 0.5D of Targeted Refraction
RESULTS - Targeted v/s Achieved Spherical Equivalent Refraction(LASIK) Group
Targeted
20 eyes
Targeted v/s Achieved Spherical Equivalent Refraction(LASEK) Group19 eyes
RESULTS - CHANGE IN SNELLEN’S LINES OF BCVA
Per
cent
age
of e
yes
No eyes lost 2 or more Snellen’s lines of BCVA
6 eyes gained 1 Snellen’s line of BCVA in Both groups2 eyes gained 2 Snellen’s lines of BCVA in LASIK group v/s 1 eye in LASEK group
CONCLUSIONS Both Mitomycin C assisted LASEK and LASIK effective in
correcting post Cataract residual refractive errors. Short term superiority of LASIK over LASEK in the
immediate post-op period. Equally good refractive correction at 6 months Gain in Snellen’s lines in BCVA, almost equal in both
groups. Subepithelial Haze in LASEK group significantly less due
to Mitomycin C , which decreased from Grade I + in first 2 months to < grade 0.5 at 6 months.
Longer term studies required to determine refractive stability of the two procedures.
REFERENCES1.Ahn CS, et al. Initial results of PRK & LASIK performed by a single surgeon. J Cat Ref Surg 1999;25:1048-10552.Steinert RF, et al. Surgical correction of moderate myopia. II, PRK & LASIK are the treatments of choice. Surv Ophthal 1998;43:157-1793.Ayala MJ, et al. LASIK to correct residual myopia after cataract surgery. J Refract Surg 2001; 17: 12-164.Sanchez-Galeana CA, et al. LASIK & PRK for residual ref error after phakic IOL implantation. J Refract Surg 2001;17:299-3045.Guell JL, et al. LASIK for correction of residual ref errors from previous surgical procedures. Ophthalmic Surg Lasers 1999;30:341-3496. Artola A, et al. PRK for residual myopia after cataract surgery. J Cat Ref Surg 1999;25:1456-14607.El Danasoury MA, et al. Comparison of PRK with LASIK in correcting low myopia: a randomised study. Ophthalmology 1999;106 :411-4208.El-Maghraby A, et al. Randomised bilateral comparison of LASIK and PRKfor 2.5 to 8 D of myopia. 1999;106:447-457
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