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P Vinciguerra, D Epstein, F Camesasca; Increasing Epithelial Flap Viability in Laser Epithelial Keratomileusis (LASEK): a new Procedure . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4130.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To assess a new procedure for performing LASEK in a less traumatic fashion with the aim of reducing recovery time. Methods: Instead of creating a standard epithelial flap, a linear, paracentral abrasion was made with a spatula. 20% ethanol was instilled in a 9.0-mm marker and dried after 5-30 seconds. The same spatula was then used to lift the epithelial edges, separate the epithelium from Bowman´s membrane (BM), and gently nudge the two epithelial sections toward the limbus. BM was now sufficiently exposed for the excimer treatment. After the laser ablation, the two flap edges were joined again and slightly superimposed over each other, thereby totally covering the stromal surface. A therapeutic contact lens was then applied. 30 eyes with a mean preoperative spherical equivalent (SE) of -5.13D±1.24D were treated with this new technique. A Nidek EC 5000 laser was used. Minimum follow-up time was 6 months. Results: 83% of the eyes regained their preoperative BSCVA by day 3 after the procedure. Six months postoperatively, the mean SE was -0.06D±0.67D. No eye displayed haze, and there was no loss of BSCVA lines in any eye. There was no flap loss or slippage. Patients who had previously undergone standard LASEK in the fellow eye reported even less postoperative discomfort after the new procedure. Conclusions: This new technique for handling the epithelium in LASEK appears to be less traumatic than standard flap preparation, which may explain the more rapid recovery of BSCVA. The fact that the epithelium remains connected to the limbus could be a factor contributing to increased flap viability. The new procedure is also technically easier and faster.
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