Flap removal may address limitations of epi-LASIK

Results of a pilot study suggest that "flapless epi-LASIK" may offer advantages compared with the standard technique for hastening epithelial healing, visual recovery, and reducing postoperative pain, reported Tom Elmer, MD.

Dr. Elmer, Buffalo, New York, compared the two surgeries in a paired eye study including 13 patients.

On postoperative day 1, uncorrected visual acuity (UCVA) was better in the eye with the flap removed in 46% of patients and in the eye with the flap replaced in 31%, while there was no difference between eyes in the remaining 23% of patients. Later during the first week, the difference favoring flap removal widened, and on postoperative day 7, UCVA was better in the eye with the flap removed in 73% of patients.

Epithelial regeneration, assessed as the day when bandage contact lens removal could be performed, occurred on postoperative day 3 or 4 in 54% of eyes with the flap removed compared with only 23% where it was left intact. Assessments of adverse events showed slight advantages for less pain and foreign body sensation if the flap was removed, while there were no differences between eyes in tearing or photophobia.

"Our impressions based on our experience with epi-LASIK were that it offered a slight improvement over conventional PRK for reducing pain in the early postoperative period, but there was no real difference between the procedures in the long-term," Dr. Elmer said. "With an interest in seeing what else we could do to further reduce short-term discomfort and improve visual recovery in a surface ablation procedure, we thought about flapless epi-LASIK.

"Now, we will further investigate this approach by comparing it with standard PRK," Dr. Elmer said.